Comparison of the safety and efficacy of unilateral biportal endoscopic lumbar interbody fusion and uniportal endoscopic lumbar interbody fusion: a 1-year follow-up

Totally endoscopic trans‑superior articular process lumbar interbody fusion: A case series on the development and preliminary evaluation of an innovative minimally invasive lumbar spine surgical technique

The present study is a retrospective analysis aimed at evaluating the early clinical efficacy and preliminary safety of full-endoscopic transforaminal upper facet joint lumbar interbody fusion (TSAP-LIF) in patients with lumbar degenerative diseases treated at the Department of Orthopaedics at Changzhi Yunfeng Hospital (Changzhi, China). The present study collected clinical follow-up data and radiological images, which were accessed and collected between January 1, 2021 and December 31, 2022. All surgeries were performed by the same group of experienced surgeons to ensure consistency in surgical technique and its impact on patient outcomes. The study included patients' preoperative baseline characteristics, operative time, intraoperative blood loss, postoperative complications and follow-up results (with a follow-up period of 6 months). Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS), and radiological evaluations were conducted using postoperative X-rays and computed tomography scans to determine the intervertebral fusion rate. Among the 9 patients, there were 4 men and 5 women, with an average age of 47.3±13.1 years (range, 23-67 years). The average operation time was 113.3±13.9 min, and the average intraoperative blood loss was 101.6±13.8 ml. The postoperative complication rate was 0%. The average hospital stay was 12.7±3.2 days. The average VAS score improved from 7.7±1.4 preoperatively to 2.6±1.2 at 3 months postoperatively and to 1.2±1.1 at 6 months postoperatively. The average ODI score improved from 56.7±8.2 preoperatively to 22.7±5.6 at 1 month postoperatively and to 10.2±4.2 at 6 months postoperatively. Radiological examinations showed an intervertebral fusion rate of 88% at 6 months postoperatively. Retrospective analysis indicates that TSAP-LIF is a safe and effective method for treating lumbar degenerative diseases. The clinical outcomes are significant, with reduced operation time, marked improvement in patient pain and function and a high intervertebral fusion rate. To further evaluate the clinical efficacy of this procedure, larger sample sizes and longer follow-up periods are required.

Comparison of the Outcomes of Endoscopic Posterolateral Interbody Fusion and Lateral Interbody Fusion in the Treatment of Lumbar Degenerative Disease: A Systematic Review and Network Meta-Analysis

OBJECTIVE

Although endoscopic technologies have been increasingly applied in lumbar fusion surgery in recent years, the advantages and disadvantages of endoscopic posterolateral fusion compared with lateral fusion remain unclear. Six different single-level lumbar interbody fusion procedures were compared to determine whether indirect decompression fusion could achieve levels of efficacy and safety comparable to those of minimally invasive direct decompression fusion in the treatment of lumbar degenerative disease (LDD).

METHOD

A literature search was conducted in the PubMed, Embase, and Cochrane Library databases, and studies on the treatment of LDD published from 2004 to March 2024 were retrieved. The data of preset clinical outcome measures, including operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, and the Oswestry Disability Index (ODI), were extracted from the studies.

RESULTS

Thirty-five studies with 3467 patients were included in this review. Network meta-analysis revealed no significant differences in improvements in pain and disability or adverse events among the procedures, except for uniportal endoscopic lumbar interbody fusion (UELIF), which resulted in a lower degree of improvement in the ODI than oblique lateral interbody fusion (OLIF). Stand-alone lateral lumbar interbody fusion (SA-LLIF) exhibited the best performance in terms of indicators of early efficacy, such as surgical time and LOS. OLIF and SA-LLIF had higher fusion rates than did UELIF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). MIS-TLIF resulted in greater EBL than did OLIF, SA-LLIF, and UELIF.

CONCLUSION

Minimally invasive lumbar interbody fusion achieves good therapeutic results in LDD patients regardless of the use of indirect or direct decompression, whereas SA-LLIF has better early efficacy.

Comparative Evaluation of Efficacy and Complications Between Biportal Endoscopic Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis

Objective

To effectuate a comprehensive juxtaposition of the clinical implications, incidence of complications, and successful fusion rates observed in the context of biportal endoscopic lumbar interbody fusion (BE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Methods

The present research initiative involved an exhaustive exploration of pertinent scholarly literature in renowned databases, which lasted until April 2023. The evaluative framework encompassed a diverse array of parameters, including but not limited to operation time, hospitalization, quantification of estimated blood loss, the assessment of outcomes via the application of the Visual Analog Scale (VAS) to gauge pain intensity, and the utilization of the Oswestry Disability Index (ODI) to measure functional impairment.

