Comparative Efficacy of 3 Methods of Lumbar Interbody Fusion for Lumbar Degenerative Diseases in a Tertiary Public Hospital.

Objective: To evaluate the clinical efficacy of large-channel endoscope-assisted posterior lumbar interbody fusion (Endo-PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open posterior lumbar interbody fusion in treatment of degenerative diseases of the lumbar spine.

Methods: Data of 110 patients with degenerative diseases of the lumbar spine were analyzed retrospectively: 31 patients underwent Endo-PLIF, 36 patients underwent MIS-TLIF, and 43 patients underwent modified TLIF. We compared operative duration, intraoperative blood loss, latent blood loss, intraoperative radiation dose, visual analog scale score, Oswestry Disability Index, anterior protrusion angle of the intervertebral space, postoperative ambulatory time, postoperative duration of hospital stay, and complications among the 3 groups. The prevalence of interbody fusion was observed at follow-up.

Results: Operative duration of Endo-PLIF was longer than that of MIS-TLIF and modified TLIF (P < 0.05). In terms of intraoperative blood loss, latent blood loss, and recovery time, Endo-PLIF and MIS-TLIF had clear advantages (P < 0.05). Visual analog scale score and Oswestry Disability Index of the 3 groups were satisfactory, but low back pain of patients in the Endo-PLIF and MIS-TLIF groups was less than that in the modified TLIF group (P < 0.05). In terms of complications and prevalence of interbody fusion, there were no significant differences among the 3 groups (P > 0.05).

Conclusions: All 3 operative methods had satisfactory efficacy. Endo-PLIF can be employed to treat lumbar degenerative diseases more precisely and in a minimally invasive fashion, but a learning curve and improvement in surgical instruments are needed.