Comparison of mid-term effectiveness of unilateral biportal endoscopy-transforaminal lumbar interbody fusion with minimally invasive surgery-transforaminal lumbar interbody fusion assisted with three-dimensional microscope in treating lumbar spondylolisthesis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Yang ¹ ,  WANG Yongtao ¹ , XIE Yizhou ^1,2 , XU Jiajia ¹ , CHEN Yuzhou ¹ , FAN Xiaohong ¹

1. Department of Orthopedics, the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan, 610072, P. R. China;
2. Department of Neurological Surgery, New York Presbyterian Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, 10065, NY, U S A;

Corresponding author：

WANG Yongtao, Email: wyt19981103@163.com

Keywords：

Unilateral biportal endoscopy technology; microscope; transforaminal lumbar interbody fusion

DOI：

10.7507/1002-1892.202210017

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Objective To compare the mid-term effectiveness of unilateral biportal endoscopy (UBE)-transforaminal lumbar interbody fusion (TLIF) and minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) assisted with three-dimensional microscope in the treatment of single-level lumbar spondylolisthesis. Methods A total of 41 single level lumbar spondylolisthesis patients who met the selection criteria were retrospectively collected between June 2018 and September 2019. Twenty-three patients were treated with UBE-TLIF (study group) and 18 with MIS-TLIF assisted with three-dimensional microscope (control group). There was no significant difference in gender, age, Meyerding degree of slippage, type of spondylolisthesis, lesion segment, course of disease, and preoperative hemoglobin (Hb) level, visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar lordosis (LL), and disc height (DH) between the two groups (P>0.05). The operation time, hospitalization time, intraoperative blood loss, Hb level between preoperative and postoperative at 1 day, and complications were compared between the two groups. The recovery of clinical sign and symptom was evaluated by VAS score and ODI before operation, and at 1 month, 3 months, 1 year, and 3 years after operation. The LL and DH were measured by radiography before operation and at last follow-up, and the fusion rate was calculated according to Suk grade at last follow-up. Results All the operations were successfully completed. There was no significant difference in operation time between the two groups (P>0.05); the hospitalization time, intraoperative blood loss, and Hb difference between pre- and post-operation in the study group were significantly less than those in the control group (P<0.05). Both groups were followed up 36-48 months, with an average of 39.2 months. In the study group, 1 case of dural tear and 2 cases of Cage subsidence occurred, without postoperative infection and epidural hematoma; in the control group, infection occurred in 1 case, dural tear in 2 cases, Cage subsidence in 1 case, and no epidural hematoma occurred; there was no significant difference in the incidence of complications between the two groups (13.04% vs. 22.22%) (χ²=0.601, P=0.438). The VAS score and ODI at each time point after operation in both groups significantly improved when compared with those before operation, and further improved with time (P<0.05). There was no significant difference in VAS scores between the two groups at each time point after operation (P>0.05); the ODI of the study group was significantly lower than that of the control group at 1 and 3 months after operation (P<0.05), and there was no significant difference between the two groups at other time points (P>0.05). The imaging test showed that the intervertebral fusion rates were 95.7% in the study group and 94.4% in the control group at last follow-up, with no significant difference (χ²=0.032, P=0.859). At last follow-up, LL and DH in the two groups significantly improved when compared with those before operation (P<0.05), and the difference between before and after operation showed no significant difference between the two groups (P>0.05). Conclusion Both UBE-TLIF and MIS-TLIF assisted with three-dimensional microscope have the advantages of clear intraoperative field and high surgical efficiency in treating lumbar spondylolisthesis, and can obtain satisfactory mid-term effectiveness. Compared with MIS-TLIF assisted with three-dimensional microscope, UBE-TLIF has the advantages of less bleeding and faster recovery.

