Zhang Xuelei, Yuan Qiumei, Zhang Yu, Gu Zuchao, Li Guo
Department of Orthopedics, Chengdu Integrated TCM & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu, Sichuan Province, China.
Department of Anesthesia and Surgery Center, Chengdu Integrated TCM & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu, Sichuan Province, China.
PLoS One. 2025 Apr 29;20(4):e0321569. doi: 10.1371/journal.pone.0321569. eCollection 2025.
To compare the mid-term clinical and radiological outcomes between unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment lumbar degenerative disease.
Patients with L4-S1 disease treated with fusion surgery in our department between August 1, 2019 and June 30, 2020 were retrospectively analyzed. The patients were categorized into ULIF and MIS-TLIF groups based on the surgical method performed. The preoperative demographic baseline and operation-related indicators of the groups were compared, including operative time, estimated blood loss (EBL), postoperative drainage volume, time to ambulation, and postoperative hospital stay. The Visual Analog Scale (VAS) was utilized to assess the severity of back pain (VAS-B) and leg pain (VAS-L). The Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scores were employed to evaluate the level of functionality. Bridwell criteria were used to evaluate interbody fusion. The lumbar lordotic angle (LLA), intervertebral disc height (IDH), and segmental lordotic angle (SLA) pre- and post-operatively were compared. The creatine kinase (CK), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6) levels pre- and post-operatively, and the complication rates were compared.
The baseline preoperative demographics of the ULIF (n=35) and MIS-TLIF (n=42) groups did not differ significantly. Compared with MIS-TLIF, ULIF had lower intraoperative blood loss and postoperative drainage volume and shorter time to ambulation and postoperative hospital stay, but longer operative time. The VAS-B, VAS-L, JOA, and ODI scores of both groups significantly improved. The VAS-L at 1 week postoperatively, the VAS-B at 1 week and 1 month postoperatively, and the JOA and ODI scores at 1 month postoperatively were better in the ULIF group. At 1 and 3 days postoperatively, the ULIF group exhibited substantially reduced levels of CRP, CK, and IL-6. The fusion rates did not differ significantly at 1 year, 2 years, and 3 years of follow-up. The IDH, SLA, and LLA improved significantly in both groups but no significant differences were observed between the two groups. Complication rates were comparable between the two groups.
Both ULIF and MIS-TLIF are proven to be safe and effective minimally invasive lumbar fusion techniques. Both achieve comparable outcomes in terms of interbody fusion rate, long-term pain relief, functional improvement, and complication rate. Compared with MIS-TLIF, ULIF has less intraoperative blood loss, less postoperative drainage volume, reduced inflammatory reaction, and faster postoperative pain relief and functional improvement.
比较单侧双孔内镜下经椎间孔腰椎椎间融合术（ULIF）与微创经椎间孔腰椎椎间融合术（MIS-TLIF）治疗单节段腰椎退行性疾病的中期临床和影像学结果。
回顾性分析2019年8月1日至2020年6月30日在我科接受融合手术治疗的L4-S1疾病患者。根据所采用的手术方法将患者分为ULIF组和MIS-TLIF组。比较两组术前人口统计学基线和手术相关指标，包括手术时间、估计失血量（EBL）、术后引流量、下床活动时间和术后住院时间。采用视觉模拟评分法（VAS）评估背痛（VAS-B）和腿痛（VAS-L）的严重程度。采用Oswestry功能障碍指数（ODI）和日本骨科协会（JOA）评分评估功能水平。采用Bridwell标准评估椎间融合情况。比较术前和术后的腰椎前凸角（LLA）、椎间盘高度（IDH）和节段性前凸角（SLA）。比较术前和术后的肌酸激酶（CK）、C反应蛋白（CRP）、红细胞沉降率（ESR）和白细胞介素-6（IL-6）水平以及并发症发生率。
ULIF组（n=35）和MIS-TLIF组（n=42）术前人口统计学基线无显著差异。与MIS-TLIF相比，ULIF术中失血量和术后引流量更少，下床活动时间和术后住院时间更短，但手术时间更长。两组的VAS-B、VAS-L、JOA和ODI评分均显著改善。ULIF组术后1周的VAS-L、术后1周和1个月的VAS-B以及术后1个月的JOA和ODI评分更好。术后1天和3天，ULIF组的CRP、CK和IL-6水平显著降低。随访1年、2年和3年时融合率无显著差异。两组的IDH、SLA和LLA均显著改善，但两组之间未观察到显著差异。两组并发症发生率相当。
ULIF和MIS-TLIF均被证明是安全有效的微创腰椎融合技术。两者在椎间融合率、长期疼痛缓解、功能改善和并发症发生率方面均取得了相当的结果。与MIS-TLIF相比，ULIF术中失血量更少，术后引流量更少，炎症反应减轻，术后疼痛缓解和功能改善更快。
