Comparison of Minimal Invasive Versus Biportal Endoscopic Transforaminal Lumbar Interbody Fusion for Single-level Lumbar Disease

Abstract

Study Design: Retrospective study. Objective: The authors aimed to compare the clinical outcomes of biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) with those of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using a microscope. Summary of Background Data: Lumbar spinal fusion has been widely performed for various lumbar spinal pathologies. Minimally invasive transforaminal interbody fusion using a tubular retractor under a microscope is a method of achieving fusion while reducing soft tissue injury. Recently, several studies have reported minimally invasive techniques for lumbar discectomy, decompression, and interbody fusion using biportal endoscopic spinal surgery. Materials and Methods: This retrospective study included 87 patients who underwent single-level TLIF for degenerative or isthmic spondylolisthesis between 2015 and 2018. Thirty-two and 55 patients underwent BE-TLIF (group A) and MI-TLIF (group B), respectively. Visual Analogue Scale scores of the back and leg and Oswestry Disability Index were collected perioperatively. Further, data regarding perioperative complications, including length of hospital stay, time to ambulation, and fusion rate, were collected. Results: The Visual Analogue Scale score at 2 weeks and 2 months postoperatively was significantly lower in group A ( P =0.001). All other clinical scores showed improvement with no significant difference between the 2 groups ( P >0.05). The difference in the fusion rates between group A (93.7%) and group B (92.7%) were not significant ( P =0.43). Conclusions: Because BE-TLIF yieldeds lesser early postoperative back pain than did MI-TLIF, it may allow early ambulation and a shorter hospitalization period. BE-TLIF may be a viable alternative to MI-TLIF in patients with degenerative or isthmic spondylolisthesis with superior clinical results in the early postoperative period.

Historical aspects of video endoscopic surgery of the lumbar spine

“…Кроме того, чрескожные эндоскопические технологии апробированы при стабилизации позвоночника [73,74], спондилодисцитах, опухолях, хронической эпидуральной гематоме позвоночника [75][76][77], огнестрельных ранениях [78,79]. В 2020 г. опубликованы первые исследования о применении бипортальной техники чрескожной эндоскопической декомпрессии при грыжах и стенозах позвоночного канала поясничного отдела [80,81]. Этот год также ознаменовался внедрением в клиническую практику электромагнитной навигации при выполнении чрескожных эндоскопических операций на поясничном отделе позвоночника [82].…”

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

“…Previous studies have reported promising postoperative outcomes [ 91 - 93 ]. Some reports have shown that endoscopic LIF yielded lesser postoperative pain and shorter hospital stay than MIS-TLIF [ 94 ]. Moreover, despite the benefits of endoscopic LIF, there are inevitable obstacles to overcome and surgeons should reach the learning curve [ 92 , 95 - 97 ].…”

Biportal Endoscopic Lumbar Interbody Fusion: Review of Current Evidence and the Literature

“…While conventional posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) techniques have shown good clinical and radiological outcomes for lumbar degenerative disease, they have also been associated with paraspinal muscle injury from subperiosteal dissections and retraction, which can lead to increased postoperative back pain and muscle atrophy 2,9,18,19) . Threfore, recent techniques for endoscopic lumbar interbody fusion (ELIF) have been developed, which are associated with minimal muscle injury to posterior musculo-ligamentous structures, good clinical outcomes, and satisfactory fusion rates 1,[4][5][6]8,[10][11][12]16,17,[21][22][23] . There are several studies on uniportal ELIF 8,12,17,[21][22][23] , and biportal ELIF has been published by several investigators [4][5][6]10,11,16) .…”

“…Unlike uniportal ELIF, independent movement of the endoscope and surgical instruments is possible, and the working portal is used only for surgical instruments not though the working cannula. As a result, biportal ELIF can achieve direct ipsilateral and contralateral decompression similar to MIS TLIF with fewer limitations of motion and vision [4][5][6]10,11,16) . Moreover, biportal ELIF has advantages in terms of minimal invasiveness 5,11,16) .…”

“…Since its introduction, several studies report that biportal ELIF show various kinds of advantages such as favorable clinical outcomes, less postoperative back pain, and a shorter hospital stays compared to open PLIF/MIS TLIF 5,6,11,16) . The objective of this review was to evaluate previously published articles and summarize the current evidence on biportal ELIF regarding its indications, surgical technique, complications and comparative results with open PLIF/MIS TLIF.…”