Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in 1-Segment Lumbar Spondylolisthesis: A Prospective Randomised Pilot Study

Abstract

BackgroundThere are currently several minimally invasive techniques for lumbar spine interbody fusion that have been shown to minimize surgical and perioperative morbidity. We aimed to evaluate the curative efficacy of endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) by comparing perioperative characteristics and 1.5-year observational outcomes in 1-segment lumbar spondylolisthesis between the minimally invasive TLIF (MIS-TLIF) technique and the optimized Endo-TLIF technique. MethodsOne hundred and two patients treated by MIS-TLIF (48 cases) or Endo-TLIF (54 cases) were included from January 2017 to January 2019. Perioperative parameters and clinical outcomes were evaluated. Inflammatory biomarkers were measured for postoperative traumatic stress and muscle injury. Fusion rates were determined at 18 months after surgery by CT and the necessity of recombinant human bone morphogenetic protein-2 (rhBMP-2) application in Endo-TLIF was also observed. ResultsThe Endo-TLIF group had similar incision length, return to work time and rate (p>0.05). Blood loss, left bed time and analgesic ratio were significantly less in Endo-TLIF group (p<0.05). The Endo-TLIF group had a significantly longer operative and radiation exposure time compared with MIS-TLIF group (p<0.05). The CRP and ESR levels were lower in the Endo-TLIF group compared with the MIS-TLIF group (p<0.05). The VAS and ODI improved significantly in both groups after surgery. Significant decreases in low back VAS in the Endo-TLIF group were found at postoperative day 1 and 3 months after surgery (p<0.05). The fusion rate in the Endo-TLIF/rhBMP-2 group (75%) was lower than that in the MIS-TLIF group (95.8%)，but it was similar to that in the Endo-TLIF/rhBMP-2 group (90%).ConclusionsEndo-TLIF has comparable perioperative analysis and clinical outcomes in comparison to MIS-TLIF and manifests a greater improvement in less multifidus muscle damage, inflammation and faster patient recovery. Thus, Endo-TLIF should be considered as a feasible and effective technique for 1-segment lumbar spondylolisthesis patients.Trial registration: ChiCTR1800015197, 13 March 2018. Trial registry: Chinese Clinical Trial Registry.

Comparison of Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases

“…Preoperative and postoperative ODI were analyzed in 7 studies, 4,21–24,26,27 2 of them 21,23 did not provide the SD. The result revealed the Endo-TLIF group was associated with lower preoperative ODI [WMD=−2.14(−3.83, −0.46), P =0.01; heterogeneity: P =0.92, I 2 =0%, fixed-effect model]compared with the MIS-TLIF group.…”

“…Seven studies 4,22–27 compared the operation time between the 2 groups. The pooled result revealed there was significant longer in the Endo-TLIF group [WMD=26.74 (2.14, 51.34), P =0.03; heterogeneity: P <0.00001, I 2 =98%, random-effect model] (Fig.…”

“…The remaining 116 reports underwent a detailed and comprehensive evaluation. Finally, 8 studies 4,[21][22][23][24][25][26][27] were included in this meta-analysis. The literature search procedure is shown in Figure 1.…”

“…Postoperative low-back pain has a close connection with muscle degeneration and atrophy, which emphasized the significance of minimizing muscle injury in every surgical procedure 5 . In contrast, Endo-TLIF uses a smaller incision with less muscle injury, preserving the paraspinal muscles and most of the anatomic structure of the lumbar vertebrae, 25 which can undoubtedly reduce postoperative pain, promote patients recovery, shorten hospital stay and return to daily life and work as quickly as possible 27 . In the present study, the length of hospital stay was significantly longer in the MIS-TLIF group than the Endo-TLIF group, indicating that the Endo-TLIF was associated with less surgical trauma.…”

“…In addition, most of the time was spent on endplate preparation, which was still a time-consuming process with conventional instruments 4 . More effective maneuverable instruments, optical systems, and artificial materials should be innovate for this technology to reduce the operation time and radiation exposure, which are closely related to health for the patients and the surgical teams 2,27 …”