Abstract
BACKGROUND: The use of oblique lumbar interbody fusion (OLIF) to treat severe central lumbar spinal stenosis remains contentious. This study sought to assess the efficacy of OLIF without posterior decompression in the treatment of severe central lumbar spinal stenosis. METHODS: Between October 2018 and October 2022, 48 patients who underwent OLIF were retrospectively analyzed. All patients had a preoperative magnetic resonance imaging diagnostic of severe central lumbar spinal stenosis according to the Schizas classification (grade C or D). All patients complained of low back and leg pain, which presented with intermittent claudication or dynamic radicular pain. The symptoms were mostly relieved in supine position. Clinical and radiological outcomes were evaluated. RESULTS: Seven patients received stand-alone OLIF. Eight patients were treated with OLIF, and percutaneous transpedicular screw fixation was performed within one week after OLIF. Thirty-three patients underwent a single-stage OLIF with percutaneous pedicle screw fixation. All patients' clinical outcomes improved significantly over time, including ODI (63.1 ± 12.2/17.5 ± 5.8/7.8 ± 4.5/6.9 ± 4.6, p < 0.01), VAS of low back pain (6.1 ± 1.7/2.4 ± 1.0/1.1 ± 0.8/1.0 ± 0.7, p < 0.01), and VAS of leg pain (5.8 ± 1.5/1.9 ± 0.9/0.9 ± 0.8/0.8 ± 0.7, p < 0.05) recorded preoperatively and 1, 3, and 12 months postoperatively. The mean disc height increased from 7.8 ± 2.1 mm preoperatively to 10.4 ± 1.7 mm one week postoperatively (p < 0.01) and dropped to 10.1 ± 1.8 mm 12 months postoperatively (p < 0.01). The segmental lordosis angle increased from 7.7 ± 3.3 preoperatively to 8.9 ± 3.2 at one week postoperatively (p < 0.01) and remained stable at 12 months (8.8 ± 3.3, p = 0.22). The CSA increased considerably over time, from 44.0 ± 18.6 mm2 preoperatively to 65.1 ± 20.8 mm2 (p < 0.01) at one week postoperatively and 124.9 ± 19.2 mm2 at 12 months postoperatively (p < 0.01). Two patients with stand-alone OLIF underwent decompression surgery due to postoperative cage subsidence and recurrence of lower extremity problems. At one year of follow-up, the fusion rate was 97.9%. CONCLUSIONS: OLIF combined with pedicle screw fixation is effective in treating severe central lumbar spinal stenosis. It is a good option for patients whose symptoms can be relieved in supine position.