Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion and endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases

Abstract

Objective To compare the safety and clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and endoscopic lumbar interbody fusion (Endo-LIF) for lumbar degenerative diseases. Methods A retrospective analysis was conducted on the data of 115 patients diagnosed with lumbar degenerative disease at Ningguo People's Hospital and Hangzhou First People's Hospital from January 2019 to July 2021, including 54 cases in the MIS-TLIF group and 61 cases in the Endo-LIF group. The clinical outcomes were compared before operation, and at 1 week, 1 month, 3 months and 1-year post-operation, including visual analogue scale (VAS), Oswestry disability index scores (ODI) and modified MacNab criteria. Results The surgical time in the Endo-LIF group was longer than that in the MIS-TLIF group ［(155.61±8.50) min vs (128.00±8.40) min］; however, the surgical bleeding volume ［(60.39±5.54) mL vs (129.39±8.59) mL］ and hospital stay ［(3.91±0.74) d vs (4.96±1.57) d］ in the Endo-LIF group were lower than those in the MIS-TLIF group, and the differences were statistically significant (P＜0.05). The VAS score of low back pain and ODI score in the two groups at each time point after operation were significantly lower than those before operation (P＜0.05). At 3 month, 1-year post-operation, the VAS score of the Endo-LIF group was lower than that of the MIS-TLIF group(P＜0.05). The 1-year post-operation MacNab efficacy evaluation showed no statistically significant difference in the excellent and good rates between the MIS-TLIF group and the Endo-LIF group (96.3% vs 96.7%, χ2=0.149, P＞0.05). Conclusion There was no significant difference in mediumshort term surgical outcomes between MIS-TLIF and Endo-LIF. Endo-LIF group has less damage to surrounding tissues, less intraoperative blood loss, and less low-back pain, which is more conducive to the recovery of patients in the long run. However, the indications of Endo-LIF are relatively limited, and the learning curve of Endo-LIF is deep, surgeons need to select indications strictly.

Keywords

• lumbar degenerative diseases
• minimally invasive transforaminal lumbar interbody fusion
• endoscopic lumbar interbody fusion
• oswestry disability index