Comparison of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion (BE-TLIF) and Oblique Lateral Interbody Fusion (OLIF) for Treatment of Degenerative Lumbar Disease: A Multicenter Retrospective Cohort Study

Background

There is no consensus regarding 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 between August 2018 and April 2022 were included. Primary outcomes included patient reported outcomes defined by the Oswestry Disability Index and visual analog scale score for low back and leg pain. Secondary outcomes included operative time and estimated blood loss, serum creatine kinase (CK) levels, rates of complications, length of hospital stay, and radiographic outcomes.

Results

Two hundred sixty-eight 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 length of hospital stay (P < 0.001), and lower serum CK (1 day postoperatively) (P < 0.001). Both treatments showed no differences in visual analog scale and Oswestry Disability Index preoperatively and at 1, 3, and 12 months postoperatively. Compared with BE-TLIF, OLIF showed better restoration of disc height (P < 0.001) and lumbar lordosis angle (P < 0.001), but not the value of segmental lordosis angle 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 segmental lordosis angle, fusion rate, and complication rate. BE-TLIF demonstrated reduced blood loss, shortened hospital stay, and lowered serum CK levels. However, BE-TLIF demonstrated inferior disc height, lumbar lordosis angle, and required a longer operation time.