Innovative Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion of Lumbar Spinal Stenosis with Degenerative Instability: A Non-Randomized Clinical Trial

PURPOSE: Lumbar spinal stenosis (LSS) with instability is most common lumbar degenerative diseases for people with low back pain. The objective of this study was to compared the clinical effects for the treatment of lumbar spinal stenosis (LSS) with degenerative instability between the innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) technique and posterior lumbar interbody fusion (PLIF) technique. PATIENTS AND METHODS: Between April 2019 and April 2020, 114 patients with single-segment LSS were prospectively included in our study (ChiCTR1900022492). Visual Analogue Scale (VAS) on lumbar and leg pain (VAS-LBP, VAS-LP), Oswestry Disability Index (ODI), serum creatine kinase (CK), the maximal cross-sectional area of multifidus muscle (Max-CSA) and the peak intensity of sulphur hexafluoride microbubble contrast agent (PI) around the surgical incision by contrast-enhanced ultrasonography were evaluated preoperatively, post-operatively and at regular follow-up. RESULTS: All patients were followed up. The VAS-LBP, VAS-LP, ODI after operation were improved significantly compared to these data before operation in all the patients (P<0.05). The VAS-LBP at 1 weeks, 3 months after operation in PE-TLIF group were significantly lower than these in PLIF group (P<0.05). The injury degree of multifidus muscle evaluated by MAX-CSA and PI was significantly less in PE-TLIF group after operation (P<0.05). There was no significant difference on the complication rate between these two groups (P>0.05). CONCLUSION: Our results presented PE-TLIF technique could obtain comparable effective outcomes as conventional PLIF for the treatment of LSS with degenerative instability. The patients with PE-TLIF had less muscle injury, less pain and quicker postoperative rehabilitation.