Results

The current meta-analysis included ten studies with a total of 736 participants. In comparison of the BE-LIF and MI-TLIF techniques, no substantial differences were observed in the parameters studied, included VAS for leg pain (P > 0.05), as well as the assessment of complication rates (7.76% versus 7.97%; P = 0.71) and fusion rates (89.59% versus 88.60%; P = 0.90). However, the early postoperative VAS for back pain (P < 0.0001) and the early postoperative ODI score (P = 0.007) were significantly lower in the BE-LIF group than in the MI-TLIF group. Additionally, a significant difference in blood loss was observed (P < 0.0001), with less blood loss in the BE-LIF group compared to the MI-TLIF group. Furthermore, the complex surgical procedure of BE-LIF resulted in a longer duration of surgery (P = 0.02) but shorter hospitalization compared with MI-TLIF (P < 0.0001).

Conclusion

Within the context of the management of lumbar degenerative diseases, BE-LIF surgery exhibits clinical effectiveness and incidence of complications comparable to MI-TLIF. In contrast to MI-TLIF, BE-LIF offers distinctive merits, including reduced blood loss, abbreviated hospitalization durations, expedited relief from postoperative back pain, and an accelerated trajectory towards functional recuperation.

A systematic review of biportal endoscopic spinal surgery with interbody fusion

Biportal endoscopic spinal surgery (BESS) with interbody fusion is a relatively novel minimally invasive technique that was developed to reduce soft tissue trauma and intraoperative blood loss and shorten recovery time while achieving comparable clinical outcomes for lumbar degenerative diseases. Despite the growing interest in BESS, a comprehensive analysis of its effectiveness, complication rates, and long-term outcomes remains lacking. This systematic review evaluated the clinical outcomes, surgical efficacy, and complication rates of BESS with interbody fusion for lumbar degenerative diseases. Recent literature on endoscopic lumbar interbody fusion was included to expand the scope and gain new perspectives, thereby, providing a comparative analysis that highlighted the advantages, limitations, and emerging trends in minimally invasive spine surgery. This review synthesized current evidence to guide future research and clinical applications. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a combination of MeSH (Medical Subject Headings) terms and relevant keywords, PubMed/Medline and Scopus databases were systematically searched for studies published between January 2000 and September 2024. The studies were assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies of Interventions) tool to determine the risk of bias. From the 12 studies that provided clinical evidence, the data extracted were patient demographics; operative time; blood loss; clinical outcomes, such as Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores and fusion rates; and complications. The mean operative time ranged from 98 to 206 minutes, with fusion rates between 70% and 95%. Most studies reported significant improvements in VAS scores for back and leg pain and ODI scores. Complications, including dural tears (2.9%-6.4%) and hematomas (1.4%-4.3%), were infrequent but notable. BESS with interbody fusion demonstrated excellent clinical outcomes, high fusion rates, and few complications. Although these results are promising, more randomized controlled trials and long-term studies are required to confirm the broader applicability, particularly in more complex or multilevel spinal pathologies.

Meta-Analysis of the Clinical Efficacy and Safety of Unilateral Biportal Endoscopic Lumbar Interbody Fusion versus Endoscopic Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases

OBJECTIVE

To compare the efficacy and safety of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) and endoscopic lumbar interbody fusion (Endo-LIF) in the treatment of lumbar degenerative diseases.

METHODS

A thorough literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the PICO framework (PROSPERO 2024CRD42024592073). The databases searched included PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database, with a time frame of January 2020 to June 2024. Outcome metrics included operative time, rate of progress of surgical time for beginners, intraoperative bleeding, hidden blood loss, total blood loss (TBL), postoperative drainage, hospitalization time, visual analog score for pain, Oswestry Disability Index, complications, fusion rates, and modified MacNab score excellence rates.

RESULTS

A total of 10 papers were included, including two that were randomized controlled trials. This study involved 710 patients, 348 in the UBE-LIF group and 362 in the Endo-LIF group. The results showed that the UBE-LIF group was superior to the Endo-LIF group in terms of operative time and rate of progress of surgical time for beginners. In contrast, the Endo-LIF group was superior to the UBE-LIF group in terms of hospitalization time, hidden blood loss, and TBL. There were no statistical differences between the two procedures regarding intraoperative bleeding, postoperative drainage, visual analog score for low back pain, Oswestry Disability Index, complications, fusion rates, and modified MacNab score excellence rates.

