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

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.

Two-year follow-up of unilateral biportal endoscopy assisted extraforaminal lumbar interbody fusion: how to perform indirect decompression and fusion under endoscopy: a retrospective study in Japan

STUDY DESIGN

Retrospective study.

PURPOSE

To compare the clinical and radiographic outcomes of unilateral biportal endoscopy-assisted extraforaminal lumbar interbody fusion (BE-ELIF) and oblique lateral interbody fusion (OLIF).

OVERVIEW OF LITERATURE

OLIF is widely recognized for its strong realignment capability, achieved through placing a large interbody cage, and its favorable clinical outcomes with indirect decompression. ELIF, similar to OLIF, does not entail exposure of the spinal canal. At our hospital, BE-ELIF involves removing the superior articular processes on both sides, inserting two expandable cages, and performing indirect canal decompression. BE-ELIF is a lumbar interbody fusion technique that provides indirect decompression similar to OLIF. However, no studies have compared the efficacy of ELIF performed under unilateral biportal endoscopy with that of OLIF.

METHODS

Forty-nine adults who underwent single-level L4/5 interbody fusion for degenerative spondylolisthesis were divided into BE-ELIF (n=27) and OLIF (n=22) groups based on the surgical approach used. Clinical outcomes were assessed using the Visual Analog Scale and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Radiographic parameters, including distance of spondylolisthesis, disc height, segmental lordosis, lumbar lordosis, pelvic tilt, and sagittal vertical axis, were evaluated preoperatively and at final follow-up.

RESULTS

OLIF provided significantly better relief of pain in lower limbs and buttocks at 1-year follow-up. No significant between-group differences were observed in JOABPEQ domains. BE-ELIF resulted in greater improvements in spondylolisthesis distance and disc height, while other parameters did not differ significantly between the two groups.

CONCLUSIONS

For L4/5 degenerative spondylolisthesis, BE-ELIF demonstrated superior spondylolisthesis reduction and disc height improvement than OLIF. Although BE-ELIF was associated with some inferior clinical outcomes, it provided satisfactory results, effective realignment, and a low complication risk.

Unilateral biportal endoscopic lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for single-segment lumbar degenerative disease: a meta-analysis

BACKGROUND

Minimally invasive spine surgery has seen rapid development in recent years. The purpose of this study was to evaluate the use of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive surgery transforaminal interbody fusion (MIS-TLIF) for the treatment of single-segment lumbar degenerative disease (LDD) through a systematic review and meta-analysis.

METHODS

In collaboration with various search terms, a comprehensive examination of the scientific literature was carried out using PubMed, China National Knowledge Infrastructure (CNKI), Wanfang, and other databases. A total of 9 studies were included retrospective cohort studies.

RESULTS

We observed statistically significant differences in intraoperative blood loss, total hospital stay, postoperative hospital stays, and 1-month postoperative Oswestry Disability Index (ODI) scores between the ULIF and MIS-TLIF groups, with the ULIF group being more dominant. MIS-TLIF group was statistically more advantageous in terms of operative time. There were no statistically significant differences in postoperative visual analogue scale (VAS) scores, 3-month postoperative and final ODI scores, excellent and good rate, complications, disc heights, and lumbar lordosis angle between the two groups.

CONCLUSIONS

Treatment of single-segment LDD with ULIF and MIS-TLIF is both safe and effective. ULIF has the advantage of less intraoperative blood loss, shorter total hospital stay, shorter postoperative hospital stay, and lower ODI scores at 1 month postoperatively compared to MIS-TLIF. There were no significant differences between ULIF and MIS-TLIF in the treatment of LDD in terms of postoperative VAS scores, 3-month postoperative and final ODI scores, satisfaction rates, fusion rates, complications, disc heights, and lumbar lordosis angle. MIS-TLIF has a shorter procedure time than ULIF.

Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study

OBJECTIVE

To investigate the clinical effectiveness of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) in the treatment of lumbar spinal stenosis.

METHODS

A total of 475 patients with lumbar spinal stenosis from January 2019 to January 2023 were included in this study. Among them, 240 patients were treated with AUSS (AUSS group); the other 235 patients were treated with unilateral bi-portal endoscopy treatment (UBE group). The differences in surgery-related clinical indicators, pain degree before and after surgery, Oswestry Disability Index (ODI), CT imaging parameters of spinal stenosis, and clinical efficacy were compared between the two groups.

RESULTS

Patients in the AUSS group had a shorter operative time than those in the UBE group, and the length of incision and surgical bleeding were less than those in the UBE group, with statistically significant differences (P < 0.05). Before operation, there was no significant difference in the VAS score of low back pain and leg pain between the two groups (P > 0. 05). After operation, patients in both groups showed a significant reduction in low back and leg pain, and their VAS scores were significantly lower than before the operation (P < 0.05). Three months after surgery, the results of CT re-examination in both groups showed that the spinal stenosis of the patients was well improved, and the measurements of lumbar spinal interspace APDC, CAC, ICA, CAD and LAC were significantly higher than those before surgery (P < 0. 05). Besides, the lumbar function of patients improved significantly in both groups, and ODI measurements were significantly lower than those before surgery (P < 0.05).

CONCLUSION

Both AUSS and UBE with unilateral laminotomy for bilateral decompression can achieve good clinical results in the treatment of lumbar spinal stenosis, but the former has the advantages of simpler operation, shorter operation time, shorter incision length, and less surgical blood loss.

Clinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up

OBJECTIVE

To explore the safety and the mid-term efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and 3D microscope-assisted transforaminal lumbar interbody fusion (MMIS-TLIF) for treating single-segment lumbar spondylolisthesis with lumbar spinal stenosis (DLS-LSS).

METHODS

The clinical data of 49 patients who underwent UBE-TLIF or MMIS-TLIF in our hospital were retrospectively analyzed, including 26 patients who underwent the UBE-TLIF and 23 patients who underwent the MMIS-TLIF. The demographic and perioperative outcomes of patients before and after surgery were reviewed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes of patients before surgery and at 1, 3, 6, 12 and 24 months after surgery. The lumbar lordosis angle (LL), disc height (DH) and lumbar intervertebral fusion rate were assessed before surgery and at the last follow-up.

RESULTS

The VAS and ODI scores of the two groups were improved compared with those before surgery. The ODI of UBE-TLIF group was lower than that of MMIS-TLIF group at 1, 3, 6, and 12 months after surgery, and there were no significant differences between the two groups at other time points (P > 0.05). There were no significant differences in VAS between the two groups at each time point (P > 0.05). However, the UBE-TLIF group had more advantages in blood loss and hospital stay. The complications between the UBE-TLIF group (11.54%) and the MMIS-TLIF group (17.39%) were comparable (P > 0.05). Radiographic outcomes showed that the LL and DH of the two groups were improved compared with those before surgery, and the difference before and after surgery was not significant (P > 0.05). The fusion rate was 96.2% in the UBE-TLIF group and 95.7% in the MMIS-TLIF group. There was no significant difference in the fusion rate between the two groups (P > 0.05).

CONCLUSIONS

Both UBE-TLIF and MMIS-TLIF have favorable outcomes for treating single-segment DLS-LSS. Both groups have the advantages of clear surgical vision, high surgical efficiency, and favorable mid-term efficacy. In addition, compared with MMIS-TLIF, UBE-TLIF causes less intraoperative bleeding and faster postoperative recovery.