ACR combined with PPS to treat lumbar degenerative diseases: a retrospective study

ACR combined with PPS to treat lumbar degenerative diseases: a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article ACR combined with PPS to treat lumbar degenerative diseases: a retrospective study Xiaobing Yan, Dapeng Feng, Jin Chu, Zhengwei Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5308721/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Study Design. Retrospective study to investigate the benefits of ACR for lumbar degenerative diseases (LDD). Objective. Investigate the outcomes of anterior column realignment(ACR) combined with percutaneous pedicle screw fixation(PPS) and differ for transforaminal lumbar interbody fusion (TLIF) for LDD. Methods. From June 2018 to December 2021, 22 consecutive patients with LDD underwent ACR. At the same time while 22 patients underwent TLIF. Preoperative and intraoperative parameters of all the patients are collected. The influences of ACR on mechanical factors and indirect decompression were evaluated by radiological parameters. Function improvements are assessed by Oswestry Disability Index (ODI), Visual Analogue Score (VAS) and Japanese Orthopaedic Association (JOA) Scores during one year of follow-up. Results. Preoperatively, there was no significant difference of age, sex, body mass index (BMI), ODI, VAS and JOA scores in both groups . Compared with ACR group, TLIF group had increased hospital stay (6.77±3.25 days vs. 5.0±1.11 days, P<0.05), blood loss (645.45±571.95ml vs. 235.45±78.30ml, P<0.05) and postoperative drainage (391.82±364.84 ml vs. 0 ml, P<0.001). ACR could significantly improve the radiological parameters. The short-term scores of function and pain of ACR group were higher than TLIF group. Conclusion. Both of ACR and TLIF could effectively resolve the symptoms of LDD. Compared with TLIF, ACR had a better improvement of short-term outcomes. ACR could be performed and improved as optional treatment strategy for LDD. ACR TLIF LDD Figures Figure 1 Figure 2 Figure 3 Introduction Lumbar degeneration diseases(LDD) have become common in the ageing population. LDD could severely reduce patient’s mobility and poor quality of life. At present, interbody fusion is an effective treatment option to LDD. However, there are controversies about the pathway of fusion. Conventional transforaminal (TLIF) procedures give satisfactory outcomes for LDD 1–3 . But the disadvantages such as injury of the nerves, iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band have not been addressed 4–6 . With the innovation of technology, lateral/oblique lumbar interbody fusion (LLIF/OLIF) and anterior lumbar interbody fusion (ALIF), as less invasion procedures, are frequently performed 7–10 . TLIF procedure could directly decompress the nerve by accessing to the intervertebral foraminal space. It is a procedure with small surgical trauma to structural integrity. In terms of prognostic outcomes, TLIF could maintain the stability of lumbar and give a high fusion rate. However, its iatrogenic damage to the paravertebral muscles haven’t been addressed. In the process of decompressing the contralateral side, there is a potential risk of direct nerve injury by continuously pulling the spinal cord. Intraoperative and postoperative complications such as dural tear, epidural hematoma and peripheral nerve fibrosis are present in patients underwent TLIF. Moreover, due to the narrow field of vision and operating space, it is often difficult to thoroughly treat the lamina. And for young doctors, the learning difficulty and curve increase steeply. Minimally invasive spinal surgery is developing and maturing. OLIF procedure could reduce pressure while retaining the psoas muscle by accessing the spine through the space between the anterior spinal blood vessels and the psoas muscle,. Compared with TLIF, it has many advantages, such as less invasion of the lumbar plexus and psoas muscle and visualization of sensory nerves and important structures. OLIF could effectively clear the disc space and implant large intervertebral grafts, which plays an important role in the establishment of lumbar lordosis, indirect decompression of the bone neural foramen and the central canal. However, compared with other lumbar vertebrae, OLIF has many potential risks in treating L5-S1 level lesions. ALIF could fully expose the intervertebral discs for a comprehensive discectomy and direct implant insertion without nerve invasion. Because of the large working corridor between the iliac vessels, ALIF is performed most safely at the L5-S1 level. However, due to the vascular anatomy and impediments of retroperitoneal viscera, ALIF is not as suitable as L5-S1 for other levels. The purpose of this study is to introduce fusion by ACR, which includes OLIF-ACR, ALIF-ACR, combine with percutaneous pedicle screw fixation(PPS) to treat LDD. The comprehensive treatment outcomes of ACR are monitored during treatment and 3-year follow-up and compared with TLIF. Methods Clinical data A prospective collection of 44 consecutive patients who underwent the first surgery of LDD at the Department of Spinal Surgery, Second Hospital of Dalian Medical University from June 2018 to December 2021. 22 of the patients were treated with ACR. The other 22 patients underwent conventional TLIF procedure.This study was performed with the approval of the ethics committee of the Second Hospital of Dalian Medical University(XJS2024-110-01). Patients met the following indications were included in the study. Trail inclusion criteria Lumbar degenerative diseases (LDD) Lumbar intervertebral discogenic low back pain Mild lumbar spinal stenosis Mild spondylolisthesis (degree I or degree II) Degenerative lumbar kyphosis Trail exclusion criteria Severe central spinal stenosis requiring posterior decompression Severe lumbar spondylolisthesis Spontaneous fusion of posterior facet joints Combined with severe osteoporosis High iliac crest covering L4 ཞL5 gap L5ཞS1 is blocked by blood vessels in front ACR procedure ACR is combined with three approaches, Another of our articles explains the procedure in detail 11 . First, patient is positioned in lateral decubitus position. OLIF is performed in degenerative lumbar lesions above L5 as previously described 10 . The cages of OLIF: Medtronic Sofamor Danek USA, lnc) (Size:16 mm*50 mm*6/12/18 DEG) (Fig. 1A). The patient is then positioned in the Trendelenburg position and ALIF is performed through the peritoneal approach. Because of the frequency of coronal imbalance between L5 and S1 levels in patients with LDD, We modify the traditional ALIF procedure with two small