A Modified Endoscopic Transforaminal Lumbar Interbody Fusion Technique: Preliminary Clinical Results of 96 Cases

Background: As a newly emerging technique, endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has become an increasingly popular procedure of interest. The purpose of this study was to introduce a modified Endo-TLIF system and share our preliminary clinical experiences and outcomes in treating lumbar degenerative disease with this procedure. Methods: Ninety-six patients (thirty-seven men and fifty-nine women; mean age 55.85 +/- 11.03 years) with lumbar degenerative diseases who underwent Endo-TLIF in our hospital were enrolled. The surgical time, volume of intraoperative blood loss, postoperative hospitalization time and postoperative drainage were documented. Clinical outcomes were evaluated by visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and modified MacNab criteria. Bone fusion was identified through computerized tomography (CT) scans or X-ray during the follow-up period. Results: All patients were followed up for at least 12 months, and the average follow-up time was 17.03 +/- 3.27 months. The mean operative time was 136.79 +/- 30.14 minutes, and the mean intraoperative blood loss was 53.06 +/- 28.89 ml. The mean VAS scores of low back pain and leg pain were 5.05 +/- 1.37 and 6.25 +/- 1.03, respectively, before surgery, which improved to 2.27 +/- 0.66 and 2.22 +/- 0.55, respectively, after the operation (P < 0.05). The final VAS scores of low back pain and leg pain were 0.66 +/- 0.60 and 0.73 +/- 0.66, respectively (P < 0.05). The preoperative ODI score (49.06 +/- 6.66) also improved significantly at the 3-month follow-up (13.00 +/- 7.37; P < 0.05). The final ODI score was 8.03 +/- 6.13 (P < 0.05). There were 10 cases of non-fusion (nine women and one man) at the 12-month follow-up, but no cases of non-union were identified by imaging at the final follow-up. Conclusions: The present study demonstrated satisfactory clinical and radiologic results among patients who received Endo-TLIF treatment from our institution. This indicates that Endo-TLIF is efficient and safe for select patients.