Comparison of clinical efficacies between unilateral biportal endoscopic lumbar interbody fusion and mini-open transforaminal lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease

English Keywords:Lumbar degenerative disease  Unilateral double-channel endoscopic lumbar interbody fusion  Mini-open transforaminal lumbar interbody fusion  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To compare the early clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion(UBE-LIF) with mini-open transforaminal lumbar interbody fusion(m-TLIF) in the treatment of single-level lumbar degenerative disease(LDD). Methods: A retrospective analysis was performed on 60 patients with single-level LDD treated in the Department of Orthopedics at our hospital between October 2019 and October 2023. There were 33 males and 27 females, aged 55-71 years(65.0±4.5 years). The patients were divided into the UBE-LIF group(n=30, operative segment: L3/4 2 cases, L4/5 22 cases, L5/S1 6 cases) and m-TLIF group(n=30, operative segment: L3/4 4 cases, L4/5 16 cases, L5/S1 10 cases) according to the surgical approach. There were no significant differences between the two groups in terms of gender, age, preoperative diagnosis, or operative segment(P>0.05). The two groups were statistically compared in terms of operative time, intraoperative blood loss, total incision length, drainage volume on the second postoperative day, postoperative ambulation time, and hospital stay. Lumbar lordosis angle(LLA), intervertebral disc heigh(IDH) were compared before operation, at 3 months, 6 months after operation, and final follow-up, and fusion rate was also compared at 6 months after operation and final follow-up. Visual analogue scale(VAS) score for low back and leg pain and Oswestry disability index(ODI) were compared before operation, at 1d, 3 months and 6 months after operation, and final follow-up. Intraoperative and follow-up complications were also compared, and at postoperative 3 months and 6 months, and final follow-up excellent and good rates were evaluated according to the modified MacNab criteria. Results: All the patients underwent successful surgery, with a follow-up period of 12 to 14 months(12.5±0.7 months). UBE-LIF group was longer in operative time than the m-TLIF group(190.9±69.0min vs 151.4±32.1min, P<0.05), but the intraoperative blood loss(87.9±43.2mL vs 126.5±74.1mL), total incision length(6.1±0.2cm vs 8.5±1.3cm), drainage volume on the second postoperative day(20.8±8.4mL vs 74.7±48.7mL), postoperative ambulation time(2.1±1.2d vs 2.8±1.3d), and hospital stay(5.4±0.9d vs 7.4±1.1d) were significantly less than those in the m-TLIF group(P<0.05). Postoperative LLA and IDH outcomes were significantly better in both groups at 3 months, 6 months, and final follow-up compared with preoperative conditions(P<0.05), but no significant differences were observed between the two groups(P>0.05). At final follow-up, the two groups of patients achieved bony fusion, with a fusion rate of 100%. VAS scores for low back and leg pain and ODI were lower in both groups at 3 months, 6 months, and final follow-up compared with preoperative values. In the early postoperative period (1d and 3 months), the VAS scores of low back and leg pain in the UBE-LIF group were lower than those in the m-TLIF group(P<0.05). There were no significant differences between the two groups at other follow-up time points(P>0.05). At final follow-up, the modified MacNab criteria-based excellent and good rates were 90.00%(27/30) in the UBE-LIF group and 86.67%(26/30) in the m-TLIF group, with no statistically significant difference between the two groups(P>0.05). One dural tear occurred intraoperatively in the m-TLIF group, and the patient underwent dural repair and had good follow-up. No complications, including epidural hematoma, wound infection, or hardware loosening or breakage, occurred in either group. There was no statistically significant difference in the incidence of complications between the two groups during either intraoperative or postoperative follow-up(P>0.05). Conclusions: Both UBE-LIF and m-TLIF achieved satisfactory results in the treatment of single-segment LDD. Compared with m-TLIF, UBE-LIF offers advantages such as small trauma, significant early relief of low back and leg pain, and rapid functional recovery.