Application of trephonic one-off plasty technique in uniportal percutaneous endoscopic lumbar interbody fusion via transarticular approach

English Keywords:Trephonic one-off plasty  Percutaneous endoscopic lumbar interbody fusion  Transarticular approach  Lumbar degenerative disease  Surgical efficiency

English Abstract:

  【Abstract】 Objectives: To investigate the safety and efficacy of trephonic one-off plasty(TOP) in percutaneous endoscopic lumbar interbody fusion(PE-LIF) via a transarticular approach. Methods: This prospective randomized controlled trial enrolled patients with single-level lumbar degenerative disease who underwent PE-LIF at our hospital between January 2022 and December 2023. Participants were randomly assigned to either the control group(n=40, 17 males and 23 females, mean age 57.3±12.9 years) received conventional transarticular approach surgery or the observation group(n=39, 12 males and 27 females, mean age 60.7±9.0 years) treated with the TOP technique. Parameters including baseline characteristics, time required to expose Kambin′s triangle, intraoperative fluoroscopy frequency, total operative time, early complications were recorded; Oswestry disability index(ODI) was recorded preoperatively, 3d, 3 months, and 1 year postoperatively. Postoperative outcomes were assessed using the modified Macnab criteria, and fusion rate was assessed with the Sanghvi lumbar fusion evaluation method. Statistical analyses were performed to compare intergroup differences. Results: No significant baseline differences existed between groups(P>0.05). The observation group demonstrated significantly shorter total operative time(135.7±16.3min vs 163.1±23.3min, P<0.001) and Kambin′s triangle exposure time(11.4±5.1min vs 31.5±9.4min, P<0.001) but required more fluoroscopic exposures(10.5±4.4 vs 1.3±1.5, P<0.001). Early complication rates showed no statistical difference(P>0.05). There was no statistical differences between the two groups in ODI at any time point(preoperatively, and 3d, 3 months, and 1 year postoperatively)(P>0.05). No significant differences were observed in excellent and good rates(82.5% vs 89.7%, P>0.05) or fusion rate one year after operation(90.0% vs 94.9%, P＞0.05). Conclusions: The TOP technique safely and effectively enhances the efficiency of transarticular PE-LIF, facilitates spinal decompression, and achieves therapeutic outcomes comparable to conventional methods.