Unilateral Biportal Endoscopic Lumbar Interbody Fusion. Technical Note and Surgical Comparison with Conventional MIS TLIF.

Abstract

Backgrounds : Minimally invasive surgery develops very extensively in past few decades, not only in the scope of decompression but until fusion surgery. Surgeon has been trying to reduce the damage to the normal anatomical structure. In this study we performed unilateral biportal endoscopic lumbar interbody fusion (ULIF) as one of the fusion option which is readily available without sophisticated minimal invasive instrument. The purpose of this study is to introduce unilateral biportal endoscopic surgery and comparing the result with conventional minimal invasive lumbar interbody fusion (MIS-TLIF) Methods : This is a retrospective cohort study of 145 lumbar spondylolisthesis patient underwent conventional MIS-TLIF or ULIF procedure. All patient were followed up until 12 months to evaluate the VAS of back pain and leg pain, ODI, SF-36 and fusion rate. Results : Back pain VAS were a little higher compared with the endoscopic group, but the VAS of leg pain were the same. Both group had improvement in ODI score and SF-36 which shows both of the procedure were quite effective in managing such cases. Conclusion : Full endoscopic fusion offer benefit of minimal invasive surgery with better visualization of decompression and endplate preparation. Long term follow up is still needed to evaluate the result of the procedure.

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.…”

“…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.…”

“…Endoscopic technique may have the potential advantage of better visualization at this stage. With the assistance of the endoscopic technique, operators could view directly inside the intervertebral space with a wider contralateral exposure, which provides more effectively intervertebral space clearance and increases the area of bone graft fusion 21 . Lim et al 4 found that there was higher bone graft area ratio in the endoscopic TLIF, when compared with Mini-open TLIF.…”

“…There were 687 patients included in this study, 335 of them in the Endo-TLIF group and 352 in the MIS-TLIF group. Five studies 4,22,[25][26][27] used percutaneous endoscopic approach, the other 3 reports 21,23,24 used biportal endoscopic approach in the Endo-TLIF group. These reports were published between 2020 and 2021.…”

“…There was 1 RCT, 27 1 prospective study, 22 and 6 retrospective studies 4,21,[23][24][25][26] included in this study. The methodological quality of the RCT was assessed using Cochrane review criteria, and the result is shown in Figure 2.…”