Extra-Flaval Lateralized Transforaminal Lumbar Interbody Fusion Using Unilateral Biportal Endoscopy: A Technical Note...

Area of Science:

• Minimally Invasive Spine Surgery
• Spinal Fusion Techniques
• Endoscopic Spine Procedures

Background:

• Unilateral biportal endoscopy (UBE)-assisted transforaminal lumbar interbody fusion (TLIF) is an emerging minimally invasive surgical option for lumbar instability.
• This study evaluates a specific lateralized, extra-flaval UBE-TLIF technique that preserves the ligamentum flavum and utilizes anatomical landmarks.

Purpose of the Study:

• To assess the clinical outcomes and safety of the lateralized, extra-flaval UBE-TLIF technique.
• To evaluate improvements in pain and functional disability following the procedure.

Main Methods:

• Retrospective analysis of 58 consecutive patients undergoing the procedure by a single surgeon.
• Procedures performed under general anesthesia with local infiltration, using biplanar fluoroscopy for guidance.
• Percutaneous pedicle screw-rod fixation without navigation or intraoperative neuromonitoring.
• Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) pain scores were measured preoperatively and at multiple follow-up points (2 weeks, 1, 6, and 12 months).

Main Results:

• Significant improvements were observed in ODI scores from 83.28 preoperatively to 6.31 at 1 year (P < 0.001).
• Both VAS back and leg pain scores showed substantial reductions, reaching near-zero levels at 1 year (P < 0.001).
• A low complication rate was reported, with one case of cage migration requiring revision and transient dysesthesia in 6.9% of patients.

Conclusions:

• The lateralized, extra-flaval UBE-TLIF technique with percutaneous fixation provides rapid and durable improvements in pain and disability.
• Preservation of the ligamentum flavum and precise corridor definition may enhance safety and facilitate cage insertion.
• Further prospective studies are warranted to standardize fusion assessment.