cages (Size:10/12/14mm * 22/26mm * 8mm) to correct the scoliosis conveniently (Fig. 1B) 9 . To make the cages stable, they are fixed with plate stable when they When they reach the appropriate location. Finally, percutaneous pedicle screws fixation performed in the prone position (Fig. 1C). All involved endoplant placement operations are performed under C-arm fluoroscopy. Radiological evaluation All patients underwent systematic radiological exam pre-, post-operation and during follow-up. The radiological data is measured by the Web viewer system of the Second Hospital of Dalian Medical University. The pelvic index (PI), lumbar lordosis(LL), disc height (DH) and Segmental disc angle (SDA) are measured on the sagittal plane of X-ray. The consequence was independently repeated at least three times. According to the CT reconstruction at 6 months after the operation and the criteria outlined classification by Siepe et al 12 . to evaluate the lumbar fusion. Assessment of clinical outcome Patient descriptors are collected and analyzed preoperatively. Perioperative indicators of the two groups of patients including operation time, intraoperative blood loss, postoperative drainage, Average hospital stay. During the postoperative period and the 3-year follow-up, the relevant efficacies are evaluated. Scores using the Oswestry Disability Index (ODI), Visual Analogue Score (VAS) and Japanese Orthopaedic Association (JOA) Scores. Statistical analysis SPSS 25.0 (SPSS, Inc., Chicago, IL, USA) is mainly used to analyze the experimental data. Data are presented as means ± standard deviation (SD). Statistical differences between two groups were determined by t-test and chi-square test. Statistical significance was defined as P value < 0.05. Results Patient information A total of 44 patients with LDD were include in this investigation. Patient characteristics of group ACR and group TLIF are summarized in Table 1 . 22 patients underwent the ACR procedure, and the other 22 patients underwent the TLIF procedure. The mean age of group ACR was 60.32 ± 12.08 years (range, 32–84 years) while the group TLIF was 63.27 ± 10.43 years (range, 46–83 years). There was no significant difference of the gender ratio and body mass index (BMI) between two groups. Operative parameter Operation relevant data were summarized in Table 2 . The mean operation time of group ACR (279.64 ± 58.482 minutes) was significantly longer than that of group TLIF (273.59 ± 115.749 minutes). However, the ACR procedure had less blood loss (235.45 ± 78.30 ml) than TLIF procedure (645.45 ± 571.95 ml), respectively. There are three patients underwent TLIF had dural tears and two patients had nerve injuries. One patient in group ACR and 2 in group TLIF had abnormal vascular injuries. In the ACR group, 2 patients had abdominal distension and abdominal pain, and 2 patient had short-term hip flexion dysfunction. The mean postoperative drainage volume in the TLIF group was 391.82 ± 364.84 ml, while the ACR procedure did not require it. The hospital stay and bedrest time in the ACR group (5.00 ± 1.11 days) were significantly less than in the TLIF group (6.77 ± 3.25 days) due to the drainage. Radiological outcomes of ACR The radiological outcomes of pre-operation, post-operation and follow-up were evaluated and analyzed. The data showed statistically significant improvement in both post-operation and 1-year follow-up (Table 3). Disc height was increased from 8.10 ± 2.07 mm preoperatively to 13.00 ± 1.86 mm postoperatively. The mean of differences was 4.9 mm. At the 1-year follow-up visit, disc height was decreased to 10.89 ± 2.23 mm and the mean differences was 2.79 mm. The mean of Lumbar lordosis was increased from 36.02 ± 10.52° to 43.75 ± 11.46° and the mean of differences was 7.73°. It increased to 44.81 ± 10.86° in 1-year follow-up. Segmental disc angle was increased from 7.85 ± 5.74° preoperatively to 12.65 ± 4.73° postoperatively, at the 1-year follow-up visit it was decreased to 10.03 ± 4.37° and the mean differences was 2.18°. The mean of |PI-LL| was decreased from 11.51 ± 7.73 to 7.26 ± 4.47, and It increased to 5.42 ± 4.89 in 1-year follow-up. Clinical outcomes Detailed changes in ODI, VAS and JOA scores of two groups from pre-operation to the final follow-up were shown in Fig. 2 and Table 4. Overall, both procedures significantly released the pain and improved the quality of life of patients. Particularly, in the visit of the improvement of ODI the ACR group was significantly more effective than the TLIF group at 1-month (p = 0.014) and 3-months (p = 0.044) follow-up (Fig. 2A,C). In VAS of back, the ACR group was significantly better than that of the TLIF group at 1-month (p = 0.003) follow-up (Fig. 2C). Similarly, the improvement of the JOA score of the ACR group was significantly better than that of the TLIF group at 1-month (p = 0.01) follow-up (Fig. 2B). From a long-term perspective, there is no significant difference between the two procedures. Case Presentation A 65-year-old female presented with low back pain and numbness in both lower limbs. The results of X-Ray demonstrated diagnosis (Fig. 3A). The MRI revealed severe spinal canal stenosis at L3/L4, L4/L5 and L5/S1(Fig. 3B). ACR procedure was performed successfully without abnormal injury (Fig. 3C). Postoperative MRI demonstrated successful indirect neural decompression (Fig. 3D). Discussion As the aggravating trend of aging population, the number of patients suffered from LDD is increasing. There exists conflicting evidence in the current research as to the which procedure is supposed to perform. For 44 patients undergoing surgery, both ACR and TLIF could effectively improve clinical conditions. In this study, specific therapy to LDD, ACR was first presented for indirect neural decompression. Similarly to the present study, Kuang et al 13 assessed the outcomes of 82 patients and found that patients who underwent TLIF had a significantly higher volume of blood loss (295.2 ± 81.4 vs. 57.0 ± 15.2 mL) and longer surgery time (130.7 ± 45.1 vs. 60.4 ± 20.8 min) than those who had ALIF. In addition, Abbasi et al 14 reported the less operative blood loss and operative time of OLIF procedure than TLIF procedure. In this study, despite the minimally invasive procedures, ACR also had blood loss during the operation. On the other hand, the multiple changes of the patient's position during general anesthesia, the exposure of the structure under different approaches, and the fixation of the CAGEs in ALIF, etc., cause ACR to require more surgical time than TLIF. In particular, our statistics on the time required for ACR cannot accurately separate out the time