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Objectives <p>This study aimed to compare surgical characteristics, complications, and long-term outcomes among open transforaminal lumbar interbody fusion (Open-TLIF), minimally invasive TLIF (MIS-TLIF), and unilateral biportal endoscopic TLIF (UBE-TLIF) for grade I–II degenerative lumbar spondylolisthesis (DLS).</p> Methods <p>From January 2018 to June 2020, 279 patients with DLS who underwent Open-TLIF, MIS-TLIF, or UBE-TLIF and completed a 5-year follow-up were enrolled. Based on surgical approach, they were divided into three groups (each <i>n</i> = 93). Baseline characteristics and surgical characteristics were collected during hospitalization, and complications were recorded over the 5-year follow-up. Functional outcomes were assessed using Visual Analog Scale for back pain (VAS-B) and leg pain (VAS-L), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores, while radiographic outcomes were evaluated based on intervertebral disc height (IDH), slip angle, slip percentage, and fusion rate.</p> Results <p>The Open-TLIF had the shortest operative time and least fluoroscopy frequency, but the highest blood loss and drainage (<i>P</i> &lt; 0.05). The MIS-TLIF required the longest operation time and most fluoroscopy, while the UBE-TLIF resulted in the smallest incision, least blood loss, shortest hospitalization, and lowest drainage (<i>P</i> &lt; 0.05). Throughout the 5-year follow-up, the MIS-TLIF group showed significantly higher VAS-L and ODI scores, and lower JOA scores at 3 and 5&#xa0;years compared to the other two groups (<i>P</i> &lt; 0.05). A similar trend was observed in radiographic outcomes such as IDH, slip angle, and slip percentage, with significant differences emerging at 3&#xa0;years and further increasing at 5&#xa0;years (<i>P</i> &lt; 0.05). There were no significant differences in total complication rates or fusion rates among the groups (<i>P</i> &gt; 0.05).</p> Conclusion <p>While short-term outcomes are similar across techniques, mid- to long-term results favor both Open- and UBE-TLIF. Given its minimally invasive advantages and faster recovery, UBE-TLIF is a preferable alternative for grade I–II DLS.</p>

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Long-term comparative study of Open-TLIF, MIS-TLIF, and UBE-TLIF in single-level degenerative lumbar spondylolisthesis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月27日

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  • Jian Luo,
  • Lihua Shen,
  • Changshen Bao,
  • Zhichao Gao

摘要

Objectives

This study aimed to compare surgical characteristics, complications, and long-term outcomes among open transforaminal lumbar interbody fusion (Open-TLIF), minimally invasive TLIF (MIS-TLIF), and unilateral biportal endoscopic TLIF (UBE-TLIF) for grade I–II degenerative lumbar spondylolisthesis (DLS).

Methods

From January 2018 to June 2020, 279 patients with DLS who underwent Open-TLIF, MIS-TLIF, or UBE-TLIF and completed a 5-year follow-up were enrolled. Based on surgical approach, they were divided into three groups (each n = 93). Baseline characteristics and surgical characteristics were collected during hospitalization, and complications were recorded over the 5-year follow-up. Functional outcomes were assessed using Visual Analog Scale for back pain (VAS-B) and leg pain (VAS-L), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores, while radiographic outcomes were evaluated based on intervertebral disc height (IDH), slip angle, slip percentage, and fusion rate.

Results

The Open-TLIF had the shortest operative time and least fluoroscopy frequency, but the highest blood loss and drainage (P < 0.05). The MIS-TLIF required the longest operation time and most fluoroscopy, while the UBE-TLIF resulted in the smallest incision, least blood loss, shortest hospitalization, and lowest drainage (P < 0.05). Throughout the 5-year follow-up, the MIS-TLIF group showed significantly higher VAS-L and ODI scores, and lower JOA scores at 3 and 5 years compared to the other two groups (P < 0.05). A similar trend was observed in radiographic outcomes such as IDH, slip angle, and slip percentage, with significant differences emerging at 3 years and further increasing at 5 years (P < 0.05). There were no significant differences in total complication rates or fusion rates among the groups (P > 0.05).

Conclusion

While short-term outcomes are similar across techniques, mid- to long-term results favor both Open- and UBE-TLIF. Given its minimally invasive advantages and faster recovery, UBE-TLIF is a preferable alternative for grade I–II DLS.