Comparison of the clinical efficacy of percutaneous endoscopic lumbar interbody fusion through different surgical approaches: a retrospective study.

Background: This is a retrospective study to compare the clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF), percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF), and trans-articular process percutaneous endoscopic lumbar interbody fusion (trans-AP PELIF).

Methods: A retrospective analysis was conducted on the clinical data of patients with lumbar spinal stenosis or lumbar disc herniation who underwent percutaneous endoscopic lumbar interbody fusion (PELIF) through different surgical approaches in our hospital from January 2018 to December 2023.According to the operation method, the patients were divided into PE-PLIF group (n = 24), PE-TLIF group (n = 16) and trans-AP PELIF group (n = 9). The perioperative, follow-up and imaging data of the three groups were compared.

Results: All patients in the three groups successfully completed the operation. Compared with the PE-PLIF group, the operation time, intraoperative blood loss and postoperative drainage volume in the PE-TLIF group and the trans-AP PELIF group were significantly reduced (P < 0.05).There was no significant difference in the length of hospital stay, complication rates, and the time to first ambulation among the three groups (P > 0.05). The Visual Analogue Scale for back pain (VAS-B) and leg pain (VAS-L), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) scores of the three groups were significantly improved compared with those before operation (P < 0.05). There was no significant difference in the VAS-B, VAS-L, JOA and ODI scores among the three groups before the operation and at the same time points after the operation (P > 0.05).Compared with pre-operation, the disc height (DH) was improved at the last follow-up (P < 0.05).There was no significant difference in lumbar lordosis angle (LLA) between the pre-operation and the last follow-up (P > 0.05). There was no significant difference in these two indicators among the three groups before the operation and at the same time points after the operation (P > 0.05). The fusion rates of the three groups were all 100%, and there was no significant difference in the fusion effect (P > 0.05).

Conclusions: The three different approaches of PELIF have good efficacy and similar postoperative recovery effect. Compared with the PE-PLIF, the PE-TLIF and the trans-AP PELIF have the advantages of shorter operation time, less intraoperative bleeding and less postoperative drainage. (Registration number: MR-22-25-033828; date of registration: 2025-04-28; retrospectively registered).