Clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion and modified posterior lumbar interbody fusion in the treatment of lumbar degenerative disease

Abstract

Background: To compare the early clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and modified posterior lumbar interbody fusion (MPLIF) in the treatment of lumbar degenerative disease (LDD). Methods: Retrospective cohort study. Ninety-five patients who were hospitalized in our department for surgical treatment of single-segment LDD from March 2019 to January 2022. They were divided into a PE-PLIF group (37 cases) and an MPLIF group (58 cases) according to the type of surgery. The operation time, intraoperative blood loss, postoperative hospitalization time, and postoperative bedridden time were recorded. The visual analogue scale (VAS) scores of leg pain and low back pain, Japanese orthopaedic association (JOA) scores, and Oswestry disability index (ODI) scores were assessed and compared before operation, 3 days after operation, 1 week after operation, 1 month after operation, 6 months after operation and the last follow-up. The modified MacNab’s criteria were recorded at the last follow-up. The fusion rate and surgical-related complications during follow-up were recorded. Results: There were no statistical difference in preoperative baseline between the two groups. The average operation time in the PE-PLIF group was highly significant longer than that in the MPLIF group (P < 0.01). Intraoperative blood loss, postoperative hospitalization time, and postoperative bedridden time were highly significant less in the PE-PLIF group than those in the MPLIF group (P < 0.01). There were highly significant differences in VAS scores of leg pain, VAS scores of low back pain, JOA scores, ODI scores at the last follow-up compared with those before surgery in the two groups (P < 0.01). At the same follow-up point, there was no statistical difference in the VAS scores of leg pain between the two groups(P＞0.05). 3 days after operation and 1 week after operation, the VAS scores of low back pain and ODI were highly significant less in the PE-PLIF group than that in the MPLIF group (P < 0.01). 3 days after operation, the JOA scores were highly significant higher in the PE-PLIF group than that in the MPLIF group (P < 0.01). At the last follow-up, the excellent rate of modified MacNab was 97.3% in the PE-PLIF group and 98.3% in the MPLIF group, which was no statistical difference (P > 0.05). All patients were obtained fusion at 6 months after operation. Two patients (5.4%) in the PE-PLIF group had complications. Conclusion: Both PE-PLIF and MPLIF surgery have a satisfactory clinical efficacy and safety for patients with LDD. Compared with MPLIF, PE-PLIF has the advantages of less intraoperative blood, faster recovery time, and less tissue damage. PE-PLIF surgery can be used as an alternative treatment for single-segment LDD.