Clinical and Radiological Outcomes of Double-Cage Full Endoscopic Transforaminal Lumbar Interbody Fusion Compared...

Degenerative lumbar diseases accompanied by instability or severe foraminal stenosis are commonly treated with lumbar interbody fusion surgery. This study aimed to evaluate the clinical efficacy and safety of double-cage full endoscopic transforaminal lumbar interbody fusion (FE-TLIF) and posterior lumbar interbody fusion (PLIF) for the treatment of patients with severe degenerative lumbar disease.

The clinical and radiological data of patients who underwent FE-TLIF using double cages or PLIF between March 2021 and February 2024 were retrospectively reviewed. Patients with single-level degenerative lumbar disease and Meyerding grade I spondylolisthesis who failed to respond to conservative treatment for 12 weeks were included. Patients with multilevel diseases, previous surgeries, or other spinal pathologies were excluded.

In total, 115 patients were included in the study (58 underwent FE-TLIF and 57 underwent PLIF). Baseline characteristics were comparable between the groups. The operation time and blood loss were significantly lower in the FE-TLIF group, and the cage height and angle were slightly greater. The FE-TLIF group showed faster postoperative pain relief, whereas the clinical outcomes at 6 and 12 months were similar between groups. At 12 months, the fusion rates and incidence of cage subsidence >2 mm did not differ significantly, even after adjustment. Both groups showed significant improvements in segmental and total lumbar lordosis and disc height, with slightly greater disc height restoration in the FE-TLIF group. The complication rates were low and comparable.

Double-cage FE-TLIF achieved fusion and radiological outcomes comparable to those of PLIF, with the advantages of reduced blood loss, shorter operative time, and faster early pain relief. This technique may serve as a minimally invasive and effective alternative for treating single-level degenerative lumbar diseases.