To compare the outcomes of O-arm navigation-guided single-position oblique lateral interbody fusion (OLIF) with posterior percutaneous fixation versus posterior decompression and fusion with internal fixation in treating grade Ⅱ lumbar spondylolisthesis.

We retrospectively reviewed 83 consecutive patients (53 men, 30 women; mean age, 66.49±7.36 years) with grade II lumbar spondylolisthesis treated between January 2019 and December 2022. Group A (n=36) underwent single-position OLIF with posterior percutaneous fixation under O-arm navigation, while Group B (n=47) received posterior decompression with instrumented fusion. Comparative parameters included operative duration, intraoperative blood loss, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), time to ambulation, hospitalization length, intervertebral disc space height, slip rate, lumbar lordosis angle, fusion, and complication rates.

All patients successfully completed the operation, with an average follow-up of (23.13±4.55) months. In group A, the average operation time was (138.65±22.38) min, the average intraoperative blood loss was (103.61±27.36) ml, the average time to ambulation was (2.19±0.79) days, and the hospital stay was (5.97±0.72) days. In group B, the average operation time was (121.41±21.19) min, the average intraoperative blood loss was (369.48±54.18) ml, the average time to ambulation was (2.53±0.92) days, and the hospital stay was (6.15±0.67) days. The average intraoperative blood in Group A was significantly lower than that in the control group (P<0.01), while there was no statistically significant difference in the average operation time, time to ambulation and hospital stay between the two groups (all P>0.05). Repeated measures variance analysis of VAS for low back and leg pain at 1 week, 6 months and the final follow-up showed that there was a significant difference between the two groups. And there was an interaction between the group and the time point. The VAS for low back and leg pain at 1 week were significant difference between the two groups (P<0.05). No significant difference of the ODI in the two groups at different time points (all P>0.05). Repeated measures variance analysis of intervertebral space, slip rate and lumbar lordosis angle at 6 months and the final follow-up showed that there was a significant difference between the two groups. There was an interaction between the groups and time points. In terms of intervertebral disc space height, slip rate and lumbar lordosis angle, there were significant differences at 6 months and the final follow-up (all P<0.05). In terms of fusion, 97.22% of group A reached grade I and 2.78% of patients reached grade Ⅱ at the final follow-up, while 82.98% of group B reached grade I and 17.02% reached grade Ⅱ, the difference was statistically significant (P<0.05). The incidence of complications in group B was 25.53% (12/47), which was higher than that in group A (11.11%). However, the difference was not statistically significant (P>0.05).

O-arm navigation-guided single-position OLIF with posterior fixation offers distinct advantages over posterior approaches in blood loss, early pain relief, slip reduction, lumbar segmental alignment restoration, and fusion rate. This minimally invasive strategy represents a viable alternative for grade Ⅱ lumbar spondylolisthesis management.