Clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion and modified posterior lumbar interbody fusion in the treatment of lumbar degenerative disease

To compare the early clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and modified posterior lumbar interbody fusion (MPLIF) in the treatment of lumbar degenerative disease (LDD).

A total of 37 patients who underwent PE-PLIF and 58 patients who underwent MPLIF from March 2019 to January 2022 were retrospectively reviewed. The operation time, intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were recorded. The visual analogue scale (VAS) scores of leg pain and low back pain, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI) scores were evaluated and compared before the operation, 3 days after the operation, 1 week after the operation, 1 month after the operation, 6 months after the operation and at the last follow-up. The modified MacNab’s criteria were applied at the last follow-up. The fusion rate and surgical-related complications during follow-up were recorded.

The average operation time in the PE-PLIF group was highly significant longer than that in the MPLIF group (P < 0.01). The intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were significantly less in the PE-PLIF group than those in the MPLIF group (P < 0.01). There were highly significant differences in VAS scores of leg pain, VAS scores of low back pain, JOA scores, ODI scores at the last follow-up compared with those before the operation in the two groups (P < 0.01). Three days after the operation and 1 week after the operation, the VAS scores for low back pain and ODI were highly significant less in the PE-PLIF group than that in the MPLIF group (P < 0.01). Three days after the operation, the JOA scores were highly significant higher in the PE-PLIF group than that in the MPLIF group (P < 0.01). All patients showed intervertebral fusion at 6 months after the operation. Two patients (5.4%) in the PE-PLIF group experienced complications.

Both PE-PLIF and MPLIF surgery were clinically effective and safe for patients with single-segment LDD. PE-PLIF surgery is a promising technique that can be used as an alternative treatment for single-segment LDD.