Comparison of clinical outcomes and imaging parameters between Endo-LIF and PLIF in the treatment of L4-S1 lumbar degenerative diseases

English Keywords:Double-segment lumbar degenerative disease  Endoscopic lumbar interbody fusion  Posterior lumbar interbody fusion  Clinical outcomes  Imaging

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy and imaging parameters of endoscopic lumbar interbody fusion(Endo-LIF) with posterior lumbar interbody fusion(PLIF) in the treatment of L4-S1 double-segment lumbar degenerative disease(LDD). Methods: A retrospective study was performed on patients with L4-S1 LDD treated with Endo-LIF or PLIF between June 2020 and June 2023. 24 patients received Endo-LIF was enrolled in the Endo-LIF group(61.58±8.74 years, follow-up of 30.74±7.62 months); 24 patients treated with PLIF matched in a 1∶1 ratio using propensity score matching(PSM) were included in the PLIF group(62.33±8.95 years, follow-up of 30.70±5.48 months). There was no statistical difference between the two groups in baseline data, such as age, gender, body mass index(BMI), follow-up period, as well as clinical diagnosis(P>0.05). Perioperative indicators(operative time, intraoperative blood loss, hospital stay) were recorded and compared between the two groups; Clinical conditions before operation, at postoperative 3d, 6 months and final follow-up, including low back and leg pain visual analogue scale(VAS) score, Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) score, as well as postoperative 3d and final follow-up imaging parameters, such as lumbar lordosis(LL), segmental lordosis(SL) of operated segment, average disc height(ADH), and sagittal diameter of spinal canal(SD) were compared; The interbody fusion rate at final follow-up and postoperative complications were also compared. Results: Endo-LIF group was less in intraoperative blood loss[90(50, 200)mL vs 200(177.5, 300)mL, P＜0.05], shorter in hospital stay[10(8.25, 12)d vs 12(11, 16.5)d, P＜0.05], but longer in operative time than the PLIF group(259.29±35.10min vs 227.71±36.60min, P＜0.05). Both groups showed significant improvement in the low back pain and leg pain VAS scores, ODI and JOA scores at all postoperative time points compared with baseline(P＜0.05). Endo-LIF group was lower in low back pain VAS score than PLIF group(2.08±0.88 points vs 2.67±0.64 points, P＜0.05) at 6-month follow-up, and also lower in ODI at 6-month and final follow-up(P＜0.05). No significant differences were found in leg pain VAS score and JOA score between the two groups at any postoperative time point(P＞0.05). Both groups showed improved ADH and SD at postoperative 3d and final follow-up compared with baseline(P＜0.05), while there was no significant difference between groups(P＞0.05). In Endo-LIF group, postoperative 3d SL was bigger than baseline and final follow-up（P＜0.05）, while in PLIF group postoperative 3d SL was bigger than baseline(P＜0.05), and SL was smaller in Endo-LIF group at final follow-up(24.65°±6.40° vs 28.03°±3.05°, P＜0.05). The LL wasn′t significantly different in intragroup and intergroup comparisons(P＞0.05). No differences in rates of fusion or complication between groups(P>0.05). Conclusions: Endo-LIF yields comparable clinical benefits to PLIF in the treatment of L4-S1 LDD, whereas its efficacy in restoring SL was inferior to that of PLIF.