Percutaneous Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Disease

Abstract

Percutaneous endoscopic lumbar interbody fusion (PE-LIF) is commonly employed in treating a variety of lumbar degenerative diseases (LDD). This study evaluated the effectiveness and safety of a modified approach known as percutaneous endoscopic posterolateral transforaminal lumbar interbody fusion (PE-PTLIF). We conducted a retrospective review of 46 patients who underwent PE-PTLIF for LDD between November 2020 and July 2021. We analyzed measurements including pre- and postoperative Visual Analogue Scores (VAS) for lower back and leg pain, Oswestry Disability Index (ODI) collected at 3 days, 3 months, 6 months, and the most recent follow-up, and spinal parameters (disc space height, lumbar lordosis angle, and lumbar spondylolisthesis rate) over time. Patients were followed for an average duration of 18.6 months. Significant improvements were observed in VAS scores for lower back pain (latest follow-up: 1.21 ± 0.57) and leg pain (latest follow-up: 1.10 ± 0.72), as well as in ODI scores (latest follow-up: 9.63% ± 4.13) (all P<0.001 compared with preoperative values). Improvements were also noted in vertebral space height and lumbar lordotic angles (P<0.001). Postoperative complications included wound infection (6.5%), cerebrospinal fluid leakage (2.2%), and reduced dorsiflexion muscle strength (2.2%), all of which were successfully managed conservatively. There were no instances of epidural hematoma, internal fixation failure, or lumbar non-fusion/fusion device displacement. Confirmation of osseous fusion was obtained via lumbar X-ray/CT scans at the final follow-up. PE-PTLIF is a promising treatment option for specific LDD including spinal stenosis, lumbar spondylolisthesis, and lumbar instability, with favorable therapeutic outcomes demonstrated.