Application and thinking of minimally invasive transforaminal lumbar interbody fusion in degenerative lumbar diseases

Comparison of Fusion Rate and Clinical Outcomes in Minimally Invasive and Conventional Posterior Fusion for Lumbar Degenerative Disease: A Network Meta-Analysis

BACKGROUND

The fusion rate, clinical efficacy, and complications of minimally invasive fusion surgery and open fusion surgery in the treatment of lumbar degenerative disease are still unclear.

METHODS

We conducted a literature search using PubMed, Embase, Cochrane Library, CNKI, and WANFANG databases.

RESULTS

This study included 38 retrospective studies involving 3097 patients. Five intervention modalities were considered: unilateral biportal endoscopic-lumbar interbody fusion (UBE-LIF), percutaneous endoscopic-lumbar interbody fusion (PE-LIF), minimally invasive-transforaminal lumbar interbody fusion (MIS-TLIF), transforaminal lumbar interbody fusion (TLIF), and posterior lumbar interbody fusion (PLIF). Quality assessment indicated that each study met acceptable quality standards. PE-LIF demonstrated reduced low back pain (Odds Ratio = 0.50, Confidence Interval: 0.38-0.65) and lower complication rate (Odds Ratio = 0.46, Confidence Interval: 0.25-0.87) compared to PLIF. However, in indirect comparisons, PE-LIF showed the lowest fusion rates, with the ranking as follows: UBE-LIF (83.2%) > MIS-TLIF (59.6%) > TLIF (44.3%) > PLIF (39.8%) > PE-LIF (23.1%). With respect to low back pain relief, PE-LIF yielded the best results, with the order of relief as follows: PE-LIF (96.4%) > MIS-TLIF (64.8%) > UBE-LIF (62.6%) > TLIF (23.0%) > PLIF (3.2%). Global and local consistency tests showed satisfactory results, and heterogeneity tests indicated good stability.

CONCLUSIONS

Compared to conventional open surgery, minimally invasive fusion surgery offered better scores for low back pain and Oswestry Disability Index, lower complication rates, reduced bleeding, and shorter hospital stays. However, minimally invasive fusion surgery did not show a significant advantage in terms of fusion rate and had a longer operative time.

Clinical efficacy and complications of MIS-TLIF and TLIF in the treatment of upper lumbar disc herniation: a comparative study

BACKGROUND

The optimal treatment modality for upper lumbar disc herniation remains unclear. Herein, we compared the clinical efficacy and application value of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and transforaminal lumbar interbody fusion (TLIF) for upper lumbar disc herniation. We aimed to provide new evidence to guide surgical decisions for treating this condition.

METHODS

We retrospectively analyzed the clinical data of 81 patients with upper lumbar disc herniation admitted between January 2017 and July 2018, including 41 and 40 patients who underwent MIS-TLIF and TLIF, respectively. Demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared. We performed consecutive comparisons of visual analog scale (VAS) scores of the lumbar and leg regions, Oswestry disability index (ODI), Japanese Orthopaedic Association scores (JOA), and MacNab scores at the final follow-up, to assess clinical outcomes 5 years postoperatively.

RESULTS

VAS scores of the back and legs were significantly lower in the MIS-TLIF than the TLIF group at 3 months and 1 year postoperatively (P < 0.05). Intraoperative bleeding and postoperative hospitalization time were significantly lower, and the time to return to work/normal life was shorter in the MIS-TLIF than in the TLIF group (P < 0.05). The differences in JOA scores and ODI scores between the two groups at 3 months, 1 year, and 3 years postoperatively were statistically significant (P < 0.05).

CONCLUSION

The early clinical efficacy of MIS-TLIF was superior to that of TLIF, but no differences were found in mid-term clinical efficacy. Further, MIS-TLIF has the advantages of fewer medical injuries, shorter hospitalization times, and faster postoperative functional recovery.

