INTRODUCTION
Lateral Lumbar Interbody Fusion (LLIF) combined with Percutaneous Pedicle Screw (PPS) fixation is increasingly recognized as a minimally invasive surgical option for treating lumbar degenerative spondylolisthesis. The technique avoids the direct retraction of paraspinal muscles associated with posterior approaches. However, its long-term outcomes and advantages, particularly in comparison to the traditional Posterior Lumbar Interbody Fusion (PLIF) approach, remain insufficiently studied. This research aimed to evaluate and compare the efficacy, invasiveness, and postoperative outcomes of LLIF with PPS versus PLIF in patients with one-level lumbar degenerative spondylolisthesis.
METHODS
A total of 40 patients with one-level lumbar degenerative spondylolisthesis were retrospectively analyzed. Twenty-five patients underwent LLIF with PPS fixation (LLIF group: 10 males, 15 females; mean age 68 years), while 15 patients underwent PLIF with pedicle screw fixation (PLIF group: 4 males, 11 females; mean age 61 years). All patients were followed for at least two years postoperatively. Parameters evaluated included operative time, intraoperative blood loss, and the change in cross-sectional area of paraspinal muscles at the surgical level, as assessed using preoperative and 2-year postoperative imaging. Statistical analyses were conducted to identify significant differences between the groups.
RESULTS
The average operative time was comparable between the LLIF group (136.8 ± 53.5 minutes) and the PLIF group (139.3 ± 15.8 minutes). However, intraoperative blood loss was significantly lower in the LLIF group (62.3 ± 41.8 ml) compared to the PLIF group (210.0 ± 93.9 ml) (p<0.05), reflecting the minimally invasive nature of LLIF. Regarding paraspinal muscle preservation, the LLIF group demonstrated stable muscle mass at the surgical level over the two-year follow-up period. The cross-sectional area was 18.3 ± 3.5 cm² (right) and 17.6 ± 3.8 cm² (left) preoperatively, and 17.0 ± 3.4 cm² (right) and 17.0 ± 3.8 cm² (left) at two years. In contrast, the PLIF group showed a significant reduction in muscle area (preoperative: 17.8 ± 3.7 cm² [right], 18.1 ± 4.5 cm² [left]; two-year follow-up: 15.9 ± 3.8 cm² [right], 16.5 ± 4.2 cm² [left]) (p<0.05).
DISCUSSION
The results of this study suggest that LLIF with PPS provides notable advantages over PLIF for patients with one-level lumbar degenerative spondylolisthesis. The reduced intraoperative blood loss highlights the minimally invasive nature of LLIF, which minimizes tissue trauma and enhances surgical efficiency. Furthermore, the preservation of paraspinal muscle tissue in the LLIF group likely contributes to improved postoperative recovery and the maintenance of long-term spinal function. In contrast, the significant muscle atrophy observed in the PLIF group may result in prolonged recovery and diminished functional outcomes. These findings underline the benefits of LLIF as a viable and effective alternative to traditional posterior approaches, particularly for patients seeking a less invasive solution.