Citation： YU Yang, WANG Yongtao, XIE Yizhou, XU Jiajia, CHEN Yuzhou, FAN Xiaohong. Comparison of mid-term effectiveness of unilateral biportal endoscopy-transforaminal lumbar interbody fusion with minimally invasive surgery-transforaminal lumbar interbody fusion assisted with three-dimensional microscope in treating lumbar spondylolisthesis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(1): 52-58. doi: 10.7507/1002-1892.202210017 Copy

1.	刘滔, 王晟昊, 谭成龙, 等. 重度腰椎峡部裂性滑脱后路椎间融合手术治疗的临床及影像学疗效评价. 中国矫形外科杂志, 2015, 23(21): 1933-1937.
2.	McNeely ML, Torrance G, Magee DJ. A systematic review of physiotherapy for spondylolysis and spondylolisthesis. Man Ther, 2003, 8(2): 80-91.
3.	张新亮, 黄大耿, 高文杰, 等. 微创经椎间孔入路腰椎椎体间融合术治疗青少年双侧峡部裂型腰椎滑脱的疗效分析. 中国医师进修杂志, 2016, 39(10): 928-932.
4.	韦玮, 李剑, 黄林海, 等. 选择性后路植骨融合联合钉棒系统内固定治疗老年峡部裂性腰椎滑脱. 中国老年学杂志, 2019, 39(20): 4995-4998.
5.	Katz JN, Zimmerman ZE, Mass H, et al. Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 2022, 327(17): 1688-1699.
6.	梅启元, 邵琳. 椎弓根内固定联合不同融合方式治疗峡部裂型腰椎滑脱症效果比较. 解放军医药杂志, 2017, 29(4): 78-81.
7.	Katuch V, Grega R, Knorovsky K, et al. Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion in the management of lumbar spondylolisthesis. Bratisl Lek Listy, 2021, 122(9): 653-656.
8.	万云芳, 许黎柳, 杨雯, 等. MIS-TLIF与开放TLIF治疗单节段腰椎退行性疾病围手术期失血量的对比研究. 全科医学临床与教育, 2022, 20(1): 75-77.
9.	Chen K, Chen H, Zhang K, et al. O-arm navigation combined with microscope-assisted MIS-TLIF in the treatment of lumbar degenerative disease. Clin Spine Surg, 2019, 32(5): E235-E240.
10.	孙芝城, 王锡阳. 退行性腰椎滑脱微创融合手术进展. 中国微创外科杂志, 2019, 19(5): 445-448.
11.	Benoist M, Ficat C, Baraf P, et al. Postoperative sciatica from epidural fibrosis and lumbar arachnoiditis. Results of 38 repeat operations. Rev Rhum Mal Osteoartic, 1979, 46(11): 593-599.
12.	王寒辉, 刘界, 徐亚勇, 等. 显微镜辅助微创通道下经椎间孔入路腰椎间融合术与开放经椎间孔椎体间融合术治疗双节段腰椎管狭窄症的短中期疗效. 实用医学杂志, 2022, 38(11): 1373-1377.
13.	张玉红, 田霖, 胡鹏, 等. 单侧双通道脊柱内镜技术治疗腰椎相关疾病的研究进展. 中国修复重建外科杂志, 2022, 36(10): 1234-1240.
