Single-Position OLIF Combined with Percutaneous Posterior Fixation Under O-Arm Navigation for the Treatment of Grade II Lumbar Spondylolisthesis: Clinical and Radiologic Outcomes

Zhida Chen¹Song-Song Wu²Yuan-Jie Jiang¹Hui Liu¹Zhuan-Zhi Huang¹Tao-Yi Cai^1*Lin Bin^1*

• ¹Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, China
• ²The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China

Introduction and aim: Grade II lumbar spondylolisthesis is frequently accompanied by segmental instability, intervertebral disc degeneration, and nerve root compression. When conservative management fails, surgery is generally warranted. Therefore, we conducted a retrospective study to evaluate the clinical and radiologic outcomes of single-position OLIF combined with percutaneous posterior fixation under O-arm navigation for the treatment of Grade II lumbar spondylolisthesis. Materials and methods: A retrospective analysis was conducted on 87 patients with Grade II lumbar spondylolisthesis who underwent single-position OLIF combined with percutaneous posterior fixation under O-arm navigation. The affected segments were as follows: 17 cases at L2, 26 cases at L3, and 44 cases at L4. Data were collected on operation duration, blood loss, hospital stay, radiological and clinical outcomes (VAS, ODI, SF-36, intervertebral disc height, slippage rate, lumbar lordosis angle, cross-sectional area, and sagittal diameter), Bridwell classification, and complications. Results: The mean operation duration was 118.7 ± 22.4 min, with an average blood loss of 83.6 ± 27.4 mL. All patients had regular follow up with an average duration of 29.5 ± 9.2 months. The VAS scores, ODI, and SF-36 at 3 months postoperatively and final follow-up showed significant improvement compared to preoperative scores (P<0.05). The IDH, SR, and LLA were significantly improved at 3 days, 12 months, and at the final follow-up compared to preoperative values (All P<0.01). Mean cross-sectional area improved significantly from 87.40 ± 29.59 mm2 preoperatively to 132.42 ± 33.53 mm2 at 12 months follow-up (P<0.001). The mean sagittal diameter at 12 months follow-up 9.23 ± 2.87 mm showed statistically significant difference compared to preoperative measurements 5.25±2.67 mm. 94.3% (82/87) of patients achieving Bridwell Grade I bone fusion. A total of 348 pedicle screws were implanted with an overall accuracy rate of approximately 98.9%. Complications were minimal, with 3 cases of psoas weakness that resolved to normal muscle strength within 2 weeks. Conclusions: It offers significant minimal invasiveness, accuracy in screw placement, and sustained reconstruction of lumbar sagittal plane, with low complication rates and high fusion success.