Endoscopic transforaminal lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis

Abstract

Background Transforaminal lumbar interbody fusion (TLIF) has been widely accepted as a standard treatment option for the patients with lumbar spondylolisthesis with good clinical outcomes. However, some patients suffered from the back pain postoperatively. With the development of minimally invasive endoscopic methods in spine surgery, the current trend of evolution lumbar spinal surgery has been toward endoscopic procedures.Purpose The purpose of this study was to evaluate the clinical outcomes and efficacy of endoscopic transforaminal lumbar interbody fusion (ELIF) in the treatment of degenerative lumbar spondylolisthesis by compare to the standard transforaminal lumbar interbody fusion (TLIF).Methods A total of 93 patients with lumbar spondylolisthesis who had surgery from February 2016 to January 2018 were categorized into different groups depending on the procedure by ELIF or TLIF. The ELIF and TLIF procedures was performed, and the clinical outcomes of blood loss, operation times, hospital stay days, pain index, ODI score, the spondylolisthesis rate and reduction rate, and the disk height and intervertebral foramen height were recorded.Results In ends 86 cases had follow-up at least one year and seven cases lost, and the follow-up rate and followed time were no difference between two groups (P > 0.05). The operational time was longer in ELIF than TLIF (P < 0.01).The hospital days and blood loss were significant less in endoscopic group than TLIF (P < 0.01). The pain index and ODI score, the spondylolisthesis rate and reduction rate, and the disk height and intervertebral foramen height were better than preoperational (P < 0.01), and there were no difference between two groups (P > 0.05). All patients achieved spinal fusion with no cases of cage extrusion, and no infection, and no dural tear of cerebrospinal fluid leakage complication. There were one case of radiculitis (man) at endoscopic group. CT-myelogram revealed the radiculitis patients had normal radiologic findings, and the patient was recovered by neurotrophy drugs and functional exercises after 3 months. Conclusions Endoscopic lumbar decompression and interbody fusion procedures was an effective and safe measure in the treatment of the lumbar spondylolisthesis. Compare to open interbody fusion techniques, endoscopic lumbar interbody fusion was a minimally invasive surgery with less bold loss discectomy. Eur Spine J 22 (4):727-733.