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

Video：

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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.	劉滔, 王晟昊, 譚成龍, 等. 重度腰椎峽部裂性滑脫后路椎間融合手術治療的臨床及影像學療效評價. 中國矯形外科雜志, 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.	張新亮, 黃大耿, 高文杰, 等. 微創經椎間孔入路腰椎椎體間融合術治療青少年雙側峽部裂型腰椎滑脫的療效分析. 中國醫師進修雜志, 2016, 39(10): 928-932.
4.	韋瑋, 李劍, 黃林海, 等. 選擇性后路植骨融合聯合釘棒系統內固定治療老年峽部裂性腰椎滑脫. 中國老年學雜志, 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.	梅啟元, 邵琳. 椎弓根內固定聯合不同融合方式治療峽部裂型腰椎滑脫癥效果比較. 解放軍醫藥雜志, 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.	萬云芳, 許黎柳, 楊雯, 等. MIS-TLIF與開放TLIF治療單節段腰椎退行性疾病圍手術期失血量的對比研究. 全科醫學臨床與教育, 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.	孫芝城, 王錫陽. 退行性腰椎滑脫微創融合手術進展. 中國微創外科雜志, 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.	王寒輝, 劉界, 徐亞勇, 等. 顯微鏡輔助微創通道下經椎間孔入路腰椎間融合術與開放經椎間孔椎體間融合術治療雙節段腰椎管狹窄癥的短中期療效. 實用醫學雜志, 2022, 38(11): 1373-1377.
13.	張玉紅, 田霖, 胡鵬, 等. 單側雙通道脊柱內鏡技術治療腰椎相關疾病的研究進展. 中國修復重建外科雜志, 2022, 36(10): 1234-1240.
14.	舒鵬, 王智偉, 陳剛. 單側雙通道脊柱內鏡下經椎間孔腰椎椎體間融合術治療單節段Ⅰ、Ⅱ度腰椎滑脫癥近期療效分析. 中國修復重建外科雜志, 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.	中華醫學會放射學分會骨關節學組, 中國醫師協會放射醫師分會肌骨學組, 中華醫學會骨科學分會骨質疏松學組, 等. 骨質疏松的影像學與骨密度診斷專家共識. 中國骨質疏松雜志, 2020, 26(9): 1249-1256.
17.	李杰, 陳意磊, 干開豐, 等. 后路固定對OLIF術后早期融合器沉降的影響. 西安交通大學學報 (醫學版), 2022, 43(1): 111-116.
18.	朱廣鐸, 鎬英杰, 于磊, 等. 經皮內鏡后路腰椎間融合術治療Ⅰ度腰椎滑脫. 中國矯形外科雜志, 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.	胡鳴, 畢大鵬, 俞勝寶. 開放與經皮椎弓根螺釘內固定治療單純胸腰椎椎體骨折的對比研究. 實用骨科雜志, 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, 田大勝, 陳磊, 等. 單邊雙通道內鏡技術在腰椎疾病中的應用研究進展. 中華骨科雜志, 2020, 40(15): 1030-1038.
23.	普星宇, 駱文遠, 高明暄, 等. 兩種不同技術聯合微創經椎間孔椎體間融合術治療退行性腰椎滑脫癥的病例對照研究. 中國骨傷, 2022, 35(5): 409-417.
24.	陳鵬程, 鐘海琳, 王樂, 等. 顯微鏡輔助下MIS-TLIF治療腰椎單節段退行性疾病的臨床療效觀察. 中國臨床解剖學雜志, 2020, 38(4): 455-460+466.
25.	李紅, 毛文, 童凱. 單側雙通道內鏡下腰椎間融合術治療腰椎滑脫的臨床療效觀察. 中國中醫骨傷科雜志, 2022, 30(9): 58-61, 66.
