Comparison of clinical efficacies between unilateral biportal endoscopic lumbar interbody fusion and midline lumbar fusion in the treatment of lumbar degenerative diseases

English Keywords:Unilateral biportal endoscopic lumbar interbody fusion  Midline lumbar fusion  Degenerative lumbar diseases

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacies of unilateral biportal endoscopic lumbar interbody fusion(ULIF) and midline lumbar fusion(MIDLF) in the treatment of lumbar degenerative diseases. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent ULIF and MIDLF surgeries for lumbar degenerative diseases in our hospital from January 2020 to January 2022. A total of 42 patients were included, with 20 cases in the ULIF group and 22 cases in the MIDLF group. There were no statistically significant differences in general data such as age, gender, diagnosis, and surgical segments between the two groups(P>0.05). The clinical efficacy was evaluated by recording the visual analogue scale(VAS) scores for low back pain and leg pain, Oswestry disability index(ODI) at preoperation, postoperative 1 week, 3 months, 6 months, and at final follow-up, as well as the surgical time, postoperative drainage volume, length of hospital stay, and incidence of surgical complications in both groups. Lumbar CT examination was performed at 6 months postoperatively to evaluate the interbody fusion status of the two groups of patients according to the Bridwell criteria. Results: The follow-up duration was 12 to 18 months(14.2±2.0 months) in the ULIF group and 12 to 17 months(14.4±1.5 months) in the MIDLF group, with no statistically significant difference(P>0.05). In the ULIF group, the surgical time was 225.68±56.43min, postoperative drainage volume was 92.3±69.7mL, and length of hospital stay was 7.1±2.1d, while in the MIDLF group, the surgical time was 163±31.2min, postoperative drainage volume was 137.5±99.4mL, and length of hospital stay was 12.2±3.3d; the differences between the two groups were statistically significant(P<0.05). The VAS scores for low back pain and leg pain as well as ODI in both groups showed significant improvement at postoperative 1 week, 3 months, 6 months, and final follow-up compared to preoperative values(P<0.05). There were no statistically significant differences in VAS scores for low back pain and leg pain between the two groups at preoperation, postoperative 6 months, and final follow-up(P>0.05), and the ULIF group showed better scores than the MIDLF group at postoperative 1 week and 3 months(P<0.05). There were no statistically significant differences in ODI between the two groups at preoperation, postoperative 1 week, 3 months, 6 months, and final follow-up(P>0.05). At 6 months postoperatively, fusion assessment showed that in the ULIF group, there were 11 cases of grade Ⅰ fusion and 6 cases of grade Ⅱ fusion, while in the MIDLF group, there were 14 cases of grade Ⅰ fusion and 5 cases of grade Ⅱ fusion; the fusion rates did not differ significantly between the two groups(P>0.05). 1 case of dural tear occurred in the ULIF group, while no surgery-related complications occurred in the MIDLF group. Conclusions: Both ULIF and MIDLF procedures can achieve sufficient neural decompression and good interbody fusion, resulting in good clinical outcomes. ULIF has an advantage in early patient recovery.