Comparison of the clinical outcomes of unilateral biportal endoscopic assisted posterior lumbar interbody fusion with minimally invasive transforaminal lumbar interbody fusion in treating lumbar degenerative diseases

English Keywords:Unilateral biportal endoscopic assisted posterior lumbar interbody fusion  Minimally invasive transforaminal lumbar interbody fusion  Lumbar degenerative disease  Efficacy comparisons

English Abstract:

  【Abstract】 Objectives: To compare the clinical outcomes of unilateral biportal endoscopic assisted posterior lumbar interbody fusion(UBE-PLIF) with minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative diseases. Methods: A retrospective case-control study was performed to analyze the clinical data of 60 patients with lumbar degenerative diseases who were admitted and treated in our hospital between January 2020 and January 2021, including 27 patients in UBE-PLIF group and 33 patients in MIS-TLIF group. There were no statistical differences(P>0.05) in the general data such as gender, age, surgical segment, disease duration, main diagnosis, and comorbid chronic diseases between the two groups. The operative time, intraoperative blood loss, postoperative drainage volume, and hospital stays were compared between the two groups. The visual analogue scale(VAS) scores for low back pain and leg pain, and Oswestry disability index(ODI) were collected preoperatively, at postoperative 3 months, 6 months, and final follow-up. The intervertebral disc height(IDH) of the operated segments was calculated before operation, at postoperative 3 days, 3 months, 6 months, and final follow-up. And the status of interbody fusion at 6 months after operation, fat infiltration grade of paraspinal muscles at 1 year after surgery, and complications were counted. Results: Patients in UBE-PLIF group were followed up for 12-15 months(13.3±1.0 months), and patients in MIS-TLIF group were followed up for 12-16 months(13.4±1.2 months) , and the differences were not statistically significant(P>0.05). The operative time, intraoperative blood loss, and postoperative drainage volume in UBE-PLIF group and MIS-TLIF group were respectively 274.3±88.2min and 181.8±58.7min, 261.1±207.7ml and 331.8±247.1ml, and 95.7±79.7 and 125.4±113.1ml, and the differences between groups were with statistical significance(P<0.05); Hospitalization days were 7.4±2.3 days in the UBE-PLIF group and 7.5±1.0 days in the MIS-TLIF group, and there was no statistical difference(P>0.05). The low back pain VAS score, leg pain VAS score, and ODI of patients in both groups at postoperative 3 months, 6 months, and final follow-up all improved significantly(P<0.05) from their preoperative values; the VAS scores of low back pain and leg pain at preoperation, postopertive 6 months, and final follow-up were with no statistical differences between groups(P>0.05), while those at 3 months of follow-up in UBE-PLIF group were superior than in MIS-TLIF group(P<0.05); There was no significant difference in ODI between the two groups at preoperation, 3 months, 6 months, and final follow-up(P>0.05). IDH of all groups of patients at 3 days, 3 and 6 months after surgery, and final follow-up was improved compared with the preoperative values, with significant differences(P<0.05), while there was no statistical difference between the two groups at such time points(P>0.05). For the bone graft fusion conditions at 6 months after surgery, 23 patients were of grade Ⅰ and 4 of grade Ⅱ in the UBE-PLIF group, and 28 patients were of grade Ⅰ and 5 of grade Ⅱ in the MIS-TLIF group, respectively(P＞0.05). As for the grades of paraspinal muscle fatty infiltration at 1 year after surgery, there were 2 patients of grade 1, 18 patients of grade 2, and 7 patients of grade 3 in the UBE-PLIF group and 0 patients of grade 1, 15 patients of grade 2, and 18 patients of grade 3 in the MIS-TLIF group, respectively, and the differences were with statistical significance(P<0.05). No patient in both groups developed operation related complications. Conclusions: Comparing with MIS-TLIF, UBE-PLIF has similar clinical efficacy in treating lumbar degenerative diseases, and the symptoms of low back and leg pain at 3 months after surgery are significantly improved, which also has the advantages such as less trauma, less intraoperative bleeding and less postoperative drainage.