Comparison of the efficacy and safety of endoscopic lumbar interbody fusion between transforaminal approach and transarticular outburst approach

English Keywords:Lumbar interbody fusion  Endoscopy  Transforaminal approach  Transfacet approach

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy and safety of uni-portal endoscopic lumbar interbody fusion by using larger-diameter endoscope for single-level lumbar disease via transforaminal approach versus transfacet approach. Methods: 46 patients underwent single-level uni-portal endoscopic lumbar interbody fusion from June 2018 to February 2022 were enrolled. 18 of the patients were male and 28 were female. The mean age was 60.9±10.5 years old(40-80 years). The follow-up time was 3-47 months. Patients were divided into two groups according to the surgical approach, 18 of which were included in the transforaminal group, and the remaining 28 were included in the transfacet group, and a full spinal endoscope of 7.1mm inner-diameter working-channel was applied to all the patients. The clinical result was evaluated before surgery, at 3d after surgery and the final follow-up, by Oswestry disability index(ODI), visual analogue scale(VAS) for back pain and leg pain, and Japanese Orthopaedic Association(JOA) score. The decompression and implant were evaluated by anteroposterior and lateral X-ray plain film and lumbar CT at 3d after operation. Bridwell criteria were used to evaluate the fusion rate based on CT images for patients followed up for more than 6 months after surgery. Results: No significant differences were found in age, gender, diagnosis, preoperative intervertebral height, surgical segment, preoperative ODI, VAS and JOA score between the two groups(P＞0.05). 72.2% of the patients in transforaminal group complained unilateral radicular symptom, while 64.3% of the patients in transfacet group suffered from bilateral radicular symptoms(P=0.020). The average operation time was 327.7±89.9min in the transforaminal group, significantly longer than the 385.9±96.7min in the transfacet group(P=0.047), and the mean length of hospital stay in the transforaminal group was 14.8±6.0d, shorter than that of 19.5±7.8d in the transfacet group(P=0.038). 75% of the patients in transfacet group underwent unilateral laminotomy with bilateral spinal canal decompression(ULBD). The ODI scores, back and leg pain VAS scores and JOA score were significantly improved postoperatively and at the final follow-up in both groups(P<0.05), while no statistical differences between groups(P＞0.05). Postoperative intervertebral height significantly increased in both group(P<0.001), but no statistical difference was found between groups(P＞0.05). The complication rate was comparable between two groups, without severe intraoperative or postoperative complication. Among the 21 patients who were followed up for more than 6 months and received CT examinations, 20(95.2%) presented bony fusion at surgical segment, and there was no statistical difference between the two groups in fusion rate. Conclusions: Both the transforaminal approach and the transarticular protrusion approach are safe and effective for the single-level lumbar interbody fusion under single-hole coaxial large channel endoscopy, and the transforaminal approach results in shorter operation time and shorter hospital stay.