Comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive tubular transforaminal lumbar interbody fusion for lumbar degenerative disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

KONG Fanguo , ZHOU Quan , QIAO Yang , WANG Wenju , ZHANG Changsheng , PAN Qipeng ,  ZHU Huimin

Department of Mininlally Invasive Spine Surgery, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Zhengzhou Henan, 450016, P. R. China;

Corresponding author：

ZHU Huimin, Email: wjzhuhm@126.com

Keywords：

Unilateral biportal endoscopy; transforaminal lumbar interbody fusion; lumbar degenerative disease

DOI：

10.7507/1002-1892.202201005

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Objective To compare the clinical and radiological outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and minimally invasive tubular TLIF (MT-TLIF) in treatment of lumbar degenerative diseases. Methods A clinical data of 75 patients with lumbar degenerative diseases, who met the selection criteria between August 2019 and August 2020, was retrospectively analyzed, including 35 patients in the UBE- TLIF group and 40 patients in the MT-TLIF group. There was no significant difference in general data such as gender, age, body mass index, disease type and duration, and surgical segment between the two groups (P>0.05), which was comparable. The operation time, intraoperative blood loss, hemoglobin (Hb) before operation and at 1 day after operation, the length of hospital stay, incidence of complications, and visual analogue scale (VAS) score of low back and leg pain, Oswestry Disability Index (ODI), Short-Form 36 Health Survey Scale (SF-36 scale), intervertebral disc height (IDH), sagittal Cobb angle, lumbar lordosis (LL), and the intervertebral fusion were compared between the two groups. Results Compared with MT-TLIF group, UBE-TLIF group had significantly longer operation time but less intraoperative blood loss and shorter length of hospital stay (P<0.05). The Hb levels in both groups decreased at 1 day after operation, but there was no significant difference in the difference before and after operation between the two groups (P>0.05). All patients were followed up, and the follow-up time was (14.7±2.5) months in the UBE-TLIF group and (15.0±3.4) months in the MT-TLIF group, with no significant difference (t=0.406, P=0.686). In both groups, the VAS score of low back pain, VAS score of leg pain, SF-36 scale, and ODI after operation significantly improved when compared with those before operation (P<0.05). There was no significant difference between 1 month after operation and last follow-up (P>0.05). There was no significant difference in the VAS score of low back pain, VAS score of leg pain, and SF-36 scale between the two groups before and after operation (P>0.05). At 1 month after operation, the ODI in the UBE-TLIF group was significantly better than that in the MT-TLIF group (P<0.05). At 1 month after operation, IDH, Cobb angle, and LL in both groups recovered when compared with those before operation (P<0.05), and were maintained until last follow-up (P>0.05). There was no significant difference in the IDH, Cobb angle, and LL between the two groups at each time point (P>0.05). Thirty-three cases (89.2%) in the UBE-TLIF group and 35 cases (87.5%) in the MT-TLIF group achieved fusion, and the difference was not significant (χ²=0.015, P=0.901). In the UBE-TLIF group, 1 case of intraoperative dural tear and 1 case of postoperative epidural hematoma occurred, with an incidence of 5.7%. In the MT-TLIF group, 1 case of intraoperative dural tear, 1 case of postoperative epidural hematoma, and 1 case of superficial infection of the surgical incision occurred, with an incidence of 7.5%. There was no significant difference in the incidence of complications between the two groups (χ²=1.234, P=1.000). Conclusion Compared with MT-TLIF, UBE-TILF can achieve similar interbody fusion in the treatment of lumbar degenerative diseases, and has the advantages of smaller incision, less bleeding, and shorter length of hospital stay.

Citation： KONG Fanguo, ZHOU Quan, QIAO Yang, WANG Wenju, ZHANG Changsheng, PAN Qipeng, ZHU Huimin. Comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive tubular transforaminal lumbar interbody fusion for lumbar degenerative disease. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(5): 592-599. doi: 10.7507/1002-1892.202201005 Copy

