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

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.