Uniportal endoscopic posterior lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion for elderly patients with lumbar degenerative diseases: a retrospective comparative study of reduced surgical trauma and accelerated early pain relief

Background Lumbar degenerative diseases are prevalent spinal disorders among the elderly population worldwide, significantly impairing their quality of life. Both minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and uniportal endoscopic posterior lumbar interbody fusion (Endo-PLIF) are established minimally invasive interbody fusion modalities for the management of these conditions. However, MIS-TLIF is associated with limitations such as soft tissue compression induced by dilator tubes and a comparatively prolonged postoperative recovery period. In the present study, we aimed to compare the clinical efficacy and radiographic outcomes of Endo-PLIF vs. MIS-TLIF in the treatment of lumbar degenerative diseases in elderly patients. Methods A retrospective analysis was performed of 77 elderly patients with lumbar degenerative diseases who were admitted to the Department of Spinal Minimally Invasive Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, between September 2021 and March 2022. The patients were divided into two groups: 35 patients underwent Endo-PLIF and 42 patients underwent MIS-TLIF. The groups were compared in terms of operative time, intraoperative blood loss, length of hospital stay, Visual analogue score (VAS), Oswestry Disability Index (ODI), serum C-reactive protein (CRP) levels, radiographic parameters (including disc space height, lumbar lordosis angle, and fusion rate), the modified MacNab criteria, and the incidence of postoperative complications. Results All procedures were successfully completed in both cohorts, with a follow-up period of more than 12 months. No statistically significant difference was observed in operative time between the two groups ( P > 0 .05). The Endo-PLIF group demonstrated significantly superior outcomes regarding intraoperative blood loss, postoperative drainage volume and length of hospital stay ( P < 0.05). Significant improvements in VAS scores and ODI were observed at all postoperative time points compared with preoperative baseline values in both groups ( P < 0.05). The Endo-PLIF group exhibited significantly lower low back pain VAS scores at 1 week, 1 month, and 3 months postoperatively, as well as a superior ODI at 3 months, compared with the MIS-TLIF group ( P < 0.05). However, no significant intergroup differences were detected in low back pain VAS scores, ODI at other time points, or leg pain VAS scores across all assessed time points ( P > 0.05). Furthermore, serum CRP levels at all postoperative intervals were significantly lower in the Endo-PLIF group than in the MIS-TLIF group ( P < 0.05). No statistically significant differences were noted between the groups in terms of complication rates, the excellent-good rate based on the modified MacNab criteria at final follow-up, postoperative disc space height, postoperative lumbar lordosis angle, or the 12-month fusion rate (94% in the Endo-PLIF group and 95% in the MIS-TLIF group, P > 0.05). Conclusion Both Endo-PLIF and MIS-TLIF achieve favorable short- to mid-term clinical and radiographic outcomes in elderly patients with lumbar degenerative diseases. Moreover, the Endo-PLIF technique offers additional advantages, including minimal invasiveness, reduced postoperative drainage, and facilitation of accelerated postoperative recovery.