14.	舒鹏, 王智伟, 陈刚. 单侧双通道脊柱内镜下经椎间孔腰椎椎体间融合术治疗单节段Ⅰ、Ⅱ度腰椎滑脱症近期疗效分析. 中国修复重建外科杂志, 2022, 36(10): 1207-1212.
15.	Koslosky E, Gendelberg D. Classification in brief: The Meyerding classification system of spondylolisthesis. Clin Orthop Relat Res, 2020, 478(5): 1125-1130.
16.	中华医学会放射学分会骨关节学组, 中国医师协会放射医师分会肌骨学组, 中华医学会骨科学分会骨质疏松学组, 等. 骨质疏松的影像学与骨密度诊断专家共识. 中国骨质疏松杂志, 2020, 26(9): 1249-1256.
17.	李杰, 陈意磊, 干开丰, 等. 后路固定对OLIF术后早期融合器沉降的影响. 西安交通大学学报 (医学版), 2022, 43(1): 111-116.
18.	朱广铎, 镐英杰, 于磊, 等. 经皮内镜后路腰椎间融合术治疗Ⅰ度腰椎滑脱. 中国矫形外科杂志, 2021, 29(19): 1734-1739.
19.	Cho JH, Lee JH, Song KS, et al. Treatment outcomes for patients with failed back surgery. Pain Physician, 2017, 20(1): E29-E43.
20.	胡鸣, 毕大鹏, 俞胜宝. 开放与经皮椎弓根螺钉内固定治疗单纯胸腰椎椎体骨折的对比研究. 实用骨科杂志, 2022, 28(5): 412-415,435.
21.	Price JP, Dawson JM, Schwender JD, et al. Clinical and radiologic comparison of minimally invasive surgery with traditional open transforaminal lumbar interbody fusion: A review of 452 patients from a single center. Clin Spine Surg, 2018, 31(2): E121-E126.
22.	朱斌, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 2020, 40(15): 1030-1038.
23.	普星宇, 骆文远, 高明暄, 等. 两种不同技术联合微创经椎间孔椎体间融合术治疗退行性腰椎滑脱症的病例对照研究. 中国骨伤, 2022, 35(5): 409-417.
24.	陈鹏程, 钟海琳, 王乐, 等. 显微镜辅助下MIS-TLIF治疗腰椎单节段退行性疾病的临床疗效观察. 中国临床解剖学杂志, 2020, 38(4): 455-460+466.
25.	李红, 毛文, 童凯. 单侧双通道内镜下腰椎间融合术治疗腰椎滑脱的临床疗效观察. 中国中医骨伤科杂志, 2022, 30(9): 58-61, 66.
26.	王栋, 高文硕, 洪奕胡, 等. 单侧双通道内镜技术治疗游离型腰椎间盘突出症. 中医正骨, 2022, 34(4): 64-69.
27.	Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
28.	Kim JE, Yoo HS, Choi DJ, et al. Learning curve and clinical outcome of biportal endoscopic-assisted lumbar interbody fusion. Biomed Res Int, 2020, 2020: 8815432. doi: 10.1155/2020/8815432.
29.	王宁, 贝朝涌, 万健, 等. 单侧双通道脊柱内镜技术行腰椎椎间融合术学习曲线研究. 中国修复重建外科杂志, 2022, 36(10): 1229-1233.
30.	Kang MS, You KH, Choi JY, et al. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine J, 2021, 21(12): 2066-2077.

