Prospective Cohort Study with a 2-Year Follow-up of Clinical Results, Fusion Rate, and Muscle Bulk for Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion

Abstract

Postoperative evaluation of the cross-sectional area of paraspinal muscle and clinical findings in patients who had interlaminar route uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (EPTLIF) after 2 years. Overview of Literature: There are limited short-term follow-up studies on efficacy, safety, and physiological changes with a 2-year follow-up. There is no study on paraspinal muscle cross-sectional area change in patients who had undergone uniportal EPTLIF. Methods: We evaluated patients who underwent EPTLIF with a minimum 24-month follow-up. Clinical parameters of the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were measured at the preoperative, 1-week postoperative mark, postoperative 3-month mark, and final follow-up. Preoperative and 1-year postoperative magnetic resonance imaging measurement of preoperative and postoperative Kjaer grade, right and left psoas muscle mass area, and right and left paraspinal muscle mass area was performed. Results: EPTLIF with a minimum 24-month follow-up of 35 levels was included. The complication rate was 6%, and the mean Bridwell's fusion grade was 1.37 (1-2). There was statistically significant improvement at 1 week, 3 months, and 2 years in VAS (4.11±1.23, 4.94±1.30, and 5.46±1.29) and in ODI (40.34±10.06, 46.69±9.14, and 49.63±8.68), respectively (p<0.05). Successful operation rate with excellent and good MacNab's criteria at 2 years was 97%. There was an increment of statistically significant bilateral psoas muscle cross-sectional area, right side (70.03±149.1 mm²) and left side (67.59±113.2 mm²) (p<0.05). Conclusions: Uniportal EPTLIF achieved good fusion and improved clinical outcomes with favorable paraspinal musculature bulk at the 2-year follow-up.

A Beginner’s Perspective on Biportal Endoscopic Spine Surgery in Single-Level Lumbar Decompression: A Comparative Study with a Microscopic Surgery

“…Likewise, spinal surgery using an endoscope is likely to have a bigger market in the future; some spine surgeons are already performing fusion surgery using an endoscope. 22 23 24 25 26 27 28 29 30) Spinal surgeons who are not yet trained in endoscopic surgery need to prepare in advance, so they do not fall behind the trend.…”

Treatment Concept and Technical Considerations of Biportal Endoscopic Spine Surgery for Lumbar Spinal Stenosis

“…The best surgical treatment option for lumbar spinal stenosis (LSS) must be decompression [1]. There have been trials, and several techniques have been developed under the name of "sufficient decompression," showing their own benefits and limitations [2][3][4]. In early 1990, subtotal laminectomy with wider decompression showed clinical success rates of 78%-88% in the early postoperative period, which decreased to approximately 70% at 1 year and approximately 50% in 5 years [5,6].…”

Innovative Developments in Lumbar Interbody Cage Materials and Design: A Comprehensive Narrative Review

“…Recent developments in endoscopy-assisted spine fusion surgeries have demonstrated clinical and radiological outcomes comparable to those of conventional open surgery [ 112 – 115 ], emphasizing the need for specialized cage designs suitable for minimal incision techniques. Recently, Kim et al [ 116 ] demonstrated the feasibility of using a larger cage originally designed for LLIF in biportal endoscopic TLIF to achieve a favorable fusion rate ( Fig.…”