1.	Cho JH, Lee JH, Song KS, et al. Treatment outcomes for patients with failed back surgery. Pain Physician, 2017, 20(1): E29-E43.
2.	Hu ZJ, Fang XQ, Zhou ZJ, et al. Effect and possible mechanism of muscle-splitting approach on multifidus muscle injury and atrophy after posterior lumbar spine surgery. J Bone Joint Surg (Am), 2013, 95(24): 192. doi: 10.2106/JBJS.L.01607.
3.	De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
4.	Kim N, Jung SB. Percutaneous unilateral biportal endoscopic spine surgery using a 30-degree arthroscope in patients with severe lumbar spinal stenosis: A technical note. Clin Spine Surg, 2019, 32(8): 324-329.
5.	Dupuis PR, Yong-Hing K, Cassidy JD, et al. Radiologic diagnosis of degenerative lumbar spinal instability. Spine, 1985, 10(3): 262-276.
6.	Heo DH, Hong YH, Lee DC, et al. Technique of biportal endoscopic transforaminal lumbar interbody fusion. Neurospine, 2020, 17(Suppl 1): S129-S137.
7.	Palmer S, Turner R, Palmer R. Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg, 2002, 97(2 Suppl): 213-217.
8.	Putzier M, Hartwig T, Hoff EK, et al. Minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF-a prospective randomized clinical trial. Spine J, 2016, 16(7): 811-819.
9.	Price JP, Dawson JM, Schwender JD, et al. Clinical and radiologic comparison of minimally invasive surgery with traditional open transforaminal lumbar interbody fusion: A review of 452 patients from a single center. Clin Spine Surg, 2018, 31(2): E121-E126.
10.	Wanderman NR, Francois EL, Nassr A, et al. Is minimally invasive transforaminal interbody fusion superior to traditional open technique? Clin Spine Surg, 2018, 31(4): 139-142.
11.	Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
12.	Kang MS, You KH, Choi JY, et al. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine, 2021, 21(12): 2066-2077.
13.	Heo DH, Park CK. Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery. Neurosurg Focus, 2019, 46(4): E18. doi: 10.3171/2019.1.FOCUS18695.
14.	Kim JE, Yoo HS, Choi DJ, et al. Learning curve and clinical outcome of biportal endoscopic-assisted lumbar interbody fusion. Biomed Res Int, 2020, 2020: 8815432. doi: 10.1155/2020/8815432.
15.	Park MK, Park SA, Son SK, et al. Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up. Neurosurg Rev, 2019, 42(3): 753-761.
16.	Park SM, Kim HJ, Kim GU, et al. Learning curve for lumbar decompressive laminectomy in biportal endoscopic spinal surgery using the cumulative summation test for learning curve. World Neurosurg, 2019, 122: e1007-e1013.

1. Cho JH, Lee JH, Song KS, et al. Treatment outcomes for patients with failed back surgery. Pain Physician, 2017, 20(1): E29-E43.
2. Hu ZJ, Fang XQ, Zhou ZJ, et al. Effect and possible mechanism of muscle-splitting approach on multifidus muscle injury and atrophy after posterior lumbar spine surgery. J Bone Joint Surg (Am), 2013, 95(24): 192. doi: 10.2106/JBJS.L.01607.
3. De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
4. Kim N, Jung SB. Percutaneous unilateral biportal endoscopic spine surgery using a 30-degree arthroscope in patients with severe lumbar spinal stenosis: A technical note. Clin Spine Surg, 2019, 32(8): 324-329.
5. Dupuis PR, Yong-Hing K, Cassidy JD, et al. Radiologic diagnosis of degenerative lumbar spinal instability. Spine, 1985, 10(3): 262-276.
6. Heo DH, Hong YH, Lee DC, et al. Technique of biportal endoscopic transforaminal lumbar interbody fusion. Neurospine, 2020, 17(Suppl 1): S129-S137.
7. Palmer S, Turner R, Palmer R. Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg, 2002, 97(2 Suppl): 213-217.
8. Putzier M, Hartwig T, Hoff EK, et al. Minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF-a prospective randomized clinical trial. Spine J, 2016, 16(7): 811-819.
9. Price JP, Dawson JM, Schwender JD, et al. Clinical and radiologic comparison of minimally invasive surgery with traditional open transforaminal lumbar interbody fusion: A review of 452 patients from a single center. Clin Spine Surg, 2018, 31(2): E121-E126.
10. Wanderman NR, Francois EL, Nassr A, et al. Is minimally invasive transforaminal interbody fusion superior to traditional open technique? Clin Spine Surg, 2018, 31(4): 139-142.
11. Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
12. Kang MS, You KH, Choi JY, et al. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine, 2021, 21(12): 2066-2077.
13. Heo DH, Park CK. Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery. Neurosurg Focus, 2019, 46(4): E18. doi: 10.3171/2019.1.FOCUS18695.
14. Kim JE, Yoo HS, Choi DJ, et al. Learning curve and clinical outcome of biportal endoscopic-assisted lumbar interbody fusion. Biomed Res Int, 2020, 2020: 8815432. doi: 10.1155/2020/8815432.
15. Park MK, Park SA, Son SK, et al. Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up. Neurosurg Rev, 2019, 42(3): 753-761.
16. Park SM, Kim HJ, Kim GU, et al. Learning curve for lumbar decompressive laminectomy in biportal endoscopic spinal surgery using the cumulative summation test for learning curve. World Neurosurg, 2019, 122: e1007-e1013.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive tubular transforaminal lumbar interbody fusion for lumbar degenerative disease

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