26.	王棟, 高文碩, 洪奕胡, 等. 單側雙通道內鏡技術治療游離型腰椎間盤突出癥. 中醫正骨, 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.	王寧, 貝朝涌, 萬健, 等. 單側雙通道脊柱內鏡技術行腰椎椎間融合術學習曲線研究. 中國修復重建外科雜志, 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. 劉滔, 王晟昊, 譚成龍, 等. 重度腰椎峽部裂性滑脫后路椎間融合手術治療的臨床及影像學療效評價. 中國矯形外科雜志, 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. 張新亮, 黃大耿, 高文杰, 等. 微創經椎間孔入路腰椎椎體間融合術治療青少年雙側峽部裂型腰椎滑脫的療效分析. 中國醫師進修雜志, 2016, 39(10): 928-932.
4. 韋瑋, 李劍, 黃林海, 等. 選擇性后路植骨融合聯合釘棒系統內固定治療老年峽部裂性腰椎滑脫. 中國老年學雜志, 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. 梅啟元, 邵琳. 椎弓根內固定聯合不同融合方式治療峽部裂型腰椎滑脫癥效果比較. 解放軍醫藥雜志, 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. 萬云芳, 許黎柳, 楊雯, 等. MIS-TLIF與開放TLIF治療單節段腰椎退行性疾病圍手術期失血量的對比研究. 全科醫學臨床與教育, 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. 孫芝城, 王錫陽. 退行性腰椎滑脫微創融合手術進展. 中國微創外科雜志, 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. 王寒輝, 劉界, 徐亞勇, 等. 顯微鏡輔助微創通道下經椎間孔入路腰椎間融合術與開放經椎間孔椎體間融合術治療雙節段腰椎管狹窄癥的短中期療效. 實用醫學雜志, 2022, 38(11): 1373-1377.
13. 張玉紅, 田霖, 胡鵬, 等. 單側雙通道脊柱內鏡技術治療腰椎相關疾病的研究進展. 中國修復重建外科雜志, 2022, 36(10): 1234-1240.
14. 舒鵬, 王智偉, 陳剛. 單側雙通道脊柱內鏡下經椎間孔腰椎椎體間融合術治療單節段Ⅰ、Ⅱ度腰椎滑脫癥近期療效分析. 中國修復重建外科雜志, 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. 中華醫學會放射學分會骨關節學組, 中國醫師協會放射醫師分會肌骨學組, 中華醫學會骨科學分會骨質疏松學組, 等. 骨質疏松的影像學與骨密度診斷專家共識. 中國骨質疏松雜志, 2020, 26(9): 1249-1256.
17. 李杰, 陳意磊, 干開豐, 等. 后路固定對OLIF術后早期融合器沉降的影響. 西安交通大學學報 (醫學版), 2022, 43(1): 111-116.
18. 朱廣鐸, 鎬英杰, 于磊, 等. 經皮內鏡后路腰椎間融合術治療Ⅰ度腰椎滑脫. 中國矯形外科雜志, 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. 胡鳴, 畢大鵬, 俞勝寶. 開放與經皮椎弓根螺釘內固定治療單純胸腰椎椎體骨折的對比研究. 實用骨科雜志, 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, 田大勝, 陳磊, 等. 單邊雙通道內鏡技術在腰椎疾病中的應用研究進展. 中華骨科雜志, 2020, 40(15): 1030-1038.
23. 普星宇, 駱文遠, 高明暄, 等. 兩種不同技術聯合微創經椎間孔椎體間融合術治療退行性腰椎滑脫癥的病例對照研究. 中國骨傷, 2022, 35(5): 409-417.
24. 陳鵬程, 鐘海琳, 王樂, 等. 顯微鏡輔助下MIS-TLIF治療腰椎單節段退行性疾病的臨床療效觀察. 中國臨床解剖學雜志, 2020, 38(4): 455-460+466.
25. 李紅, 毛文, 童凱. 單側雙通道內鏡下腰椎間融合術治療腰椎滑脫的臨床療效觀察. 中國中醫骨傷科雜志, 2022, 30(9): 58-61, 66.
26. 王棟, 高文碩, 洪奕胡, 等. 單側雙通道內鏡技術治療游離型腰椎間盤突出癥. 中醫正骨, 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. 王寧, 貝朝涌, 萬健, 等. 單側雙通道脊柱內鏡技術行腰椎椎間融合術學習曲線研究. 中國修復重建外科雜志, 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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