Qianqin Hu,1 Keyi Xiao,2 Jin-Niang Nan,3 Shang-Wun Jhang,4 Chien-Min Chen,4– 6,* Guang-Xun Lin7,* 

1First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, People’s Republic of China; 2The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 3Department of Clinical Medicine, Nanchang Medical College, Nanchang, Jiangxi, People’s Republic of China; 4Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; 5Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan; 6Department of Biomedical Sciences National Chung Cheng University, Chiayi, Taiwan; 7Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Chien-Min Chen, Email 96015@cch.org.tw Guang-Xun Lin, Email linguangxun@hotmail.com

Objective: To effectuate a comprehensive juxtaposition of the clinical implications, incidence of complications, and successful fusion rates observed in the context of biportal endoscopic lumbar interbody fusion (BE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
Methods: The present research initiative involved an exhaustive exploration of pertinent scholarly literature in renowned databases, which lasted until April 2023. The evaluative framework encompassed a diverse array of parameters, including but not limited to operation time, hospitalization, quantification of estimated blood loss, the assessment of outcomes via the application of the Visual Analog Scale (VAS) to gauge pain intensity, and the utilization of the Oswestry Disability Index (ODI) to measure functional impairment.
Results: The current meta-analysis included ten studies with a total of 736 participants. In comparison of the BE-LIF and MI-TLIF techniques, no substantial differences were observed in the parameters studied, included VAS for leg pain (P > 0.05), as well as the assessment of complication rates (7.76% versus 7.97%; P = 0.71) and fusion rates (89.59% versus 88.60%; P = 0.90). However, the early postoperative VAS for back pain (P < 0.0001) and the early postoperative ODI score (P = 0.007) were significantly lower in the BE-LIF group than in the MI-TLIF group. Additionally, a significant difference in blood loss was observed (P < 0.0001), with less blood loss in the BE-LIF group compared to the MI-TLIF group. Furthermore, the complex surgical procedure of BE-LIF resulted in a longer duration of surgery (P = 0.02) but shorter hospitalization compared with MI-TLIF (P < 0.0001).
Conclusion: Within the context of the management of lumbar degenerative diseases, BE-LIF surgery exhibits clinical effectiveness and incidence of complications comparable to MI-TLIF. In contrast to MI-TLIF, BE-LIF offers distinctive merits, including reduced blood loss, abbreviated hospitalization durations, expedited relief from postoperative back pain, and an accelerated trajectory towards functional recuperation.

Keywords: BESS, biportal endoscopy, lumbar interbody fusion, lumbar degenerative disease, minimally invasive spine surgery, UBE