Comparing the efficacy and complications of unilateral biportal endoscopic fusion versus minimally invasive fusion for lumbar degenerative diseases: a systematic review and mate-analysis

BACKGROUND

Unilateral biportal endoscopic (UBE) has been gradually applied in clinical practice. UBE has two channels, with good visual field and operating space, and has achieved good results in the treatment of lumbar spine diseases. Some scholars combine UBE with vertebral body fusion to replace traditional open fusion surgery and minimally invasive fusion surgery. The efficacy of biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is still controversial. In this systematic review and meta-analysis, BE-TLIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) are compared in the efficacy and complications of lumbar degenerative diseases.

METHODS

PubMed, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) were used to search literatures related to BE-TLIF before January 2023, to identify relevant studies, and systematically review all literatures. Evaluation indicators mainly include operation time, hospital stay, estimated blood loss, visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab.

RESULTS

A total of 9 studies were included in this study; a total of 637 patients were collected, and 710 vertebral bodies were treated. Nine studies showed that there was no significant difference in VAS score, ODI, fusion rate, and complication rate between BE-TLIF and MI-TLIF at the final follow-up after surgery.

CONCLUSION

This study suggests that BE-TLIF is a safe and effective surgical approach. BE-TLIF surgery has similar good efficacy to MI-TLIF in the treatment of lumbar degenerative diseases. And compared with MI-TLIF, it has the advantages of early postoperative relief of low-back pain, shorter hospital stay, and faster functional recovery. However, high-quality prospective studies are needed to validate this conclusion.

Clinical Effect of Minimally Invasive Microendoscopic-Assisted Transforaminal Lumbar Interbody Fusion for Single-Level Lumbar Disc Herniation

OBJECTIVE

This retrospective study aimed to compare the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) through the Wiltse approach (W-TLIF) vs minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion (ME-TLIF) in single-segment lumbar disc herniation (LDH).

METHODS

A retrospective study was conducted to study the differences in specific clinical outcomes between single-segment LDH patients receiving W-TLIF and ME-TLIF. Single-segment LDH patients admitted to the Fujian Medical University Union Hospital from March 2015 to June 2018 were included. All the participants were divided into the ME-TLIF group or the W-TLIF group according to their TLIF surgery types. Demographic characteristics, the visual analog score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scale, blood loss volume, postoperative drainage, ambulated time, initial postoperative back pain, hospitalization duration, expenses, and improvement rates of patients in the two groups were collected for analysis. Radiographic fusion was ultimately assessed via the Bridwell interbody fusion grading system. All selected patients with TLIF were followed up for 1 year.

RESULTS

Fifty-seven patients were selected, with 26 in the ME-TLIF group and 31 in the W-TLIF group, both of whom were followed up for 1 year. The mean age of the included patients was 53.75 ± 9.313 years, and the sex ratio was indiscrimination. There was no significant difference in demographic data or operating time between the two groups prior to surgery. The blood loss volume (ME-TLIF: 228.5 vs W-TLIF: 681.3), postoperative drainage (ME-TLIF:82.1 ± 23.5 vs W-TLIF: 345.8 ± 65.2), initial postoperative back pain (ME-TLIF: VAS_3 days: 1.96 ± 0.60 VAS_7 days: 1.73 ± 0.53, W-TLIF: VAS_3 days: 2.48 ± 0.51 VAS_7 days: 1.87 ± 0.43), and hospitalization duration (ME-TLIF: 9.04 vs. W-TLIF: 11.29) were all significantly lower in the ME-TILF group (p < 0.05). However, there were no statistical differences between the two groups in VAS, ODI, and JOA at 1 month, 3 months, 6 months, and 1 year postoperatively (p > 0.05). The fusion rates of the two groups showed no notable difference (p > 0.05), while the X-ray exposure time in the ME-TLIF group was significantly longer than in the W-TLIF group (p < 0.05).

CONCLUSIONS

ME-TLIF surgery was an effective and satisfactory surgical technique to manage LDH. Although ME-TLIF increased the operation time and intraoperative fluoroscopic irradiation volume, it could effectively relieve low back pain from early postoperative onset and promote early postoperative recovery compared with W-TLIF.