1. 刘滔, 王晟昊, 谭成龙, 等. 重度腰椎峡部裂性滑脱后路椎间融合手术治疗的临床及影像学疗效评价. 中国矫形外科杂志, 2015, 23(21): 1933-1937.
2. McNeely ML, Torrance G, Magee DJ. A systematic review of physiotherapy for spondylolysis and spondylolisthesis. Man Ther, 2003, 8(2): 80-91.
3. 张新亮, 黄大耿, 高文杰, 等. 微创经椎间孔入路腰椎椎体间融合术治疗青少年双侧峡部裂型腰椎滑脱的疗效分析. 中国医师进修杂志, 2016, 39(10): 928-932.
4. 韦玮, 李剑, 黄林海, 等. 选择性后路植骨融合联合钉棒系统内固定治疗老年峡部裂性腰椎滑脱. 中国老年学杂志, 2019, 39(20): 4995-4998.
5. Katz JN, Zimmerman ZE, Mass H, et al. Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 2022, 327(17): 1688-1699.
6. 梅启元, 邵琳. 椎弓根内固定联合不同融合方式治疗峡部裂型腰椎滑脱症效果比较. 解放军医药杂志, 2017, 29(4): 78-81.
7. Katuch V, Grega R, Knorovsky K, et al. Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion in the management of lumbar spondylolisthesis. Bratisl Lek Listy, 2021, 122(9): 653-656.
8. 万云芳, 许黎柳, 杨雯, 等. MIS-TLIF与开放TLIF治疗单节段腰椎退行性疾病围手术期失血量的对比研究. 全科医学临床与教育, 2022, 20(1): 75-77.
9. Chen K, Chen H, Zhang K, et al. O-arm navigation combined with microscope-assisted MIS-TLIF in the treatment of lumbar degenerative disease. Clin Spine Surg, 2019, 32(5): E235-E240.
10. 孙芝城, 王锡阳. 退行性腰椎滑脱微创融合手术进展. 中国微创外科杂志, 2019, 19(5): 445-448.
11. Benoist M, Ficat C, Baraf P, et al. Postoperative sciatica from epidural fibrosis and lumbar arachnoiditis. Results of 38 repeat operations. Rev Rhum Mal Osteoartic, 1979, 46(11): 593-599.
12. 王寒辉, 刘界, 徐亚勇, 等. 显微镜辅助微创通道下经椎间孔入路腰椎间融合术与开放经椎间孔椎体间融合术治疗双节段腰椎管狭窄症的短中期疗效. 实用医学杂志, 2022, 38(11): 1373-1377.
13. 张玉红, 田霖, 胡鹏, 等. 单侧双通道脊柱内镜技术治疗腰椎相关疾病的研究进展. 中国修复重建外科杂志, 2022, 36(10): 1234-1240.
14. 舒鹏, 王智伟, 陈刚. 单侧双通道脊柱内镜下经椎间孔腰椎椎体间融合术治疗单节段Ⅰ、Ⅱ度腰椎滑脱症近期疗效分析. 中国修复重建外科杂志, 2022, 36(10): 1207-1212.
15. Koslosky E, Gendelberg D. Classification in brief: The Meyerding classification system of spondylolisthesis. Clin Orthop Relat Res, 2020, 478(5): 1125-1130.
16. 中华医学会放射学分会骨关节学组, 中国医师协会放射医师分会肌骨学组, 中华医学会骨科学分会骨质疏松学组, 等. 骨质疏松的影像学与骨密度诊断专家共识. 中国骨质疏松杂志, 2020, 26(9): 1249-1256.
17. 李杰, 陈意磊, 干开丰, 等. 后路固定对OLIF术后早期融合器沉降的影响. 西安交通大学学报 (医学版), 2022, 43(1): 111-116.
18. 朱广铎, 镐英杰, 于磊, 等. 经皮内镜后路腰椎间融合术治疗Ⅰ度腰椎滑脱. 中国矫形外科杂志, 2021, 29(19): 1734-1739.
19. Cho JH, Lee JH, Song KS, et al. Treatment outcomes for patients with failed back surgery. Pain Physician, 2017, 20(1): E29-E43.
20. 胡鸣, 毕大鹏, 俞胜宝. 开放与经皮椎弓根螺钉内固定治疗单纯胸腰椎椎体骨折的对比研究. 实用骨科杂志, 2022, 28(5): 412-415,435.
21. Price JP, Dawson JM, Schwender JD, et al. Clinical and radiologic comparison of minimally invasive surgery with traditional open transforaminal lumbar interbody fusion: A review of 452 patients from a single center. Clin Spine Surg, 2018, 31(2): E121-E126.
22. 朱斌, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 2020, 40(15): 1030-1038.
23. 普星宇, 骆文远, 高明暄, 等. 两种不同技术联合微创经椎间孔椎体间融合术治疗退行性腰椎滑脱症的病例对照研究. 中国骨伤, 2022, 35(5): 409-417.
24. 陈鹏程, 钟海琳, 王乐, 等. 显微镜辅助下MIS-TLIF治疗腰椎单节段退行性疾病的临床疗效观察. 中国临床解剖学杂志, 2020, 38(4): 455-460+466.
25. 李红, 毛文, 童凯. 单侧双通道内镜下腰椎间融合术治疗腰椎滑脱的临床疗效观察. 中国中医骨伤科杂志, 2022, 30(9): 58-61, 66.
26. 王栋, 高文硕, 洪奕胡, 等. 单侧双通道内镜技术治疗游离型腰椎间盘突出症. 中医正骨, 2022, 34(4): 64-69.
27. Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
28. Kim JE, Yoo HS, Choi DJ, et al. Learning curve and clinical outcome of biportal endoscopic-assisted lumbar interbody fusion. Biomed Res Int, 2020, 2020: 8815432. doi: 10.1155/2020/8815432.
29. 王宁, 贝朝涌, 万健, 等. 单侧双通道脊柱内镜技术行腰椎椎间融合术学习曲线研究. 中国修复重建外科杂志, 2022, 36(10): 1229-1233.
30. Kang MS, You KH, Choi JY, et al. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine J, 2021, 21(12): 2066-2077.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of mid-term effectiveness of unilateral biportal endoscopy-transforaminal lumbar interbody fusion with minimally invasive surgery-transforaminal lumbar interbody fusion assisted with three-dimensional microscope in treating lumbar spondylolisthesis

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