Comparison of the Outcomes of Endoscopic Posterolateral Interbody Fusion and Lateral Interbody Fusion in the Treatment of Lumbar Degenerative Disease: A Systematic Review and Network Meta-Analysis.

Abstract

Objective: Although endoscopic technologies have been increasingly applied in lumbar fusion surgery in recent years, the advantages and disadvantages of endoscopic posterolateral fusion compared with lateral fusion remain unclear. Six different single-level lumbar interbody fusion procedures were compared to determine whether indirect decompression fusion could achieve levels of efficacy and safety comparable to those of minimally invasive direct decompression fusion in the treatment of lumbar degenerative disease (LDD).

Method: A literature search was conducted in the PubMed, Embase, and Cochrane Library databases, and studies on the treatment of LDD published from 2004 to March 2024 were retrieved. The data of preset clinical outcome measures, including operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, and the Oswestry Disability Index (ODI), were extracted from the studies.

Results: Thirty-five studies with 3467 patients were included in this review. Network meta-analysis revealed no significant differences in improvements in pain and disability or adverse events among the procedures, except for uniportal endoscopic lumbar interbody fusion (UELIF), which resulted in a lower degree of improvement in the ODI than oblique lateral interbody fusion (OLIF). Stand-alone lateral lumbar interbody fusion (SA-LLIF) exhibited the best performance in terms of indicators of early efficacy, such as surgical time and LOS. OLIF and SA-LLIF had higher fusion rates than did UELIF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). MIS-TLIF resulted in greater EBL than did OLIF, SA-LLIF, and UELIF.

Conclusion: Minimally invasive lumbar interbody fusion achieves good therapeutic results in LDD patients regardless of the use of indirect or direct decompression, whereas SA-LLIF has better early efficacy.