spent on operations such as postures. Previous investigations reported an increased length of stay of patients underwent TLIF or MIS-TLIF than patients underwent OLIF 15 . In this study, both hospital stay and bedrest time in the ACR group were significantly less than in the TLIF group. With a minimally invasive incision of less than 1.5 cm in length, ACR avoids damage to the psoas muscle as much as possible. Kevin et al 16 reviewed the complications associated with OLIF and indicated that there were several risks associated with OLIF which should be kept in mind when choosing the surgical approach. Similarly, the research of Zeng et al 17 analyzed 235 patients underwent OLIF showed that the risk of complications, especially in the early stage of development should be noted. In this study, patients of both ACR and TLIF had a low complication rate in 1-year follow-up. The reason of the consequence may be because all operations were performed by a same experienced surgeon. Nevertheless, peritoneal injury was not investigated in this study because ALIF was done via a transperitoneal approach. However, 2 patients in the postoperative ACR group had abdominal distension and pain, and after some physical therapy assisted exhaust, patients went to the ground for rehabilitation function exercise, these conditions had significant relief, and there was no such occurrence in the later follow-up. Numerous studies on OLIF and ALIF had focused on the variation of radiological results 18–22 . These studies showed both OLIF and ALIF could effectively perform indirect nerve decompression. Amplification of DH could rescue hypertrophied ligamentum flavum and disc herniation to achieve indirect decompression. LL and PI-LL were closely related to lumbar function and the biomechanics of the sagittal plane. In the present study, imaging data were collected and analyzed after surgery and 1-year follow-up. Radiographical parameters were substantially improved, and |PI-LL| is more of an equilibrium state, proved that ACR group has better ability to correct sagittal position imbalance. Interestingly, the imaging parameters did not alter significantly after one year, which demonstrated the reliability of the ACR procedure. The ACR enters the intervertebral space from the front and side to the front, which can more effectively open and restore the height of the intervertebral space, without pulling the dural sac and nerve root, avoiding the damage of the nerve root and dural sac, and retaining the spine. The bony structure and muscles of the posterior column. But there are still limitations. The limitation of OLIF lies in the inability to explore the spinal canal, and OLIF needs to stretch the psoas major muscle, which easily damages the lateral femoral cutaneous nerve, lumbar plexus, genital femoral nerve and sympathetic chain, resulting in lower limb roots Pain, paresthesia, numbness in the psoas major and groin area. Mehren et al. reported 3 cases of nerve injury after OLIF, accounting for 0.37%; Silvestre et al. reported 7 cases of nerve injury after OLIF, accounting for 3.9%. ALIF cuts off the anterior longitudinal ligament, there is a risk of GAGE ​​prolapse. It is easy to damage the upper abdomen and inferior plexus, leading to the risk of retrograde ejaculation and large blood vessel damage. According to reports in the literature, the incidence of retrosacral nerve damage leading to retrograde ejaculation in male patients after the retroperitoneal approach is 0 ~ 10%. Although some of the above-mentioned complications and problems may occur in combined approach surgery, the damage of large blood vessels and the prolapse of CAGE can be solved by surgical techniques. The combined approach technique via retroperitoneal and anterior psoas major approach can effectively reduce tissue damage and bleeding, and preserve the posterior ligament complex. And it effectively solves the nerve interference caused by the minimally invasive wilste approach, and better establishes the lordosis. Therefore, this operation is a safer and effective minimally invasive operation for the treatment of lumbar degenerative diseases. In addition to these encouraging radiographic parameters, our cohort demonstrated statistically significant improvements in VAS, ODI and JOA scores. The consequences were similar to the previous studies 23–27 . Patients of present study often need to take analgesic to relieve the pain of incision of TLIF surgery. However, only a few patients complain about pain from the incisions of ACR surgery. In the course of the investigation we found this effect was reflected in the improvement of short-term VAS of back. ACR improvement rates for low back pain were significantly higher than TLIF at 1-3-month follow-up. However, there was no differences during the subsequent follow-up. Functionally, the changes of ODI of ACR group were obviously bigger than TLIF group in 1-3-month follow-up. From the perspective of JOA scores, short-term socres of ACR were only significantly higher in 1-month follow up. In sum total of the above results, ACR had a greater contribution to rapid rehabilitation in this cohort. Conclusion In conclusion, both of ACR and TLIF could effectively improve the symptoms of LDD. ACR had greater outcomes of short-term rehabilitation. ACR could be the valid optional treatment strategy for LDD. Declarations Ethics approval and consent to participate This study was approved by the Ethics Review Committee of the Second Affiliated Hospital of Dalian Medical University and obtained the unique iden- tification number of research registration (the research registration number is XJS2024-110-01). Each patient signed a written informed consent form. In this study, all methods were performed in accordance with the Declaration of Helsinki relevant guidelines and regulations. Availability of data and materials Data cannot be provided due to identifying information of participants but are available from the corresponding author on reasonable request. Consent for publication Not applicable. Competing interests This study have no competing interests. Funding This research received no specifc grant from any funding agency in the public, commercial or not-for-proft sectors. Authors’ contributions Conceptualization and Methodology: XBY. Data Curation and Formal analysis: XBY, CJ. 