Long-term comparative study of Open-TLIF, MIS-TLIF, and UBE-TLIF in single-level degenerative lumbar...

This study aimed to compare surgical characteristics, complications, and long-term outcomes among open transforaminal lumbar interbody fusion (Open-TLIF), minimally invasive TLIF (MIS-TLIF), and unilateral biportal endoscopic TLIF (UBE-TLIF) for grade I-II degenerative lumbar spondylolisthesis (DLS).

From January 2018 to June 2020, 279 patients with DLS who underwent Open-TLIF, MIS-TLIF, or UBE-TLIF and completed a 5-year follow-up were enrolled. Based on surgical approach, they were divided into three groups (each n = 93). Baseline characteristics and surgical characteristics were collected during hospitalization, and complications were recorded over the 5-year follow-up. Functional outcomes were assessed using Visual Analog Scale for back pain (VAS-B) and leg pain (VAS-L), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores, while radiographic outcomes were evaluated based on intervertebral disc height (IDH), slip angle, slip percentage, and fusion rate.

The Open-TLIF had the shortest operative time and least fluoroscopy frequency, but the highest blood loss and drainage (P < 0.05). The MIS-TLIF required the longest operation time and most fluoroscopy, while the UBE-TLIF resulted in the smallest incision, least blood loss, shortest hospitalization, and lowest drainage (P < 0.05). Throughout the 5-year follow-up, the MIS-TLIF group showed significantly higher VAS-L and ODI scores, and lower JOA scores at 3 and 5 years compared to the other two groups (P < 0.05). A similar trend was observed in radiographic outcomes such as IDH, slip angle, and slip percentage, with significant differences emerging at 3 years and further increasing at 5 years (P < 0.05). There were no significant differences in total complication rates or fusion rates among the groups (P > 0.05).

While short-term outcomes are similar across techniques, mid- to long-term results favor both Open- and UBE-TLIF. Given its minimally invasive advantages and faster recovery, UBE-TLIF is a preferable alternative for grade I-II DLS.