Comparison of biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) and oblique lateral interbody fusion (OLIF) for treatment of degenerative lumbar disease: a multicentre retrospective cohort study.

Abstract

Introduction: There is no consensus in the use of biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) and oblique lateral interbody fusion (OLIF) in the management of degenerative lumbar disease.

Methods: Consecutive patients were included between August 2018 and April 2022. Primary outcomes included patient reported outcomes defined by the Oswestry Disability Index (ODI) score and visual analog scale (VAS) score of low back and leg. Secondary outcomes included operative time and estimated blood loss, serum creatine kinase (CK) levels, rates of complications, length of hospital stay (LOS) and radiographic outcomes.

Results: 268 patients were included: 133 and 135 underwent BE-TLIF and OLIF. Compared with OLIF, BE-TLIF took longer operatively (P<0.001) but resulted in reduced blood loss (P<0.001), shorter LOS (P<0.001), and lower serum CK (1 day postoperatively) (P<0.001). Both treatments showed no differences in VAS and ODI preoperatively and at 1, 3, and 12 months postoperatively. Compared with BE-TLIF, OLIF showed better restoration of disc height (DH) (P<0.001) and lumbar lordosis angle (LLA) (P< 0.001), but not the value of segmental lordosis angle (SLA) at 1 day, 1 month, and 12 months postoperatively. There was no difference in complication rates between BE-TLIF and OLIF (P=0.146).

Conclusions: Compared with OLIF, BE-TLIF is a safe and effective alternative strategy. It achieved comparable results in patient-reported outcomes, restoration of SLA, fusion rate, and complication rate. BE-TLIF demonstrated reduced blood loss, shortened hospital stay, and lowered serum CK levels. However, BE-TLIF demonstrated inferior DH, LLA, and required a longer operation time.