Full-Endoscopic Posterior Lumbar Interbody Fusion Via an Interlaminar Approach Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Retrospective Study

Abstract

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been performed as a minimally invasive surgery for lumbar degenerative disease, but previous MIS-TLIF methods have shown limitations by their own characters. In this study, we developed a newly interbody fusion technique of full-endoscopic posterior lumbar interbody fusion (FE-PLIF) via an interlaminar approach, presented its preliminary clinical results in comparison with MIS-TLIF procedure. This study retrospectively reviewed 52 patients who underwent FE-PLIF (n= 22) or MIS-TLIF (n= 30) surgery between October 2018 and February 2019. Patient demographics, intraoperative parameters, and perioperative complications were collated. Clinical and radiologic outcomes were evaluated at each follow-up for up to 12 months. FE-PLIF demonstrated a longer operation time, less blood loss, and shorter hospitalization duration than MIS-TLIF. The visual analog scale (VAS) score for leg pain in both groups and for back pain in FE-PLIF group significantly improved at 1 week, while the VAS score for back pain in MIS-TLIF group significantly improved at 3 months. No significant difference in the VAS and Oswestry disability index scores was found between the groups at 3 months and 12 months. Fusion rates of definite grades were not significantly different between the groups (73.3% vs. 70.0%, P > 0.05). All patients who suffered from cage subsidence or nonunion were asymptomatic and did not require revision surgery during the follow-up. The FE-PLIF interlaminar approach is a safe and effective interbody fusion technique with less surgical trauma and similar outcomes compared to MIS-TLIF. However, this technique still requires technical advancements to improve efficiency and reduce technical complexity.