CONCLUSIONS

Postoperative pain and safety were comparable between the two endoscopic procedures.The UBE-LIF procedure was shorter, whereas the Endo-LIF had less TBL and a shorter recovery time.

Comparative efficacy and fusion outcomes of unilateral bi-portal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in treating single-segment degenerative lumbar spondylolisthesis with lumbar spinal stenosis: a two-year retrospective study

BACKGROUND

Degenerative lumbar spondylolisthesis (DLS) with lumbar spinal stenosis (LSS) is a common condition resulting in substantial lower back pain and disability. Surgical intervention is recommended only when conservative treatment fails. This study compared UBE-TLIF and MIS-TLIF regarding clinical outcomes and fusion rates in patients with single-segment DLS with LSS.

METHODS

A total of 85 patients who underwent either UBE-TLIF (n = 40) or MIS-TLIF (n = 45) were examined retrospectively. Clinical results were evaluated by the Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI) for functional outcomes. Radiographs and CT were utilized to assess radiological outcomes such as disc height (DH), lumbar lordosis (LL), and interbody fusion rates. The two groups were also compared in terms of perioperative data (operation time, blood loss, hospital stay, and fluoroscopy exposure).

RESULTS

Both surgical techniques showed similar statistically significant improvements in VAS and ODI scores. Fusion rates at 2 years postoperatively were identical, including 95% for the UBE-TLIF group and 97.7% for the MIS-TLIF group. However, compared with MIS-TLIF, the operative time and fluoroscopy exposure were longer for UBE-TLIF, but intraoperative blood loss and length of hospital stay were reduced.

CONCLUSIONS

UBE-TLIF and MIS-TLIF can successfully treat single-segment DLS in the presence of LSS, achieving similar clinical and radiological outcomes with low complication rates. Although UBE-TLIF has certain advantages regarding perioperative outcomes (less blood loss and shorter hospital stay), MIS-TLIF is associated with shorter operative times and lower fluoroscopy exposure.

The biportal endoscopic posterior open-door laminoplasty with the use of mini-plate for cervical spondylotic myelopathy: Case report and literature review

INTRODUCTION

Biportal endoscopy, a newly developed technique rapidly applied in lumbar spine surgery, has recently been utilized for treating cervical spine diseases. We present a case of cervical spondylotic myelopathy managed with open-door laminoplasty fixed by mini-plate and performed with biportal endoscopy assistance.

PRESENTATION OF CASE

The patient, a 62-year-old woman, presented with gradually developing weakness in the lower extremities. CT and MR images showed cervical stenosis at C4-5 and C5-6. We performed a posterior open-door laminoplasty using biportal endoscopy assisted by a mini-plate. After completing the gutters on both sides of the hinge and open-door, we detached the spinous process from the lamina through endoscopic-guided burr grinding. The skin incisions of the portals on the open-door side were connected for direct fixation of the elevated lamina with a mini-plate. There was improvement in ambulatory capacity for the patient along with radiological evidence of decompressed cervical canal.

DISCUSSION

Endoscopic technology is increasingly employed in spinal surgery, with several studies documenting the utilization of biportal endoscopic techniques to facilitate open-door laminoplasty procedures for managing myelopathic cervical spondylosis. The procedures we report allow for safer and more efficient placement of the mini-plate that prevents door re-closing.

CONCLUSIONS

The potential applications of biportal endoscopic technology in open-door cervical spine surgery are worth considering, given the soft tissue damage caused by traditional posterior cervical spine surgery. However, the safety and effectiveness of this method still require more studies with a larger number of cases and longer follow-up to be substantiated.

Complications in Minimally Invasive Spine Surgery in the Last 10 Years: A Narrative Review

OBJECTIVE

Minimally invasive spine surgery (MISS) employs small incisions and advanced techniques to minimize tissue damage while achieving similar outcomes to open surgery. MISS offers benefits such as reduced blood loss, shorter hospital stays, and lower costs. This review analyzes complications associated with MISS over the last 10 years, highlighting common issues and the impact of technological advancements.