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Clinical and radiological outcomes of spinal endoscopic discectomy-assisted oblique lumbar interbody fusion: preliminary results. Neurosurg Focus 43, E13 (2017). Miscusi, M. et al. Comparison of pure lateral and oblique lateral inter-body fusion for treatment of lumbar degenerative disk disease: a multicentric cohort study. Eur Spine J 27, 222–228 (2018). Udby, P. M. & Bech-Azeddine, R. Clinical outcome of stand-alone ALIF compared to posterior instrumentation for degenerative disc disease: A pilot study and a literature review. Clin Neurol Neurosurg 133, 64–69 (2015). Li, H.-J. et al. Comparative study between mini-open TLIF via Wiltse’s approach and conventional open TLIF in lumbar degenerative diseases. Eur Rev Med Pharmacol Sci 22, 53–62 (2018). Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.DemographicDataofPatients.pdf Table2.Clinicaldata.pdf Table3.ComparitionofRadiologicalparameters.pdf Table4.Clinicaloutcomesofpreoperationandfollowup.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5308721","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":372376976,"identity":"d6d13df8-09b2-4a71-8ffe-771392a2380d","order_by":0,"name":"Xiaobing Yan","email":"","orcid":"","institution":"The Second Affliated Hospital of Dalian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaobing","middleName":"","lastName":"Yan","suffix":""},{"id":372376977,"identity":"08cab1db-8929-4ba3-b8e6-6b9adbf752e8","order_by":1,"name":"Dapeng Feng","email":"","orcid":"","institution":"The Second Affliated Hospital of 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16:31:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1331914,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5308721/v1/02025ffb-3c1f-456e-b786-1b6a67245da2.pdf"},{"id":69079693,"identity":"cf56a7fb-6fcd-4751-b8d9-6565936cf3c3","added_by":"auto","created_at":"2024-11-15 11:44:14","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":97652,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.DemographicDataofPatients.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5308721/v1/ead7c85afef462cfeea73b97.pdf"},{"id":69080431,"identity":"d47794fd-7c84-43c8-8415-1e5d536bc083","added_by":"auto","created_at":"2024-11-15 11:52:13","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":51443,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.Clinicaldata.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5308721/v1/5c90d793b2440c0516052f7d.pdf"},{"id":69079696,"identity":"d21ce700-bffc-4f60-b2b2-dfd8981bbe87","added_by":"auto","created_at":"2024-11-15 11:44:14","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":52172,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.ComparitionofRadiologicalparameters.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5308721/v1/f4601b04609c73cb26d872dd.pdf"},{"id":69080433,"identity":"62829783-4919-4f0f-bfc2-3ca2d32b21f1","added_by":"auto","created_at":"2024-11-15 11:52:14","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":53559,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.Clinicaloutcomesofpreoperationandfollowup.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5308721/v1/244ae6b351b705d9b22225a0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"ACR combined with PPS to treat lumbar degenerative diseases: a retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLumbar degeneration diseases(LDD) have become common in the ageing population. LDD could severely reduce patient\u0026rsquo;s mobility and poor quality of life. At present, interbody fusion is an effective treatment option to LDD. However, there are controversies about the pathway of fusion. Conventional transforaminal (TLIF) procedures give satisfactory outcomes for LDD\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e. But the disadvantages such as injury of the nerves, iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band have not been addressed\u003csup\u003e4\u0026ndash;6\u003c/sup\u003e. With the innovation of technology, lateral/oblique lumbar interbody fusion (LLIF/OLIF) and anterior lumbar interbody fusion (ALIF), as less invasion procedures, are frequently performed\u003csup\u003e7\u0026ndash;10\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTLIF procedure could directly decompress the nerve by accessing to the intervertebral foraminal space. It is a procedure with small surgical trauma to structural integrity. In terms of prognostic outcomes, TLIF could maintain the stability of lumbar and give a high fusion rate. However, its iatrogenic damage to the paravertebral muscles haven\u0026rsquo;t been addressed. In the process of decompressing the contralateral side, there is a potential risk of direct nerve injury by continuously pulling the spinal cord. Intraoperative and postoperative complications such as dural tear, epidural hematoma and peripheral nerve fibrosis are present in patients underwent TLIF. Moreover, due to the narrow field of vision and operating space, it is often difficult to thoroughly treat the lamina. And for young doctors, the learning difficulty and curve increase steeply.\u003c/p\u003e \u003cp\u003eMinimally invasive spinal surgery is developing and maturing. OLIF procedure could reduce pressure while retaining the psoas muscle by accessing the spine through the space between the anterior spinal blood vessels and the psoas muscle,. Compared with TLIF, it has many advantages, such as less invasion of the lumbar plexus and psoas muscle and visualization of sensory nerves and important structures. OLIF could effectively clear the disc space and implant large intervertebral grafts, which plays an important role in the establishment of lumbar lordosis, indirect decompression of the bone neural foramen and the central canal. However, compared with other lumbar vertebrae, OLIF has many potential risks in treating L5-S1 level lesions. ALIF could fully expose the intervertebral discs for a comprehensive discectomy and direct implant insertion without nerve invasion. Because of the large working corridor between the iliac vessels, ALIF is performed most safely at the L5-S1 level. However, due to the vascular anatomy and impediments of retroperitoneal viscera, ALIF is not as suitable as L5-S1 for other levels.\u003c/p\u003e \u003cp\u003eThe purpose of this study is to introduce fusion by ACR, which includes OLIF-ACR, ALIF-ACR, combine with percutaneous pedicle screw fixation(PPS) to treat LDD. The comprehensive treatment outcomes of ACR are monitored during treatment and 3-year follow-up and compared with TLIF.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eClinical data\u003c/h2\u003e \u003cp\u003eA prospective collection of 44 consecutive patients who underwent the first surgery of LDD at the Department of Spinal Surgery, Second Hospital of Dalian Medical University from June 2018 to December 2021. 