Early Clinical Evaluation of Percutaneous Full-endoscopic Transforaminal Lumbar Interbody Fusion with Pedicle Screw Insertion for Treating Degenerative Lumbar Spinal Stenosis

Objective To compare the clinical efficacy of percutaneous full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) with percutaneous pedicle screws (PPSs) performed by using a visualization system with that of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of degenerative lumbar spinal stenosis (LSS). Methods From June 2017 to May 2018, the data of a total of 78 patients who met the selection criteria were retrospectively reviewed and were divided into the Endo-TLIF group (40 cases) and the MIS-TLIF group (38 cases) according to the surgical method used. The visual analog scale (VAS) and the Japanese Orthopaedic Association (JOA) scale were administered preoperatively and at the 1-week, 3-month, and 1-2-year follow-ups. The fusion rate and major complications, including revision, were also recorded. Results All the patients were followed up for 24 to 34 months, with an average follow-up of 30.7 months. The intraoperative blood loss and length of hospital stay for the Endo-TLIF group (60.56 +/- 0.36 mL, 8.12 +/- 0.92 days, respectively) were statistically significantly lower than those for the MIS-TLIF group (65.47 +/- 0.91 mL, 9.66 +/- 1.34 days, respectively) (P < 0.05). The VAS and JOA scores of the patients in the two groups at postoperative 1 week, 3 months, 1 year, 2 years (Endo-TLIF VAS: 4.16 +/- 0.92, 3.72 +/- 1.54, 1.32 +/- 0.45, 1.29 +/- 0.34; JOA:16.71 +/- 0.99, 19.86 +/- 0.24, 24.91 +/- 0.97, 25.88 +/- 0.52; MIS-TLIF VAS: 4.17 +/- 1.41, 2.98 +/- 0.91, 1.54 +/- 0.32, 1.33 +/- 0.18; JOA: 16.67 +/- 0.67, 19.58 +/- 0.65, 25.33 +/- 0.73, 25.69 +/- 0.33) were statistically significantly improved from the preoperative scores (Endo-TLIF: 8.45 +/- 1.44, 14.36 +/- 0.56; MIS-TLIF: 8.11 +/- 0.93, 14.45 +/- 0.34, respectively) (P < 0.01). The VAS and JOA scores of the Endo-TLIF group were statistically significantly better than those of the MIS-TLIF group at 3 months and 1 year after surgery (P < 0.05). There were no statistically significant differences in the scores between the two groups at any of the other time points (P > 0.05). There was no significant difference in the intervertebral altitude between the two groups at the 3-month (11.36 +/- 0.23, 11.21 +/- 0.42, respectively) or final follow-up (10.88 +/- 0.64, 10.81 +/- 0.39, respectively) (P > 0.05). Dural tears, cerebrospinal fluid leakage, infection, and neurologic injury did not occur. Both groups showed good intervertebral fusion at the last follow-up. The intervertebral fusion rate was 97.5% (39/40) in the Endo-TLIF group and 94.7% (36/38) in the MIS-TLIF group, with no statistically significant difference between the two groups (chi(2) = 0.118, P = 0.731). At the final follow-up, the modified MacNab's criteria were 92.5% and 89.5% between the two groups. Conclusion Endo-TLIF with percutaneous pedicle screws (PPS) performed by using a visualization system for lumbar degenerative disease may be regarded as an efficient alternative surgery for degenerative lumbar spinal stenosis. It is a safe and minimally invasive way to perform this surgery and has shown satisfactory clinical outcomes.