METHODS

A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was conducted using PubMed, MEDLINE, Embase via OVID, and Cochrane databases, covering publications from January 2013 to March 2024. Keywords related to MISS and complications were used. Studies on adult patients undergoing MISS with tubular, uniportal, or biportal endoscopy, reporting intraoperative or postoperative complications, were included. Non-English publications, abstracts, and small case series were excluded. Data on MISS approach, patient demographics, and complications were extracted and reviewed by 2 independent researchers.

RESULTS

The search identified 880 studies, with 137 included after screening and exclusions. Key complications in cervical MISS were hematomas, transient nerve root palsy, and dural tears. In thoracic MISS, complications included cerebrospinal fluid leaks and durotomy. In lumbar MISS, common complications were incidental dural injuries, postoperative neuropathic conditions, and disc herniation recurrences. Complications varied by surgical approach.

CONCLUSION

MISS offers reduced anatomical disruption compared to open surgery, potentially decreasing nerve injury risk. However, complications such as nerve injuries, durotomies, and hardware misplacement still occur. Intraoperative neuromonitoring and advanced technologies like navigation can help mitigate these risks. Despite variability in complication rates, MISS remains a safe, effective alternative with ongoing advancements enhancing its outcomes.

Comparison of Fusion Rate and Clinical Outcomes in Minimally Invasive and Conventional Posterior Fusion for Lumbar Degenerative Disease: A Network Meta-Analysis

BACKGROUND

The fusion rate, clinical efficacy, and complications of minimally invasive fusion surgery and open fusion surgery in the treatment of lumbar degenerative disease are still unclear.

METHODS

We conducted a literature search using PubMed, Embase, Cochrane Library, CNKI, and WANFANG databases.

RESULTS

This study included 38 retrospective studies involving 3097 patients. Five intervention modalities were considered: unilateral biportal endoscopic-lumbar interbody fusion (UBE-LIF), percutaneous endoscopic-lumbar interbody fusion (PE-LIF), minimally invasive-transforaminal lumbar interbody fusion (MIS-TLIF), transforaminal lumbar interbody fusion (TLIF), and posterior lumbar interbody fusion (PLIF). Quality assessment indicated that each study met acceptable quality standards. PE-LIF demonstrated reduced low back pain (Odds Ratio = 0.50, Confidence Interval: 0.38-0.65) and lower complication rate (Odds Ratio = 0.46, Confidence Interval: 0.25-0.87) compared to PLIF. However, in indirect comparisons, PE-LIF showed the lowest fusion rates, with the ranking as follows: UBE-LIF (83.2%) > MIS-TLIF (59.6%) > TLIF (44.3%) > PLIF (39.8%) > PE-LIF (23.1%). With respect to low back pain relief, PE-LIF yielded the best results, with the order of relief as follows: PE-LIF (96.4%) > MIS-TLIF (64.8%) > UBE-LIF (62.6%) > TLIF (23.0%) > PLIF (3.2%). Global and local consistency tests showed satisfactory results, and heterogeneity tests indicated good stability.

CONCLUSIONS

Compared to conventional open surgery, minimally invasive fusion surgery offered better scores for low back pain and Oswestry Disability Index, lower complication rates, reduced bleeding, and shorter hospital stays. However, minimally invasive fusion surgery did not show a significant advantage in terms of fusion rate and had a longer operative time.

Perioperative Takotsubo Stress Cardiomyopathy During Endoscopic Spinal Surgery: A Case Report

CASE

A 37-year-old man American Society of Anesthesiologists grade 1 patient with lumbar canal stenosis at the L4-L5 level underwent endoscopic decompression. Toward the end of the procedure, the patient developed sudden-onset bradycardia, followed by ventricular arrhythmia and acute pulmonary edema. The patient was successfully managed with resuscitation and supportive management and recovered uneventfully thereafter. A diagnosis of perioperative stress cardiomyopathy was subsequently made after evaluation of the patient.

CONCLUSION

The possibility of takotsubo cardiomyopathy should be considered in cases of acute perioperative cardiac decompensation and pulmonary edema in patients undergoing spinal surgery.

Evaluation of the learning curve and complications in unilateral biportal endoscopic transforaminal lumbar interbody fusion: cumulative sum analysis and risk-adjusted cumulative sum analysis

PURPOSE

To evaluate the learning curve and complications in unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF) using the Cumulative Sum (CUSUM) analysis and Risk-adjusted Cumulative Sum (RA-CUSUM) analysis.