22 of the patients were treated with ACR. The other 22 patients underwent conventional TLIF procedure.This study was performed with the approval of the ethics committee of the Second Hospital of Dalian Medical University(XJS2024-110-01). Patients met the following indications were included in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTrail inclusion criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eLumbar degenerative diseases (LDD)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLumbar intervertebral discogenic low back pain\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMild lumbar spinal stenosis\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMild spondylolisthesis (degree I or degree II)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDegenerative lumbar kyphosis\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eTrail exclusion criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSevere central spinal stenosis requiring posterior decompression\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSevere lumbar spondylolisthesis\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSpontaneous fusion of posterior facet joints\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCombined with severe osteoporosis\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHigh iliac crest covering L4 ཞL5 gap\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eL5ཞS1 is blocked by blood vessels in front\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eACR procedure\u003c/h3\u003e\n\u003cp\u003eACR is combined with three approaches, Another of our articles explains the procedure in detail\u003csup\u003e11\u003c/sup\u003e. First, patient is positioned in lateral decubitus position. OLIF is performed in degenerative lumbar lesions above L5 as previously described\u003csup\u003e10\u003c/sup\u003e. The cages of OLIF: Medtronic Sofamor Danek USA, lnc) (Size:16 mm*50 mm*6/12/18 DEG) (Fig.\u0026nbsp;1A). The patient is then positioned in the Trendelenburg position and ALIF is performed through the peritoneal approach. Because of the frequency of coronal imbalance between L5 and S1 levels in patients with LDD, We modify the traditional ALIF procedure with two small cages (Size:10/12/14mm * 22/26mm * 8mm) to correct the scoliosis conveniently (Fig.\u0026nbsp;1B)\u003csup\u003e9\u003c/sup\u003e. To make the cages stable, they are fixed with plate stable when they When they reach the appropriate location. Finally, percutaneous pedicle screws fixation performed in the prone position (Fig.\u0026nbsp;1C). All involved endoplant placement operations are performed under C-arm fluoroscopy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eRadiological evaluation\u003c/h3\u003e\n\u003cp\u003eAll patients underwent systematic radiological exam pre-, post-operation and during follow-up. The radiological data is measured by the Web viewer system of the Second Hospital of Dalian Medical University. The pelvic index (PI), lumbar lordosis(LL), disc height (DH) and Segmental disc angle (SDA) are measured on the sagittal plane of X-ray. The consequence was independently repeated at least three times. According to the CT reconstruction at 6 months after the operation and the criteria outlined classification by Siepe et al\u003csup\u003e12\u003c/sup\u003e. to evaluate the lumbar fusion.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of clinical outcome\u003c/h2\u003e \u003cp\u003ePatient descriptors are collected and analyzed preoperatively. Perioperative indicators of the two groups of patients including operation time, intraoperative blood loss, postoperative drainage, Average hospital stay. During the postoperative period and the 3-year follow-up, the relevant efficacies are evaluated. Scores using the Oswestry Disability Index (ODI), Visual Analogue Score (VAS) and Japanese Orthopaedic Association (JOA) Scores.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS 25.0 (SPSS, Inc., Chicago, IL, USA) is mainly used to analyze the experimental data. Data are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Statistical differences between two groups were determined by t-test and chi-square test. Statistical significance was defined as \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003ePatient information\u003c/h2\u003e\n \u003cp\u003eA total of 44 patients with LDD were include in this investigation. Patient characteristics of group ACR and group TLIF are summarized in Table \u003cspan\u003e1\u003c/span\u003e. 22 patients underwent the ACR procedure, and the other 22 patients underwent the TLIF procedure. The mean age of group ACR was 60.32\u0026thinsp;\u0026plusmn;\u0026thinsp;12.08 years (range, 32\u0026ndash;84 years) while the group TLIF was 63.27\u0026thinsp;\u0026plusmn;\u0026thinsp;10.43 years (range, 46\u0026ndash;83 years). There was no significant difference of the gender ratio and body mass index (BMI) between two groups.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eOperative parameter\u003c/h2\u003e\n \u003cp\u003eOperation relevant data were summarized in Table \u003cspan\u003e2\u003c/span\u003e. The mean operation time of group ACR (279.64\u0026thinsp;\u0026plusmn;\u0026thinsp;58.482 minutes) was significantly longer than that of group TLIF (273.59\u0026thinsp;\u0026plusmn;\u0026thinsp;115.749 minutes). However, the ACR procedure had less blood loss (235.45\u0026thinsp;\u0026plusmn;\u0026thinsp;78.30 ml) than TLIF procedure (645.45\u0026thinsp;\u0026plusmn;\u0026thinsp;571.95 ml), respectively. There are three patients underwent TLIF had dural tears and two patients had nerve injuries. One patient in group ACR and 2 in group TLIF had abnormal vascular injuries. In the ACR group, 2 patients had abdominal distension and abdominal pain, and 2 patient had short-term hip flexion dysfunction. The mean postoperative drainage volume in the TLIF group was 391.82\u0026thinsp;\u0026plusmn;\u0026thinsp;364.84 ml, while the ACR procedure did not require it. The hospital stay and bedrest time in the ACR group (5.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11 days) were significantly less than in the TLIF group (6.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25 days) due to the drainage.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eRadiological outcomes of ACR\u003c/h2\u003e\n \u003cp\u003eThe radiological outcomes of pre-operation, post-operation and follow-up were evaluated and analyzed. The data showed statistically significant improvement in both post-operation and 1-year follow-up (Table 3). Disc height was increased from 8.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07 mm preoperatively to 13.