Comparison of the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF) with Quadrant channel transforaminal lumbar interbody fusion(Quadrant-TLIF) in the treatment of single-segment lumbar spondylolisthesis

English Keywords:Lumbar spondylolisthesis  Unilateral biportal endoscopy  Quadrant channel  Transforaminal lumbar interbody fusion

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy of transforaminal lumbar interbody fusion(TLIF) under unilateral biportal endoscopy(UBE) with TLIF under Quadrant channel in the treatment of single-segment grade I-II lumbar spondylolisthesis. Methods: A retrospective analysis was conducted on 87 patients with single-segment grade I-II lumbar spondylolisthesis treated between January 2019 and June 2024. Among them, 47 patients underwent UBE-TLIF(UBE-TLIF group), and 40 patients underwent Quadrant channel minimally invasive TLIF(Quadrant-TLIF group). No statistically significant differences were observed in baseline data between the two groups, including gender, age, body mass index, disease duration, and follow-up duration(P>0.05). Operative time, follow-up duration, intraoperative blood loss, postoperative drainage volume, intraoperative fluoroscopy frequency, time to ambulation, postoperative hospital stay, and intraoperative and postoperative complications were recorded. Visual analog scale(VAS) scores for low back pain and leg pain, and Oswestry disability index(ODI) were assessed preoperatively and at 1 week, 3 months postoperatively, and at the final follow-up. Intervertebral height(IH), Cobb angle, and lumbar lordosis(LL) were measured on X-ray films preoperatively and at the final follow-up. At the final follow-up, interbody fusion grade was evaluated using the Bridwell criteria, and clinical outcomes were assessed using the modified MacNab criteria. Results: All surgeries were successfully completed without conversion to open surgery. The UBE-TLIF group had a significantly longer operative time(212.8±21.4min) compared with the Quadrant-TLIF group(168.6±17.5min) (P<0.05), but demonstrated significantly less intraoperative blood loss, less postoperative drainage volume, shorter time to ambulation, and shorter postoperative hospital stay(P<0.05). In the UBE-TLIF group, one case of dural tear occurred intraoperatively, which was repaired with sutures and dural patch coverage; Postoperative cerebrospinal fluid leakage was resolved after fluid resuscitation and Trendelenburg positioning. One case of spinal hematoma occurred without radicular leg pain, which was resolved after administration of conservative treatment. Postoperative imaging revealed three S1 pedicle screws breaching the medial pedicle wall without neurological symptoms, requiring no special intervention. In the Quadrant-TLIF group, one patient developed great toe dorsiflexion weakness, which was recovered after three months of oral mecobalamin; One patient experienced burning pain in the L5 nerve root distribution, which was resolved after nerve root block. Postoperative imaging revealed two S1 screws breaching the medial pedicle wall without neurological symptoms, requiring no special intervention. No wound infections or other complications occurred in either group. All patients were followed up, with a mean follow-up of 15.7±2.5 months in the UBE-TLIF group and 15.6±2.9 months in the Quadrant-TLIF group, showing no statistically significant difference(P>0.05). Both groups showed significant improvements in IH, Cobb angle, and LL at the final follow-up compared with preoperative values(P<0.05), with no statistically significant differences between the two groups at any corresponding time point(P>0.05). VAS scores for low back pain and leg pain, as well as ODI, significantly improved in both groups at 1 week, 3 months, and the final follow-up compared with preoperative values(P<0.05). At 1 week postoperatively, the UBE-TLIF group had significantly lower low back pain VAS scores than the Quadrant-TLIF group(P<0.05); However, no significant differences were found between the two groups in low back pain VAS at other time points, or in leg pain VAS and ODI at any time point(P>0.05). At the final follow-up, in the UBE-TLIF group the fusion conditions according to Bridwell criteria were 36 of grade Ⅰ, 5 of grade Ⅱ, and 6 of grade Ⅲ, with a fusion rate of 87.23%; In the Quadrant-TLIF group, the fusion conditions were 30 of grade Ⅰ, 6 of grade Ⅱ, and 4 of grade Ⅲ, with a fusion rate of 90.0%. No statistically significant difference was found in fusion rates between the two groups(P>0.05). According to the modified MacNab criteria, the UBE-TLIF group achieved excellent results in 36 cases, good in 6, fair in 5, and poor in 0, with an excellent-to-good rate of 89.4%; The Quadrant-TLIF group achieved excellent in 31, good in 6, fair in 3, and poor in 0, with an excellent-to-good rate of 92.5%. No statistically significant difference was observed in the excellent-to-good rates between the two groups(P>0.05). Conclusions: Both UBE-TLIF and Quadrant-TLIF are minimally invasive procedures for treating grade Ⅰ-Ⅱ lumbar spondylolisthesis, which can effectively improve the degree of spondylolisthesis and lumbar sagittal balance. UBE-TLIF offers advantages of less intraoperative bleeding, shorter hospital stay, and faster early postoperative low back pain relief.