A clinical comparison between microscopic minimally invasive transforaminal interbody fusion(MIS-TLIF)with the enhanced recovery after surgery(ERAS)protocol and unilateral biportal transforaminal lumbar interbody fusion(BE-TLIF)
Wu Pang Hung
Yihao Liang
Rohit Akshay Kavishwar
Wongthawat Liawrungrueang
Abstract：Objective Unilateral biportal endoscopy has become a procedure of choice for lumbar discectomies and decompressions at our center replacing the microscopic techniques.Lumbar fusion is performed either by unilateral biportal endoscopic transforaminal lumbar interbody fusion(BE-TLIF)or minimally invasive transforaminal lumbar interbody fusion by microscopic tubular technique(MT-TLIF).Our aim was to compare these two techniques.Methods This is a retrospective study involving 59 patients who underwent lumbar fusion between November 2019 and November 2021.28 patients underwent BE-TLIF for 34 levels of fusion and 31 patients underwent MT-TLIF for 36 levels of fusion.All the patients were followed up for more than 12 months.Clinical outcomes were measured by Visual Analogue Score(VAS)for back pain and leg pain,pre-operatively and at subsequent follow-up's.Functional outcomes were measured by the Oswestry Disability Index(ODI)and McNab's criteria.The Bridwell grading system was used for assessing fusion on X-rays at follow-up.Results Both the cohorts(BE-TLIF and MT-TLIF)showed significant improvement of back pain and leg pain post-operatively and all the follow-ups.There was statistically significant improvement of VAS for back pain at immediate post-operative,6 weeks post-operative,6 months post-operative and final follow-up in BE-TLIF group as compared to MT-TLIF.At final follow-up BE-TLIF cohort had better ODI scores(P=0.04).Fusion rates were better in BE-TLIF group at 6 months but eventually they were similar in both the groups at final follow-up but BE-TLIF cohort showed less subsidence than MT-TLIF group at final follow-up(P=0.02).Conclusions UBE fusion offers a promising option for lumbar fusion,with fusion rates comparable to MIS-TLIF.It also provides advantages such as better clinical outcome scores,early ambulation,shorter hospital stay,less blood loss,earlier time to fusion,and lower subsidence rate.Both techniques exhibited low infection rates with no significant intergroup differences.
Keywords：Spinal fusionLumbar vertebraeMinimally invasive surgical procedures
Publication Date：2025-07-19
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：12( 584-595 )