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86 mm postoperatively. The mean of differences was 4.9 mm. At the 1-year follow-up visit, disc height was decreased to 10.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23 mm and the mean differences was 2.79 mm. The mean of Lumbar lordosis was increased from 36.02\u0026thinsp;\u0026plusmn;\u0026thinsp;10.52\u0026deg; to 43.75\u0026thinsp;\u0026plusmn;\u0026thinsp;11.46\u0026deg; and the mean of differences was 7.73\u0026deg;. It increased to 44.81\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86\u0026deg; in 1-year follow-up. Segmental disc angle was increased from 7.85\u0026thinsp;\u0026plusmn;\u0026thinsp;5.74\u0026deg; preoperatively to 12.65\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u0026deg; postoperatively, at the 1-year follow-up visit it was decreased to 10.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.37\u0026deg; and the mean differences was 2.18\u0026deg;. The mean of |PI-LL| was decreased from 11.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.73 to 7.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47, and It increased to 5.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.89 in 1-year follow-up.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003eClinical outcomes\u003c/h2\u003e\n \u003cp\u003eDetailed changes in ODI, VAS and JOA scores of two groups from pre-operation to the final follow-up were shown in Fig. 2 and Table 4. Overall, both procedures significantly released the pain and improved the quality of life of patients. Particularly, in the visit of the improvement of ODI the ACR group was significantly more effective than the TLIF group at 1-month (p\u0026thinsp;=\u0026thinsp;0.014) and 3-months (p\u0026thinsp;=\u0026thinsp;0.044) follow-up (Fig. 2A,C). In VAS of back, the ACR group was significantly better than that of the TLIF group at 1-month (p\u0026thinsp;=\u0026thinsp;0.003) follow-up (Fig. 2C). Similarly, the improvement of the JOA score of the ACR group was significantly better than that of the TLIF group at 1-month (p\u0026thinsp;=\u0026thinsp;0.01) follow-up (Fig. 2B). From a long-term perspective, there is no significant difference between the two procedures.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003eCase Presentation\u003c/h2\u003e\n \u003cp\u003eA 65-year-old female presented with low back pain and numbness in both lower limbs. The results of X-Ray demonstrated diagnosis (Fig. 3A). The MRI revealed severe spinal canal stenosis at L3/L4, L4/L5 and L5/S1(Fig. 3B). ACR procedure was performed successfully without abnormal injury (Fig. 3C). Postoperative MRI demonstrated successful indirect neural decompression (Fig. 3D).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs the aggravating trend of aging population, the number of patients suffered from LDD is increasing. There exists conflicting evidence in the current research as to the which procedure is supposed to perform. For 44 patients undergoing surgery, both ACR and TLIF could effectively improve clinical conditions. In this study, specific therapy to LDD, ACR was first presented for indirect neural decompression.\u003c/p\u003e \u003cp\u003eSimilarly to the present study, Kuang et al\u003csup\u003e13\u003c/sup\u003e assessed the outcomes of 82 patients and found that patients who underwent TLIF had a significantly higher volume of blood loss (295.2 \u0026plusmn; 81.4 vs. 57.0 \u0026plusmn; 15.2 mL) and longer surgery time (130.7 \u0026plusmn; 45.1 vs. 60.4 \u0026plusmn; 20.8 min) than those who had ALIF. In addition, Abbasi et al\u003csup\u003e14\u003c/sup\u003e reported the less operative blood loss and operative time of OLIF procedure than TLIF procedure. In this study, despite the minimally invasive procedures, ACR also had blood loss during the operation. On the other hand, the multiple changes of the patient's position during general anesthesia, the exposure of the structure under different approaches, and the fixation of the CAGEs in ALIF, etc., cause ACR to require more surgical time than TLIF. In particular, our statistics on the time required for ACR cannot accurately separate out the time spent on operations such as postures.\u003c/p\u003e \u003cp\u003ePrevious investigations reported an increased length of stay of patients underwent TLIF or MIS-TLIF than patients underwent OLIF\u003csup\u003e15\u003c/sup\u003e. In this study, both hospital stay and bedrest time in the ACR group were significantly less than in the TLIF group. With a minimally invasive incision of less than 1.5 cm in length, ACR avoids damage to the psoas muscle as much as possible.\u003c/p\u003e \u003cp\u003eKevin et al\u003csup\u003e16\u003c/sup\u003e reviewed the complications associated with OLIF and indicated that there were several risks associated with OLIF which should be kept in mind when choosing the surgical approach. Similarly, the research of Zeng et al\u003csup\u003e17\u003c/sup\u003e analyzed 235 patients underwent OLIF showed that the risk of complications, especially in the early stage of development should be noted. In this study, patients of both ACR and TLIF had a low complication rate in 1-year follow-up. The reason of the consequence may be because all operations were performed by a same experienced surgeon. Nevertheless, peritoneal injury was not investigated in this study because ALIF was done via a transperitoneal approach. However, 2 patients in the postoperative ACR group had abdominal distension and pain, and after some physical therapy assisted exhaust, patients went to the ground for rehabilitation function exercise, these conditions had significant relief, and there was no such occurrence in the later follow-up.\u003c/p\u003e \u003cp\u003eNumerous studies on OLIF and ALIF had focused on the variation of radiological results\u003csup\u003e18\u0026ndash;22\u003c/sup\u003e. These studies showed both OLIF and ALIF could effectively perform indirect nerve decompression. Amplification of DH could rescue hypertrophied ligamentum flavum and disc herniation to achieve indirect decompression. LL and PI-LL were closely related to lumbar function and the biomechanics of the sagittal plane. In the present study, imaging data were collected and analyzed after surgery and 1-year follow-up. Radiographical parameters were substantially improved, and |PI-LL| is more of an equilibrium state, proved that ACR group has better ability to correct sagittal position imbalance. Interestingly, the imaging parameters did not alter significantly after one year, which demonstrated the reliability of the ACR procedure.