Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FAN Zuoran , WU Xiaolin , GUO Zhu , ZHOU Chuanli ,  CHEN Bohua ,  XIANG Hongfei

Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266003, P. R. China;

Corresponding author：

CHEN Bohua, Email: bhchen@hotmail.com; XIANG Hongfei, Email: xianghf@qdu.edu.cn

Keywords：

Lumbar spinal stenosis; lumbar disc herniation; lumbar interbody fusion; unilateral biportal endoscopy technique; endoscopic transforaminal lumbar interbody fusion

DOI：

10.7507/1002-1892.202303095

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. Methods A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Results Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences (P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups (P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05). And there was no significant difference between the two groups at each time point after operation (P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months (P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group (P<0.05). Conclusion For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.

Citation： FAN Zuoran, WU Xiaolin, GUO Zhu, ZHOU Chuanli, CHEN Bohua, XIANG Hongfei. Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1098-1105. doi: 10.7507/1002-1892.202303095 Copy

1.	Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol, 2010, 24(2): 253-265.
2.	Xie YZ, Shi Y, Zhou Q, et al. Comparison of the safety and efficacy of unilateral biportal endoscopic lumbar interbody fusion and uniportal endoscopic lumbar interbody fusion: a 1-year follow-up. J Orthop Surg Res, 2022, 17(1): 360.
3.	Hara M, Takahashi H, Yokoyama Y, et al. Comparison of the invasiveness of conventional discectomy and microendoscopic discectomy for lumbar disc herniation: Differences in the methods of approach. Asian J Endosc Surg, 2015, 8(1): 40-47.
4.	Rasouli MR, Rahimi-Movaghar V, Shokraneh F, et al. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev, 2014, (9): CD010328.
5.	Goldstein CL, Macwan K, Sundararajan K, et al. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review. J Neurosurg Spine, 2016, 24(3): 416-427.
6.	Pan M, Li Q, Li S, et al. Percutaneous endoscopic lumbar discectomy: Indications and complications. Pain Physician, 2020, 23(1): 49-56.
7.	Lv Z, Jin L, Wang K, et al. Comparison of effects of peld and fenestration in the treatment of geriatric lumbar lateral recess stenosis. Clin Interv Aging, 2019, 14: 2187-2194.
8.	Zhao Y, Fan Y, Yang L, et al. Percutaneous endoscopic lumbar discectomy (PELD) via a transforaminal and interlaminar combined approach for very highly migrated lumbar disc herniation (LDH) between L4/5 and L5/S1 level. Med Sci Monit, 2020, 26: e922777.
9.	朱斌, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 2020, 40(15): 1030-1038.
10.	Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8.
11.	Heo DH, Quillo-Olvera J, Park CK. Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg, 2018, 120: e684-e689.
12.	Kim SK, Kang SS, Hong YH, et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res, 2018, 13(1): 22.
13.	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.
14.	黄豪杰, 庞祖才, 冯学烽, 等. 椎间混合植骨对微创腰椎融合术后椎间融合率的影响. 中国实用医药, 2021, 16(19): 8-11.
15.	Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician, 2015, 18(1): 61-70.
16.	Alimi M, Hofstetter CP, Pyo SY, et al. Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates. J Neurosurg Spine, 2015, 22(4): 339-352.
17.	Storzer B, Schnake KJ. Microscopic bilateral decompression by unilateral approach in spinal stenosis. Eur Spine J, 2016, 25 Suppl 2: 270-271.
18.	Heo DH, Sharma S, Park CK. Endoscopic treatment of extraforaminal entrapment of l5 nerve root (far out syndrome) by unilateral biportal endoscopic approach: technical report and preliminary clinical results. Neurospine, 2019, 16(1): 130-137.
19.	Park JH, Jun SG, Jung JT, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy. Orthopedics, 2017, 40(5): e779-e783.
20.	Hwa Eum J, Hwa Heo D, Son SK, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
21.	Heo DH, Park CK. Percutaneous biportal endoscopic decompression for lumbar central stenosis and foraminal stenosis//Kim JS, Lee JH, Ahn Y. Endoscopic procedures on the spine. Singapore: Springer, 2020: 261-274.
22.	江潮, 黄永辉, 左华, 等. 单侧双通道内镜下腰椎融合术与微创经椎间孔腰椎融合术治疗单节段腰椎管狭窄伴不稳症的早期临床疗效. 中国医学科学院学报, 2022, 44(4): 563-569.
23.	唐强, 钟德君, 王清, 等. 椎间自体骨植骨面积比与椎间融合率的关系. 中国组织工程研究, 2021, 25(36): 5821-5826.
24.	Abudurexiti T, Qi L, Muheremu A, et al. Micro-endoscopic discectomy versus percutaneous endoscopic surgery for lumbar disk herniation. J Int Med Res, 2018, 46(9): 3910-3917.

1. Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol, 2010, 24(2): 253-265.
2. Xie YZ, Shi Y, Zhou Q, et al. Comparison of the safety and efficacy of unilateral biportal endoscopic lumbar interbody fusion and uniportal endoscopic lumbar interbody fusion: a 1-year follow-up. J Orthop Surg Res, 2022, 17(1): 360.
3. Hara M, Takahashi H, Yokoyama Y, et al. Comparison of the invasiveness of conventional discectomy and microendoscopic discectomy for lumbar disc herniation: Differences in the methods of approach. Asian J Endosc Surg, 2015, 8(1): 40-47.
4. Rasouli MR, Rahimi-Movaghar V, Shokraneh F, et al. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev, 2014, (9): CD010328.
5. Goldstein CL, Macwan K, Sundararajan K, et al. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review. J Neurosurg Spine, 2016, 24(3): 416-427.
6. Pan M, Li Q, Li S, et al. Percutaneous endoscopic lumbar discectomy: Indications and complications. Pain Physician, 2020, 23(1): 49-56.
7. Lv Z, Jin L, Wang K, et al. Comparison of effects of peld and fenestration in the treatment of geriatric lumbar lateral recess stenosis. Clin Interv Aging, 2019, 14: 2187-2194.
8. Zhao Y, Fan Y, Yang L, et al. Percutaneous endoscopic lumbar discectomy (PELD) via a transforaminal and interlaminar combined approach for very highly migrated lumbar disc herniation (LDH) between L4/5 and L5/S1 level. Med Sci Monit, 2020, 26: e922777.
9. 朱斌, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 2020, 40(15): 1030-1038.
10. Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8.
11. Heo DH, Quillo-Olvera J, Park CK. Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg, 2018, 120: e684-e689.
12. Kim SK, Kang SS, Hong YH, et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res, 2018, 13(1): 22.
13. 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.
14. 黄豪杰, 庞祖才, 冯学烽, 等. 椎间混合植骨对微创腰椎融合术后椎间融合率的影响. 中国实用医药, 2021, 16(19): 8-11.
15. Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician, 2015, 18(1): 61-70.
16. Alimi M, Hofstetter CP, Pyo SY, et al. Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates. J Neurosurg Spine, 2015, 22(4): 339-352.
17. Storzer B, Schnake KJ. Microscopic bilateral decompression by unilateral approach in spinal stenosis. Eur Spine J, 2016, 25 Suppl 2: 270-271.
18. Heo DH, Sharma S, Park CK. Endoscopic treatment of extraforaminal entrapment of l5 nerve root (far out syndrome) by unilateral biportal endoscopic approach: technical report and preliminary clinical results. Neurospine, 2019, 16(1): 130-137.
19. Park JH, Jun SG, Jung JT, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy. Orthopedics, 2017, 40(5): e779-e783.
20. Hwa Eum J, Hwa Heo D, Son SK, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
21. Heo DH, Park CK. Percutaneous biportal endoscopic decompression for lumbar central stenosis and foraminal stenosis//Kim JS, Lee JH, Ahn Y. Endoscopic procedures on the spine. Singapore: Springer, 2020: 261-274.
22. 江潮, 黄永辉, 左华, 等. 单侧双通道内镜下腰椎融合术与微创经椎间孔腰椎融合术治疗单节段腰椎管狭窄伴不稳症的早期临床疗效. 中国医学科学院学报, 2022, 44(4): 563-569.
23. 唐强, 钟德君, 王清, 等. 椎间自体骨植骨面积比与椎间融合率的关系. 中国组织工程研究, 2021, 25(36): 5821-5826.
24. Abudurexiti T, Qi L, Muheremu A, et al. Micro-endoscopic discectomy versus percutaneous endoscopic surgery for lumbar disk herniation. J Int Med Res, 2018, 46(9): 3910-3917.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content