Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis
Abstract:BackgroundEndoscopic lumbar interbody fusion is a new technology that is mostly used for single-segment and unilateral lumbar spine surgery. The purpose of this study is to introduce percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) with unilateral laminotomy for bilateral decompression (ULBD) for lumbar spondylolisthesis and evaluate the efficacy by comparing it with open posterior lumbar interbody fusion (PLIF).MethodsTwenty-eight patients were enrolled in PE-PLIF with the ULBD group and th… Show more
“…A total of 27 articles were included ( Table 1 ), comprising 953 patients in the Endo-LIF group and 1011 undergoing either Open-LIF ( n = 320) or MIS-LIF ( n = 691). Most studies were cohort studies ( n = 25; 18 being retrospective ( 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ), five prospective ( 31 , 32 , 33 , 34 , 35 ), and two not specified ( 36 , 37 )). A quasi-experimental study ( 38 ) and a RCT ( 39 ) were also included.…”
Section: Resultsmentioning
confidence: 99%
“… Figure 8 Endo-LIF vs MIS-LIF: forest plots with the mean difference for post-operative disability ( 6 , 14 , 15 , 16 , 18 , 21 , 22 , 23 , 29 , 35 , 36 , 38 ). Figure 9 Endo-LIF vs Open-LIF: forest plots with the mean difference for post-operative disability ( 13 , 19 , 24 , 26 , 31 , 32 , 33 , 37 ). …”
Section: Resultsmentioning
confidence: 99%
“…Endo-LIF vs Open-LIF: forest plots with the mean difference for post-operative disability (13, 19,24,26,31,32,33,37). https://doi.org/10.1530/EOR-23-0167…”
Section: Post-operative Pain and Disabilitymentioning
Study design
Systematic review; meta-analysis.
Purpose
Lumbar degenerative disease is frequent and has a tremendous impact on patients’ disability and quality-of-life. Open and minimally invasive procedures have been used to achieve adequate decompression and fusion. Endoscopic lumbar interbody fusion (Endo-LIF) is emerging as an alternative, trying to reduce morbidity, while achieving comparable to superior clinical outcomes. The aim of this work is to perform a systematic review and meta-analysis to investigate how Endo-LIF compares to open or minimally invasive procedures.
Methods
Electronic databases (MEDLINE, Scopus, Web of Science, Cochrane) were systematically reviewed using the query: ‘(percutaneous OR endoscop*) AND (open OR minimal* invasive) AND lumbar AND fusion’. PRISMA guidelines were followed.
Results
Twenty-seven articles were included (25 cohort study, 1 quasi-experimental study, and 1 randomized control trial; for meta-analytical results, only observational studies were considered). Endo-LIF conditioned longer operative time, with significantly lower blood loss, bedtime, and hospital length of stay. Early post-operative back pain favored endoscopic techniques. Endo-LIF and non-Endo-LIF minimally invasive surgery displayed comparable results for most back and leg pain or disability outcomes, despite Endo-LIF having been associated with higher disability at late follow-up (versus Open-LIF). No differences were found regarding fusion rates, cage subsidence, or adverse events. Definitive conclusions regarding fusion rate cannot be drawn due to low number of studies and unstandardized fusion definition.
Conclusion
Endo-LIF is an effective and safe alternative to conventional lumbar interbody fusion procedures. Evidence shortcomings may be addressed, and future randomized control trials may be performed to compare techniques and to validate results.
“…A total of 27 articles were included ( Table 1 ), comprising 953 patients in the Endo-LIF group and 1011 undergoing either Open-LIF ( n = 320) or MIS-LIF ( n = 691). Most studies were cohort studies ( n = 25; 18 being retrospective ( 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ), five prospective ( 31 , 32 , 33 , 34 , 35 ), and two not specified ( 36 , 37 )). A quasi-experimental study ( 38 ) and a RCT ( 39 ) were also included.…”
Section: Resultsmentioning
confidence: 99%
“… Figure 8 Endo-LIF vs MIS-LIF: forest plots with the mean difference for post-operative disability ( 6 , 14 , 15 , 16 , 18 , 21 , 22 , 23 , 29 , 35 , 36 , 38 ). Figure 9 Endo-LIF vs Open-LIF: forest plots with the mean difference for post-operative disability ( 13 , 19 , 24 , 26 , 31 , 32 , 33 , 37 ). …”
Section: Resultsmentioning
confidence: 99%
“…Endo-LIF vs Open-LIF: forest plots with the mean difference for post-operative disability (13, 19,24,26,31,32,33,37). https://doi.org/10.1530/EOR-23-0167…”
Section: Post-operative Pain and Disabilitymentioning
Study design
Systematic review; meta-analysis.
