Percutaneous Uniportal Endoscopic Decompression Combined with Biportal Endoscopic Lumbar Interbody Fusion versus Minimally Invasive Quadrant Transforaminal Lumbar Interbody Fusion for Single-Level Lumbar Spinal Stenosis

Abstract

Objective: To compare the clinical outcomes between group A (hybrid endoscopic technique: percutaneous uniportal endoscopic decompression combined with biportal endoscopic lumbar interbody fusion [LIF]) and group B (minimally invasive Quadrant transforaminal LIF) for lumbar spinal stenosis.

Methods: This study included 68 consecutive patients (group A: 32 patients; group B: 36 patients) retrospectively enrolled and treated between June 2019 and June 2021. Perioperative data were prospectively collected, including radiological outcomes (intervertebral disc height, sagittal Cobb angle, lumbar lordosis) and clinical outcomes (Oswestry Disability Index, visual analog scale [VAS], and Short Form 36 Health Survey [SF-36]). Paravertebral muscle injury was assessed by serum creatine phosphokinase levels. Additionally, fusion rate and perioperative complication rates were compared between the two groups.

Results: At 1 month postoperatively, group A demonstrated significantly better outcomes in VAS-Back, VAS-Leg, and SF-36 scores compared to group B (P < 0.05). At 3 months postoperatively, group A demonstrated significantly better outcomes in VAS-Back, Oswestry Disability Index, and SF-36 scores compared to group B (P < 0.05). Creatine phosphokinase levels in group A were significantly lower than those in group B at 1, 3, and 7 days postoperatively (P < 0.05). However, no significant intergroup differences were observed in intervertebral disc height, sagittal Cobb angle, and lumbar lordosis at 1 and 12 months postoperatively (P > 0.1). Additionally, fusion rates and surgical complication rates did not differ significantly between groups (P > 0.05).

Conclusions: The hybrid endoscopic technique (percutaneous uniportal endoscopic decompression combined with biportal endoscopic LIF) demonstrates comparable clinical outcomes and fusion rates to minimally invasive Quadrant transforaminal LIF for lumbar spinal stenosis, while achieving reduced postoperative pain and improved early functional recovery.

Keywords: Endoscopic spine surgery; Lumbar spinal stenosis; Minimally invasive Quadrant transforaminal lumbar interbody fusion.