Effect of Different Minimally Invasive Posterior Stabilization Techniques After Direct Lateral Interbody Fusion With Long-Term Clinical and Radiological Outcomes in Railway Workers: A Retrospective Single-Center Study.

Abstract

Study DesignRetrospective study.ObjectiveTo investigate the clinical and radiological outcomes of patients with lumbar degenerative disc disease (DDD) treated with one-level Direct lateral interbody fusion (DLIF) in combination with minimally invasive percutaneous pedicle screw fixation (PPSF) and percutaneous facet joint fixation (PFJF).MethodsThis retrospective single-center study included 98 patients (67 men, 31 women) aged 28 to 59 years with one level lumbar DDD with foraminal and central stenosis, were divided into groups after DLIF: PPSF (n = 50) and PFJF (n = 48). Intraoperative parameters, perioperative clinical data and radiological assessment with X-ray, MRI and CT were used before operation and mean 45-month follow-up. Workload intensity criteria were used to analyze return to work rate.ResultsThe DLIF-PFJF group had significantly shorter surgery time (P = .04), duration of anesthesia (P = .02), X-ray time (P = .02), less back pain (P = .03), better functional status according to ODI (P = .04) and SF-36 PCS (P = .04), less atrophic changes in the multifidus muscle compared with DLIF-PPSF. There were no statistically significant differences in the volume of blood loss, duration of inpatient treatment, VAS leg pain, SF-36 MCS, Macnab results, mean disc height, intervertebral foramen height, sagittal disc angle, global lumbar lordosis, fusion rate, and the number of complications. In heavy/very heavy workload patients, the DLIF-PFJF had a statistically significantly higher rate of return to work compared to the DLIF-PPSF group.ConclusionsDLIF-PFJF appears to be superior to DLIF-PPSF, minimizing invasiveness, which significantly reduces the damage to the paraspinal muscles and also has significant long-term clinical advantages and return to work rates. Both minimally invasive techniques have comparable radiographic parameters, including the height of the intervertebral foramen and disc, fusion rates, global and segmental sagittal correction after surgery.