Comparison of biportal endoscopic vs minimally invasive transforaminal lumbar interbody fusion for single-level low-grade lumbar spondylolisthesis: A retrospective cohort study

Background

Lumbar spondylolisthesis is a common spinal disorder that often leads to low back pain, radiating leg pain, and intermittent claudication. Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been widely adopted as an effective surgical treatment for this condition. In recent years, biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) has emerged as a novel minimally invasive technique that offers enhanced visualization and may reduce paraspinal muscle injury. However, comparative studies with mid-term follow-up between BE-TLIF and MI-TLIF for single-level low-grade lumbar spondylolisthesis remain limited.

Aim

To compare the mid-term clinical and radiographic outcomes between BE-TLIF and MI-TLIF in the treatment of single-level lumbar spondylolisthesis.

Methods

We conducted a retrospective comparative cohort study of 63 patients with single-level degree I or II lumbar spondylolisthesis who underwent surgery between December 2020 and December 2022. Thirty-two patients were treated with BE-TLIF and 31 with MI-TLIF. Patient demographics, operative parameters, complications, and clinical outcomes [assessed by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI)] were recorded. Radiographic assessments included disc height (DH), lumbar lordosis (LL), segmental lordosis angle (SLA), slip percentage (SP), and fusion rate (FR) on X-ray and computed tomography scans.

Results

The BE-TLIF group had a significantly longer operative time (189.36 ± 20.94 minutes vs 150.35 ± 21.16 minutes, P < 0.001) but a shorter hospital stay (5.14 ± 1.28 days vs 6.19 ± 1.33 days, P = 0.005) compared to the MI-TLIF group. The BE-TLIF group demonstrated significantly lower low back VAS scores at 3 days postoperatively (3.65 ± 0.78 vs 4.32 ± 0.69, Bonferroni-corrected P = 0.005) and lower postoperative creatine kinase (CK) levels (251.21 ± 29.48 IU/L vs 316.52 ± 33.37 IU/L, P < 0.001). There were no statistically significant differences in ODI scores, DH, LL, SLA, SP, or FR (90.6% vs 90.3%, P = 0.979) between the two groups at the final follow-up. The complication rates did not differ significantly between the two groups.

Conclusion

BE-TLIF demonstrated favorable clinical and radiographic outcomes in this cohort, with no statistically significant difference observed compared to MI-TLIF in most mid-term measures; however, these comparisons were exploratory and do not establish equivalence. BE-TLIF was associated with a shorter hospital stay, lower early postoperative pain, and a lower postoperative CK level whose clinical significance requires further study.