Mini-incision oblique lumbar interbody fusion (OLIF) and anterolateral screw-rod fixation for surgical treatment of L5 spondylolisthesis.

OBJECTIVE: To explore the clinical efficacy of mini-incision oblique lumbar interbody fusion (OLIF) and anterolateral screw-rod fixation through the approach between the great vessels and the psoas muscle for the surgical treatment of L5 spondylolisthesis. METHODS: From December 2019 to February 2021, patients with L5 spondylolisthesis undergoing OLIF51 (L5-S1 OLIF) using the OLIF25 (L2-5 OLIF) cage and anterolateral screw-rod fixation were enrolled in this retrospective study. The gender, age, BMI, BMD, operation time, intraoperative blood loss, intraoperative fluoroscopy, surgical segments, cage length and height, incision length, drainage removal time, hospitalization time, intraoperative and postoperative complications, and other relevant data of all patients were recorded. Visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate the symptoms, signs, and neurological function of all patients before surgery and during postoperative follow-up. RESULTS: There were 26 cases of L5 spondylolisthesis enrolled. The average operation time was 117.3 ± 13.0 minutes. The mean intraoperative fluoroscopy usage was 11 (8-19) times. The mean blood loss was 20 (10-55) mL, and the average incision length was 48.5 ± 3.7 mm. The drainage removal time was 2 (1-3) days. The mean hospital stay duration was 5 (3-6) days, and the follow-up duration was 29.8 ± 4.1 months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (P < 0.01), and the ODI significantly decreased from 73.2 ± 12.5% to 13.8 ± 4.3% 2 years after surgery (P < 0.01). Anterior intervertebral space height, posterior intervertebral space height, lumbar lordosis, and segmental lordotic angle significantly improved after surgery (P < 0.05). Fusion grades based on the Bridwell grading system at the 2-year follow-up were grade I in 20 segments (76.9%) and grade II in six segments (23.1%). No patients experienced any form of permanent iatrogenic nerve damage or major complications. CONCLUSION: This study introduces a promising novel approach for treating L5 spondylolisthesis using a mini-incision OLIF51 with a larger OLIF25 cage and anterolateral screw-rod fixation. This method may offer advantages such as reduced blood loss, rapid postoperative recovery, and enhanced support and biomechanical stability.