METHODS

This study retrospectively analyzed 184 consecutive patients who received ULIF in our hospital, including 104 males and 80 females. CUSUM analysis and RA-CUSUM analysis were used to evaluate the learning curve of ULIF based on the operation time and surgical failure rate, respectively. All postoperative complications were defined as surgical failure. Variables of different phases were compared based on the learning curve.

RESULTS

The CUSUM analysis showed the cutoff point for ULIF was 29 cases, and the RA-CUSUM analysis showed the cutoff point for ULIF was 41 cases. Operating time and hospital stay were significantly decreased as the learning curve progressed (P < 0.05). Visual analogue score (VAS) and Oswestry disability index (ODI) at the last follow-up were significantly lower than preoperatively. At the last follow-up, a total of 171 patients reached intervertebral fusion, with a fusion rate of 92.9% (171/184). A total of eleven complications were observed, and RA-CUSUM analysis showed that the incidence of complications in the early phase was 17.07% and in the late phase was 2.6%, with a significant difference (P < 0.05).

CONCLUSION

ULIF is an effective minimally invasive lumbar fusion surgical technique. But a learning curve of at least 29 cases will be required to master ULIF, while 41 cases will be required to achieve a stable surgical success rate.

Case Report: Bacterial meningitis due to cerebrospinal fluid leakage following unilateral biportal endoscopic spinal surgery: a cautionary tale

Unilateral biportal endoscopic spinal surgery (UBE) is a rapidly growing surgical method and has attracted much interest recently. The most common complication of this technique is cerebrospinal fluid (CSF) leakage due to intraoperative dural tears. There have been no reports of bacterial meningitis due to dural tears in UBE surgery and its treatment and prevention. We reported a 47 year-old man with CSF due to an intraoperative dural tear. A drainage tube was routinely placed and removed on the fourth day after surgery, resulting in fever and headache on the fifith postoperative day. Blood and CSF cultures showed Klebsiella pneumoniae infection, and with lumbar drainage and appropriate antibiotics based on sensitivity tests, the patient's fever and headache were effectively relieved. This case report suggests the importance of prolonged drainage tube placement, adequate drainage, careful intraoperative separation to avoid dural tears, and effective sensitive antibiotic therapy.

The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective

Lumbar interbody fusion stands as a preferred surgical solution for degenerative lumbar spine diseases. The procedure primarily aims to establish lumbar segment stability, directly addressing patient symptoms associated with spinal complications. Traditional open surgery, though effective, is linked with notable morbidities and extended recovery time. To mitigate these concerns, minimally invasive surgery (MIS) has garnered significant popularity, presenting an appealing alternative with numerous benefits such as reduced soft tissue trauma, decreased blood loss, and expedited recovery. Among MIS procedures, full endoscopic spinal surgery, characterized by its minimal invasiveness, holds the potential to further minimize morbidities while enhancing surgical outcomes. Endoscopic lumbar interbody fusion, a novel procedure within this paradigm, has gained attention for offering advantages comparable to those of minimally invasive transforaminal lumbar interbody fusion. However, the safety, efficacy, and associated surgical techniques and instrument design of this method continue to be subjects of ongoing debate. This paper critically reviews current evidence on the safety, efficacy, and advantages of endoscopic lumbar spinal interbody fusion, examining whether it could indeed supersede existing mainstream techniques.

[Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation]

Objective

To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation.

Methods

A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score).

Results

Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences ( P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). And there was no significant difference between the two groups at each time point after operation ( P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months ( P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group ( P<0.05).

Conclusion

For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.

Minimally invasive endoscopy in spine surgery: where are we now?

INTRODUCTION

Endoscopic spine surgery (ESS) is a minimally invasive surgical technique that offers comparable efficacy and safety with less collateral damage compared to conventional surgery. To achieve clinical success, it is imperative to stay abreast of technological advancements, modern surgical instruments and technique, and updated evidence.

PURPOSES

To provide a comprehensive review and updates of ESS including the nomenclature, technical evolution, bibliometric analysis of evidence, recent changes in the spine communities, the prevailing of biportal endoscopy, and the future of endoscopic spine surgery.

METHODS

We conducted a comprehensive review of the literature on ESS for the mentioned topics from January 1989 to November 2022. Three major electronic databases were searched, including MEDLINE, Scopus, and Embase. Covidence Systematic Review was used to organize the eligible records. Two independent reviewers screened the articles for relevance.

