Clinical comparison of unilateral biportal endoscopic lumbar fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis：A retrospective study with 24-Month Follow-Up

Abstract

Abstract Objcetive: To explore the safety the mid-term efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion ( UBE-TLIF ) and 3D microscope-assisted transforaminal lumbar interbody fusion ( MMIS-TLIF ) in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis ( DLS-LSS ).。Methods The clinical data of 49 patients who underwent UBE-TLIF or MMIS-TLIF in our hospital from September 2019 to March 2021 were retrospectively analyzed. Among them, 26 patients underwent UBE-TLIF and 23 patients underwent MMIS-TLIF. The demographic and perioperative outcomes of patients before and after surgery were reviewed. Visual analogue scale ( VAS ) and Oswestry disability index ( ODI ) were used to evaluate the clinical outcomes of patients before operation and at 1 month, 3 months, 6 months, 12 months and 24 months after operation. The lumbar lordosis angle ( LL ), disc height ( DH ) and lumbar intervertebral fusion rate were assessed before operation and at the last follow-up.Results The VAS and ODI of the two groups were improved compared with those before operation. The ODI of UBE-TLIF was lower than that of MMIS-TLIF at 1 month, 3 months, 6 months and 12 months after operation, and there was no significant difference between the two groups at other time points ( P > 0.05 ). There was no significant difference in VAS between the two groups at each time point ( P > 0.05 ). However, UBE-TLIF had more advantages in blood loss and hospital stay. The complications between the UBE-TLIF (11.54%) and the MMIS-TLIF (17.39%) were minor ( P > 0.05 ). Radiographic outcomes showed that the LL and DH of the two groups were improved compared with those before operation, and the difference before and after operation was not significant ( P > 0.05 ). The fusion rate was 96.2% in the UBE-TLIF group and 95.7% in the MMIS-TLIF group. There was no significant difference in the fusion rate between the two groups ( P > 0.05 ).Conclusions Both UBE-TLIF and MMIS-TLIF have favorable outcomes in the treatment of single-segment DLS-LSS. They have the advantages of clear surgical vision, high surgical efficiency, and favorable mid-term efficacy. In addition, compared with MMIS-TLIF, UBE-TLIF causes less intraoperative bleeding and faster postoperative recovery.