Comparison of the short-term efficacy of MIS-TLIF and Endo-LIF for the treatment of two-segment lumbar degenerative disease

Abstract

Background: This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches.

Methods: From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion.

Results: There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups.

Conclusion: There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise.

Keywords: Lumbar degenerative disease; Lumbar vertebrae; Minimally invasive; Minimally invasive surgery; Pedicle screw.

Fig. 1

56-year-old female with low back pain with right lower extremity pain for 6 months. (a): MRI of the lumbar spine showed deformed bulging and herniated discs at L4/5 and L5/S1, and lumbar spondylolisthesis at L4. (b, c): Transverse MRI showing L4/5 and L5/S1 disc herniation and L5/S1 spinal stenosis. (d): Intraoperative operation under Quadtrant channel. (e): Lateral X-ray after surgery. (f): CT review at the final follow-up showed an intact bone block and trabecular growth was seen between the implant block and the host bone

Fig. 2

(a) 64-year-old woman with low back pain and bilateral lower extremity pain for 10 years. MRI of the lumbar spine shows L3 and L4 lumbar spondylolisthesis. (b, c): Transactional MRI showing bulging and herniated discs at L3-4 and L4-5 with spinal stenosis. (d, e, f, g): The cage was placed in L4/5 and L3/4, and the endoscopic view showed that the cage was placed in place and the nerve root decompression was complete. (h, i): Insertion of the nail bar system and proper repositioning. j: CT review at the final follow-up showed an intact bone block and trabecular growth was seen between the implant block and the host bone