Purpose
Lumbar degenerative disease is frequent and has a tremendous impact on patients’ disability and quality-of-life. Open and minimally invasive procedures have been used to achieve adequate decompression and fusion. Endoscopic lumbar interbody fusion (Endo-LIF) is emerging as an alternative, trying to reduce morbidity, while achieving comparable to superior clinical outcomes. The aim of this work is to perform a systematic review and meta-analysis to investigate how Endo-LIF compares to open or minimally invasive procedures.
Methods
Electronic databases (MEDLINE, Scopus, Web of Science, Cochrane) were systematically reviewed using the query: ‘(percutaneous OR endoscop*) AND (open OR minimal* invasive) AND lumbar AND fusion’. PRISMA guidelines were followed.
Results
Twenty-seven articles were included (25 cohort study, 1 quasi-experimental study, and 1 randomized control trial; for meta-analytical results, only observational studies were considered). Endo-LIF conditioned longer operative time, with significantly lower blood loss, bedtime, and hospital length of stay. Early post-operative back pain favored endoscopic techniques. Endo-LIF and non-Endo-LIF minimally invasive surgery displayed comparable results for most back and leg pain or disability outcomes, despite Endo-LIF having been associated with higher disability at late follow-up (versus Open-LIF). No differences were found regarding fusion rates, cage subsidence, or adverse events. Definitive conclusions regarding fusion rate cannot be drawn due to low number of studies and unstandardized fusion definition.
Conclusion
Endo-LIF is an effective and safe alternative to conventional lumbar interbody fusion procedures. Evidence shortcomings may be addressed, and future randomized control trials may be performed to compare techniques and to validate results.
“… 7 Despite this, endoscopic decompression techniques, which are relatively new, have increased in popularity. 15 Increased utilization of endoscopic procedures can be attributed to the minimally invasive nature of endoscopic procedures. 12 Previous studies comparing open to endoscopic decompression surgery have found fewer surgical complications in the latter cohort.…”
“…In addition, less postoperative low back pain compared to other techniques was observed [ 21 ]. The reason for this reduced pain may be due to less surgical trauma [ 24 ], less estimated blood loss [ 29 ], and shorter hospital stay [ 39 ] with ELIF compared to the other surgical techniques.…”
Full endoscopic techniques are becoming more popular for degenerative lumbar pathologies. Percutaneous endoscopic lumbar interbody fusion (PETLIF) is a minimally invasive surgical technique for spondylolisthesis and lumbar spinal canal stenosis with instability. Nagahama first introduced PETLIF in 2019. This study investigated the clinical outcomes and complications of 24 patients who underwent PETLIF in our facility and compared them with previous studies. Literature searches were conducted on PubMed and Web of Science. The PETLIF surgical technique involves three steps to acquire disc height under general anesthesia. The procedure includes bone harvesting, spondylolisthesis reduction, endoscopic foraminoplasty, disc height expansion using an oval dilator, and intervertebral disc curettage. A cage filled with autologous bone is inserted into the disc space and secured with posterior fixation. Patients underwent PETLIF with an average operation time of 130.8 min and a blood loss of 24.0 mL. Postoperative hospital stays were 9.5 days. Improvement in VAS, disc height, spinal canal area, and % slip was observed, while lumbar lordosis remained unchanged. Complications included end plate injury, subsidence, and exiting nerve root injury. The differences between PETLIF and the extracted literature were found in patients’ age, direct decompression, epidural or local anesthesia, approach, order of PPS, and cage insertion. In conclusion, PETLIF surgery is a practical, minimally invasive surgical technique for patients with lumbar degenerative diseases suffering from back and leg pain, demonstrating significant improvements in pain scores. However, it is essential to carefully consider the potential complications and continue to refine the surgical technique further to enhance the safety and efficacy of this procedure.
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