The early clinical efficacy analysis of unilateral biportal endoscopic transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases

English Keywords:Lumbar degenerative diseases  Lumbar interbody fusion  Endoscopic surgery  Unilateral biportal

English Abstract:

  【Abstract】 Objectives: To evaluate the early clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF/BETLIF) in the treatment of lumbar degenerative diseases. Methods: 60 patients with lumbar degenerative diseases who underwent BETLIF surgery from March 2019 to May 2021 were selected, including 33 cases of grade Ⅰ degenerative lumbar spondylolisthesis (L3/4 1 case, L4/5 27 cases, L5/S1 5 cases), 6 cases of grade Ⅰ degenerative lumbar spondylolisthesis with isthmus fissure(L3/4 1 case, L4/5 3 cases, L5/S1 2 cases), 15 cases of disc herniation with segmental instability(L4/5 14 cases， L5/S1 1 case), 5 cases of lumbar spinal stenosis with segmental instability(L3/4 1 case, L4/5 4 cases), and 1 case of simple lumbar instability(L4/5 1 case). There were 14 males and 46 females, aged from 38 to 70 years old, averaged 56±8 years; with a mean body mass index(BMI) of 25.2±3.0kg/m2. The operative time, postoperative drainage, ambulation time, postoperative length of hospital stay and complications were recorded. The visual analogue scale(VAS) of leg and low back pain was collected before operation, at postoperative 1 week, and 1, 3, and 6 months; Oswestry disability index(ODI) was collected before operation, at postoperative 1, 3, and 6 months; the modified Macnab criteria grade was recorded at the 6th month after operation. The improvement rate of VAS scores of leg pain and low back pain and ODI 6-month postoperatively were calculated. The VAS score of leg pain/low back pain and ODI before and after operation were analysed according to the one-way repeated measures ANOVA for statistical difference, the differences of improvements between postoperative 6-month VAS score of leg pain and low back pain 6-month postoperatively were compared by paired sample t-test. According to Bridwell interbody fusion grading system, the surgical segmental fusion was evaluated on X-ray/CT images at 6-month after operation by two spinal surgeons. Results: The average operative time was 145.9±12.6min. 35 cases out of 60(58.3%) had indwelling drainage tubes after operation, with an average drainage volume of 56.40ml. The average ambulation time was 2.9±1.0d, and the average postoperative hospital stay was 7.8±2.7d. The surgical complications included intraoperative dural tear in 2 cases and postoperative subcutaneous edema in 3 cases. The VAS scores of leg and low back pain at 1 week and 1, 3 and 6 months after operation were significantly lower than those before operation(P＜0.05). The improvement rate of the VAS scores of leg pain and low back pain 6-month postoperatively were (65.6±7.1)% and (62.3±7.2)% respectively, with leg pain VAS better improved than low back pain VAS(P<0.05). The ODI at 1, 3 and 6 months after operation were significantly lower than those before operation(P<0.05), and the improvement rate of the ODI 6-month postoperatively were (60.9±4.7)%. The X-ray/CT at 6 months after operation revealed that 26 cases(43.4%) had segmental fusion, 29 cases(48.3%) had fusion trends but not fused, and 5 cases(8.3%) showed no segmental fusion at all. According to modified Macnab criteria, 55 patients were excellent(91.7%) and 5 patients were good(8.3%) at 6-month after operation. Conclusions: As a safe and effective lumbar interbody fusion technique, BETLIF has great early clinical efficacy for the treatment of lumbar degenerative diseases.