Oblique lateral interbody fusion combined with unilateral versus bilateral posterior fixation in patients with osteoporosis

PURPOSE: To compare the clinical efficacy of oblique lateral interbody fusion (OLIF) combined with unilateral (UPSF) and bilateral pedicle screw internal fixation (BPSF) in patients with osteoporosis. METHODS: Clinical data of 57 patients who underwent single-segment OLIF surgery with a clear diagnosis of osteoporosis from December 2018 to May 2021 were retrospectively analyzed, of which 27 patients underwent OLIF + UPSF and 30 patients underwent OLIF + BPSF. Surgical technique-related indexes were recorded, including operative time, operative blood loss and postoperative hospital stay; clinical outcome-related indexes included postoperative complications, Visual analogue scale (VAS) and Oswestry disability index (ODI) at preoperative, 1 week, 1 month, 3 months, and 12 months postoperative follow-up; and imaging outcome-related indexes included the measurement of preoperative and postoperative segmental lordosis (SL), and observation of the degree of cage subsidence and bone graft fusion. RESULTS: The surgery was successfully performed in 57 patients, and there was no statistical difference in operative blood loss and postoperative hospital stay between UPSF group and BPSF group (P > 0.05). In terms of operative time, there was a significant difference (UPSF group: 92.30 ± 11.03 min, BPSF group: 119.67 ± 16.41, P < 0.05). Postoperative VAS and ODI scores exhibited significant improvement (P < 0.05). At the 12 months postoperative follow-up, the VAS and ODI scores in the BPSF group were significantly better than those in the UPS group (P < 0.05). Compared with the preoperative images, the SL was significantly improved in both groups after surgery (P < 0.05). At 6 months postoperatively, the fusion rate in the UPSF group was significantly lower than that in the BPSF group (P < 0.05). At 1 year postoperatively, the fusion rate in the UPSF group was not significantly different from that in the BPSF group (P > 0.05). At 1 year postoperatively, the rate and degree of cage subsidence was higher in the UPSF group than in the BPSF group (P < 0.05). CONCLUSION: In the long term, OLIF combined with bilateral posterior fixation applied to the osteoporosis patients is superior to OLIF surgery combined with unilateral posterior fixation in terms of clinical and imaging outcomes. It is effective in improving pain relief and functional improvement, accelerating bone graft fusion, and reducing cage subsidence compared with UPSF.