Comparison of clinical efficacy and surgeon's neck flexion time between unilateral biportal endoscopic lumbar fusion versus minimally invasive transforaminal lumbar fusion in the treatment of single-level lumbar degenerative diseases: a single center retrospective study.

Abstract

Purpose: This retrospective study aimed to evaluate the clinical efficacy and surgeon's neck flexion time between unilateral biportal endoscopic lumbar fusion (UBE-LIF) versus minimally invasive transforaminal lumbar fusion (MIS-TLIF) in the treatment of single-level lumbar degenerative diseases (LDD).

Methods: This study retrospectively enrolled patients with single-level LDD received UBE-LIF or MIS-TLIF between June 2018 to May 2022. The patients were separated into two groups based on the surgical method used: the UBE-LIF group (n = 38) and the MIS-TLIF group (n = 42). Various parameters, including operative time, fluoroscopy frequency, blood loss, length of hospital stay, total expenses, visual analogue scale (VAS), and Oswestry Disability Index (ODI), modified MacNab criteria, fusion rate, and complications were evaluated and compared between the two groups. And time for neck flexion during surgery by the surgeon were recorded. After the surgery, surgeons completed a questionnaire based on a visual analog scale to assess their discomfort symptoms of the neck, shoulders, and back.

Results: There were no significant differences in VAS or ODI scores at 12 months after surgery among two groups. However, the UBE-LIF group had significantly better VAS scores for low back pain on the first day after surgery than the MIS-TLIF group(2.00 ± 0.70) (2.55 ± 0.94) (P < 0.05). Additionally, the UBE-LIF group had shorter intraoperative bleeding (78.42 ± 51.440) ml (169.29 ± 52.656) ml (P < 0.05). There were no significant differences in fluoroscopy frequency and incidence of complications among two groups. But total expenses in the UBE-LIF group (73246 ± 4354) yuan were significantly higher than those in the MIS-TLIF group (60577 ± 4160) yuan (P < 0.05). In the UBE-LIF group, the surgeon's neck flexion time was significantly reduced(52.00 ± 18.233) min (102.83 ± 11.77) min (P < 0.05), and there was a statistically significant reduction in the visual analog scale discomfort scores for the neck, back, and shoulders (P < 0.05).

Conclusions: Both UBE-LIF and MIS-TLIF can achieve good postoperative results. UBE has less intraoperative bleeding, less postoperative drainage flow, lower postoperative patient low back pain score, and slightly higher cost than MIS-TLIF. However, the surgeon has a shorter time to lower their head during surgery and higher comfort during surgery.