\u003c/p\u003e \u003cp\u003eThe ACR enters the intervertebral space from the front and side to the front, which can more effectively open and restore the height of the intervertebral space, without pulling the dural sac and nerve root, avoiding the damage of the nerve root and dural sac, and retaining the spine. The bony structure and muscles of the posterior column. But there are still limitations. The limitation of OLIF lies in the inability to explore the spinal canal, and OLIF needs to stretch the psoas major muscle, which easily damages the lateral femoral cutaneous nerve, lumbar plexus, genital femoral nerve and sympathetic chain, resulting in lower limb roots Pain, paresthesia, numbness in the psoas major and groin area. Mehren et al. reported 3 cases of nerve injury after OLIF, accounting for 0.37%; Silvestre et al. reported 7 cases of nerve injury after OLIF, accounting for 3.9%. ALIF cuts off the anterior longitudinal ligament, there is a risk of GAGE ​​prolapse. It is easy to damage the upper abdomen and inferior plexus, leading to the risk of retrograde ejaculation and large blood vessel damage. According to reports in the literature, the incidence of retrosacral nerve damage leading to retrograde ejaculation in male patients after the retroperitoneal approach is 0\u0026thinsp;~\u0026thinsp;10%. Although some of the above-mentioned complications and problems may occur in combined approach surgery, the damage of large blood vessels and the prolapse of CAGE can be solved by surgical techniques. The combined approach technique via retroperitoneal and anterior psoas major approach can effectively reduce tissue damage and bleeding, and preserve the posterior ligament complex. And it effectively solves the nerve interference caused by the minimally invasive wilste approach, and better establishes the lordosis. Therefore, this operation is a safer and effective minimally invasive operation for the treatment of lumbar degenerative diseases.\u003c/p\u003e \u003cp\u003eIn addition to these encouraging radiographic parameters, our cohort demonstrated statistically significant improvements in VAS, ODI and JOA scores. The consequences were similar to the previous studies\u003csup\u003e23\u0026ndash;27\u003c/sup\u003e. Patients of present study often need to take analgesic to relieve the pain of incision of TLIF surgery. However, only a few patients complain about pain from the incisions of ACR surgery. In the course of the investigation we found this effect was reflected in the improvement of short-term VAS of back. ACR improvement rates for low back pain were significantly higher than TLIF at 1-3-month follow-up. However, there was no differences during the subsequent follow-up. Functionally, the changes of ODI of ACR group were obviously bigger than TLIF group in 1-3-month follow-up. From the perspective of JOA scores, short-term socres of ACR were only significantly higher in 1-month follow up. In sum total of the above results, ACR had a greater contribution to rapid rehabilitation in this cohort.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, both of ACR and TLIF could effectively improve the symptoms of LDD. ACR had greater outcomes of short-term rehabilitation. ACR could be the valid optional treatment strategy for LDD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Review Committee of the Second\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAffiliated Hospital of Dalian Medical University and obtained the unique iden-\u003c/p\u003e\n\u003cp\u003etification number of research registration (the research registration number is\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXJS2024-110-01). Each patient signed a written informed consent form. In this study,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eall methods were performed in accordance with the Declaration of Helsinki\u0026nbsp;\u003c/p\u003e\n\u003cp\u003erelevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData cannot be provided due to identifying information of participants but\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eare available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specifc grant from any funding agency in the public,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ecommercial or not-for-proft sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization and Methodology: XBY.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData Curation and Formal analysis: XBY, CJ.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting - Original Draft: XBY,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting - Review \u0026amp; Editing: DPF; ZWL*.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKhechen, B. et al. Comparison of Postoperative Outcomes Between Primary MIS TLIF and MIS TLIF With Revision Decompression. Spine (Phila Pa 1976) 44, 150\u0026ndash;156 (2019).\u003c/li\u003e\n\u003cli\u003eZhao, Y., Liang, Y. \u0026amp; Mao, K. Radiographic and clinical outcomes following MIS-TLIF in patients with adult lumbar degenerative scoliosis. J Orthop Surg Res 13, 93 (2018).\u003c/li\u003e\n\u003cli\u003ede Kunder, S. L. et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J 17, 1712\u0026ndash;1721 (2017).\u003c/li\u003e\n\u003cli\u003eGarg, B. \u0026amp; Mehta, N. Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF): A review of indications, technique, results and complications. J Clin Orthop Trauma 10, S156\u0026ndash;S162 (2019).\u003c/li\u003e\n\u003cli\u003eWong, A. P. et al. Intraoperative and perioperative complications in minimally invasive transforaminal lumbar interbody fusion: a review of 513 patients. J Neurosurg Spine 22, 487\u0026ndash;495 (2015).\u003c/li\u003e\n\u003cli\u003ePark, Y., Lee, S. B., Seok, S. O., Jo, B. W. \u0026amp; Ha, J. W. Perioperative surgical complications and learning curve associated with minimally invasive transforaminal lumbar interbody fusion: a single-institute experience. Clin Orthop Surg 7, 91\u0026ndash;96 (2015).\u003c/li\u003e\n\u003cli\u003eI, T., J, H., K, P. \u0026amp; R, M. A meta-analysis comparing ALIF, PLIF, TLIF and LLIF. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 44, (2017).\u003c/li\u003e\n\u003cli\u003eChoy, W. J. et al. History of Integral Fixation for Anterior Lumbar Interbody Fusion (ALIF): The Hartshill Horseshoe. World Neurosurg 129, 394\u0026ndash;400 (2019).\u003c/li\u003e\n\u003cli\u003eAebi, M. ALIF L5/S1 in adolescent patient with osteochondrosis. Eur Spine J 27, 561\u0026ndash;562 (2018).\u003c/li\u003e\n\u003cli\u003eMehren, C. \u0026amp; Korge, A. Minimally invasive anterior oblique lumbar interbody fusion (OLIF). Eur Spine J 25, 471\u0026ndash;472 (2016).