RESULTS

In total, 312 articles were finally included for review. We found various use of nomenclatures in the field of ESS publication. To address this issue, we proposed the use of distinct terms to describe the biportal and uniportal techniques, as well as their specific approaches. In the realm of technical advancement, ESS has rapidly evolved from addressing disc herniation and spinal stenosis to encompassing endoscopic fusion, along with technological innovations such as navigation, robotics, and augmented reality. According to bibliometric analysis, China, South Korea, and the USA have accounted for almost three-quarters of total publications. The studies of the biportal endoscopy are becoming increasingly popular in South Korea where the top ten most-cited articles have been published. The biportal endoscopy technique is relatively simple to adopt, as it relies on a more familiar approach, requires less expensive instruments, has a shorter learning curve, and is also well-suited for interbody fusion. The uniportal approach provided the smallest area of soft tissue dissection. While robotics and augmented reality in ESS are not widely embraced, the use of navigation in ESS is expected to become more streamlined, particularly with the emergence of recent electromagnetic-based navigation technologies.

CONCLUSIONS

In this paper, we provide a comprehensive overview of the evolution of ESS, as well as an updated summary of current trends in the field, including the biportal and uniportal approaches. Additionally, we summarize the nomenclature used in ESS, present a bibliometric analysis of the field, and discuss future directions for the advancement of the field.

Transforaminal Interbody Fusion Using the Unilateral Biportal Endoscopic Technique Compared With Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spine Diseases: Analysis of Clinical and Radiological Outcomes

BACKGROUND

There has been a widespread application of minimally invasive spinal surgery techniques in the past few years. Unilateral biportal endoscopic has been successfully used in a variety of lumbar spine diseases, but there are few studies on lumbar fusion assisted by unilateral biportal endoscopy.

OBJECTIVE

To compare the clinical and radiological outcomes of transforaminal interbody fusion using the unilateral biportal endoscopic technique (UBEIF) and transforaminal lumbar interbody fusion (TLIF) in patients with lumbar disease.

METHODS

We studied 128 patients, 58 in the UBEIF group and 70 in the TLIF group. The Oswestry disability index, creatine kinase, visual analog score (VAS) for leg and back pain were used to assess clinical outcomes. Radiographic outcomes were assessed using the fusion rate, internal fixation loosening, and adjacent segment degeneration.

RESULTS

Back and leg pain VAS scores in both groups were significantly lower 3, 6, and 12 months after surgery ( P < .05). A significant reduction in Oswestry disability index in both groups was observed 6 and 12 months after surgery ( P < .05). Compared with the TLIF group at 1 week after surgery, UBEIF patients' VAS score for back pain significantly improved ( P < .05). There was no difference in fusion rate between the 2 groups (98.27% vs 98.57%).

CONCLUSION

UBEIF and TLIF have similar clinical and radiographic outcomes in the treatment of single-segment lumbar disease with lumbar instability, including improved back and leg pain, improved disability, and high fusion rates. Furthermore, with UBEIF, less blood is lost, there is better relief of early back pain, and hospital stays are shorter.

Postoperative bone graft migration into the thecal sac and shifting down to the lower level after an endoscopic lumbar interbody fusion: a case report

BACKGROUND

Postoperative bone graft migration (PBGM) is a fairly rare spinal postoperative complication. Its occurrence after endoscopic surgery has rarely been reported in the literature so far. This is a case report of a 52-year-old male occurring PBGM into the thecal sac in the 8th days after an endoscopic lumbar interbody fusion (ELIF), which can make surgeons more minded with such serious rare complication after BGM.

CASE PRESENTATION

A 52-year-old male patient, underwent a L4-5 ELIF, presented with an acute radiculopathy on right leg and urinary incontinence in the 8^th postoperative day. An emergency lumbar Computed Tomography(CT scan) and Magnetic Resonance Imaging (MRI) demonstrated bone graft migration into the thecal sac at the L4-5 level, and shifting down to the lower level. The revision surgery was performed at once successfully. Finally, the patient got well managed before discharge.

CONCLUSION

Supported by this case report, we believe that PBGM into the thecal sac is a rare but horrible complication of ELIF. However, too much volume of bone graft and its posterior placement are more prone to developing this complication. Finally, we are not sure that the outcome presented in this study will be repeated in future cases.