\u003c/li\u003e\n\u003cli\u003eFeng, D. P., Liu, M. Q., Zhang, W., Wang, J. Q. \u0026amp; Li, Z. W. Anterior column realignment via a minimally invasive hybrid approach in adult spinal deformity surgery: a short-term retrospective study. BMC Musculoskelet Disord 24, 979 (2023).\u003c/li\u003e\n\u003cli\u003eSiepe, C. J. et al. Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation. Eur Spine J 24, 838\u0026ndash;851 (2015).\u003c/li\u003e\n\u003cli\u003eKuang, L., Wang, B. \u0026amp; L\u0026uuml;, G. Transforaminal Lumbar Interbody Fusion Versus Mini-open Anterior Lumbar Interbody Fusion With Oblique Self-anchored Stand-alone Cages for the Treatment of Lumbar Disc Herniation: A Retrospective Study With 2-year Follow-up. Spine (Phila Pa 1976) 42, E1259\u0026ndash;E1265 (2017).\u003c/li\u003e\n\u003cli\u003eAbbasi, H. \u0026amp; Abbasi, A. Oblique Lateral Lumbar Interbody Fusion (OLLIF): Technical Notes and Early Results of a Single Surgeon Comparative Study. Cureus 7, e351 (2015).\u003c/li\u003e\n\u003cli\u003eAbbasi, H. \u0026amp; Grant, A. Effect of Body Mass Index on Perioperative Outcomes in Minimally Invasive Oblique Lateral Lumbar Interbody Fusion versus Open Fusions: A Multivariant Analysis. Cureus 10, e2288 (2018).\u003c/li\u003e\n\u003cli\u003ePhan, K., Maharaj, M., Assem, Y. \u0026amp; Mobbs, R. J. Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF). J Clin Neurosci 31, 23\u0026ndash;29 (2016).\u003c/li\u003e\n\u003cli\u003eZeng, Z.-Y. et al. Complications and Prevention Strategies of Oblique Lateral Interbody Fusion Technique. Orthop Surg 10, 98\u0026ndash;106 (2018).\u003c/li\u003e\n\u003cli\u003eZhang, C., Wang, K., Jian, F. \u0026amp; Wu, H. Efficacy of Oblique Lateral Interbody Fusion in Treatment of Degenerative Lumbar Disease. World Neurosurg S1878-8750(18)32698\u0026ndash;6 (2018) doi:10.1016/j.wneu.2018.11.139.\u003c/li\u003e\n\u003cli\u003eBeng, T. B., Kotani, Y., Sia, U. \u0026amp; Gonchar, I. Effect of Indirect Neural Decompression with Oblique Lateral Interbody Fusion Was Influenced by Preoperative Lumbar Lordosis in Adult Spinal Deformity Surgery. Asian Spine J 13, 809\u0026ndash;814 (2019).\u003c/li\u003e\n\u003cli\u003eFujibayashi, S. et al. Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease. Spine (Phila Pa 1976) 40, E175-182 (2015).\u003c/li\u003e\n\u003cli\u003eNorotte, G. \u0026amp; Barrios, C. Clinical and radiological outcomes after stand-alone ALIF for single L5-S1 degenerative discopathy using a PEEK cage filled with hydroxyapatite nanoparticles without bone graft. Clin Neurol Neurosurg 168, 24\u0026ndash;29 (2018).\u003c/li\u003e\n\u003cli\u003eMobbs, R. J., Phan, K., Assem, Y., Pelletier, M. \u0026amp; Walsh, W. R. Combination Ti/PEEK ALIF cage for anterior lumbar interbody fusion: Early clinical and radiological results. J Clin Neurosci 34, 94\u0026ndash;99 (2016).\u003c/li\u003e\n\u003cli\u003eAnand, N. et al. Analysis of Spino-Pelvic Parameters and Segmental Lordosis with L5-S1 Oblique Lateral Interbody Fusion at the Bottom of a Long Construct in Circumferential Minimally Invasive Surgical Correction of Adult Spinal Deformity. World Neurosurg 130, e1077\u0026ndash;e1083 (2019).\u003c/li\u003e\n\u003cli\u003eHeo, D. H. \u0026amp; Kim, J.-S. Clinical and radiological outcomes of spinal endoscopic discectomy-assisted oblique lumbar interbody fusion: preliminary results. Neurosurg Focus 43, E13 (2017).\u003c/li\u003e\n\u003cli\u003eMiscusi, M. et al. Comparison of pure lateral and oblique lateral inter-body fusion for treatment of lumbar degenerative disk disease: a multicentric cohort study. Eur Spine J 27, 222\u0026ndash;228 (2018).\u003c/li\u003e\n\u003cli\u003eUdby, P. M. \u0026amp; Bech-Azeddine, R. Clinical outcome of stand-alone ALIF compared to posterior instrumentation for degenerative disc disease: A pilot study and a literature review. Clin Neurol Neurosurg 133, 64\u0026ndash;69 (2015).\u003c/li\u003e\n\u003cli\u003eLi, H.-J. et al. Comparative study between mini-open TLIF via Wiltse\u0026rsquo;s approach and conventional open TLIF in lumbar degenerative diseases. Eur Rev Med Pharmacol Sci 22, 53\u0026ndash;62 (2018).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ACR, TLIF, LDD","lastPublishedDoi":"10.21203/rs.3.rs-5308721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5308721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy Design.\u003c/strong\u003e Retrospective study to investigate the benefits of ACR for lumbar degenerative diseases (LDD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective. \u003c/strong\u003eInvestigate the outcomes of anterior column realignment(ACR) combined with percutaneous pedicle screw fixation(PPS) and differ for transforaminal lumbar interbody fusion (TLIF) for LDD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom June 2018 to December 2021, 22 consecutive patients with LDD underwent ACR. At the same time while 22 patients underwent TLIF. Preoperative and intraoperative parameters of all the patients are collected. The influences of ACR on mechanical factors and indirect decompression were evaluated by radiological parameters. Function improvements are assessed by Oswestry Disability Index (ODI), Visual Analogue Score (VAS) and Japanese Orthopaedic Association (JOA) Scores during one year of follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreoperatively, there was no significant difference of age, sex, body mass index (BMI), ODI, VAS and JOA scores in both groups . Compared with ACR group, TLIF group had increased hospital stay (6.77±3.25 days vs. 5.0±1.11 days, P\u0026lt;0.05), blood loss (645.45±571.95ml vs. 235.45±78.30ml, P\u0026lt;0.05) and postoperative drainage (391.82±364.84 ml vs. 0 ml, P\u0026lt;0.001). ACR could significantly improve the radiological parameters. The short-term scores of function and pain of ACR group were higher than TLIF group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth of ACR and TLIF could effectively resolve the symptoms of LDD. Compared with TLIF, ACR had a better improvement of short-term outcomes. ACR could be performed and improved as optional treatment strategy for LDD.\u003c/p\u003e","manuscriptTitle":"ACR combined with PPS to treat lumbar degenerative diseases: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 11:44:08","doi":"10.21203/rs.3.rs-5308721/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b8552062-e245-4ce5-98f4-8698b631d05b","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-15T16:23:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-15 11:44:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5308721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5308721","identity":"rs-5308721","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}