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Comparative evaluation of the efficacy and safety of PE-TLIF and MIS-TLIF in single segment spinal degenerative disease: a meta-analysis of cohort studies
⁎Corresponding author: Tianwei Sun. billsuntw@163.com
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Received: ,
Accepted: ,
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
Percutaneous endoscopic transforaminal luminal interbody fusion (PE-TLIF) and minimally invasive transforaminal luminal interbody fusion (MIS-TLIF) are commonly employed minimally invasive surgical approaches for lumbar degenerative disease. The aim of this study is to compare the efficacy and safety of the two surgical methods.
To compare the clinical and perioperative outcomes of PE-TLIF versus MIS-TLIF.
We searched the Cochrane Library using (MIS-TLIF) AND ((PE-TLIF) OR (P-TLIF)) OR (Endo TLIF) as the search term, Embase, PubMed, and China National Knowledge Infrastructure databases from database establishment to February 15, 2025, and select literature with single segment surgery as the surgical approach. We conducted a meta-analysis and systematic review of Visual Analog Scale (VAS), Oswestry Disability Index (ODI), surgical duration, hospital stay, evidence of complications, and intra-operative blood loss for the back and legs.
Fourteen studies involving 1102 patients were included. Compared with MIS-TLIF, PE-TLIF showed lower VAS scores for back pain at 3 months postoperatively [SMD = −0.45, 95 %CI(−0.56, −0.34), P < 0.00001] and 12 months postoperatively [SMD = −0.16, 95 %CI (−0.30, −0.02), P = 0.02]. In the VAS (L) comparison, the two groups showed a statistically significant difference at 6 months post-surgery [SMD = −0.19, 95 %CI(−0.37, −0.01), P = 0.03]. Similarly, PE-TLIF had a lower ODI compared to MIS-TLIF only in 6 months after surgery [SMD = −1.75, 95 %CI(−2.94, −0.56), P = 0.004]. The two surgical approaches demonstrated statistically significant differences in operative time [WMD = 18.37, 95 % CI: 3.89 to 32.84, P = 0.01], intraoperative blood loss[WMD = −42.51, 95 % CI: 57.25 to −27.77, P < 0.00001], and hospital stays[WMD = −1.08, 95 % CI: 1.65 to −0.50, P = 0.0002], while showing no significant differences in complication rates[WMD = 1.12, 95 % CI: 0.67 to 1.84, P = 0.67,] and fusion rates[WMD = 0.79, 95 % CI: 0.48 to 1.31, P = 0.37].
hospital stay This meta-analysis indicates that PE-TLIF and MIS-TLIF each have their respective advantages. Given the limited number of high-quality studies and heterogeneity in results, further multicenter randomized controlled trials are required to confirm these findings.
Keywords
PE-TLIF
MIS-TLIF
Lumbar Vertebrae
Degenerative disc disease
Cohort studies
Meta-analysis
1 Background
Lumbar degenerative diseases (LDD) include lumbar disc herniation, lumbar spondylolisthesis, lumbar instability, etc.1 With the aging population, more and more people are troubled by LDD. These diseases may cause long-term persistent lower back pain, which may radiate to one or both lower limbs, with or without symptoms such as numbness and restricted movement.2,3 These symptoms may seriously reduce the patient's quality of life and cause a heavy economic burden. Conservative treatment is suitable for most patients, however, as the disease progresses, some patients may choose surgical treatment due to various discomforts.
Transforaminal lumbar interbody fusion (TLIF) is a widely used surgical approach for the treatment of degenerative lumbar spine diseases. However, continuous traction during surgery may lead to ischemia, denervation, and lumbar muscle dysfunction, resulting in chronic postoperative pain in patients.4 Experimental studies have shown that sustained retraction or compression of spinal nerve roots may reduce intraneural blood flow and impair conduction in animal models.5,6 Minimally invasive spinal surgery (MIS) has emerged over the past two decades as an important evolution in the treatment of degenerative lumbar spine diseases, Techniques such as minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), oblique lumbar interbody fusion (OLIF), and lateral lumbar interbody fusion (LLIF) have demonstrated promising outcomes in terms of reduced blood loss, faster functional recovery, and shorter hospital stays compared to traditional open approaches.7,8 Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) represents a further refinement, combining the benefits of endoscopic visualization with percutaneous instrumentation.9
PE-TLIF is a type of Endo-TLIF that uses an endoscope to directly reach the intervertebral disc through the intervertebral foramen, without the need to completely remove the vertebral plate, superior articular process, inferior articular process, or ligamentum flavum.10 This gives PE-TLIF the advantages of minimal surgical trauma and less muscle damage. However, the steep learning curve of PE-TLIF affects the surgeon's choice of surgical approach.11
This study aims to explore the differences in safety and clinical efficacy between MIS-TLIF and PE-TLIF.
2 Methods and materials
This study strictly followed the Preferred Reporting Items for Systematic Reviews and Meta analysis (PRISMA) statement guidance for meta-analysis.12
2.1 Search strategy
We conducted a literature search in the following databases: The Cochrane Library, Embase, PubMed and the China National Knowledge Infrastructure (CNKI), From the date of database establishment until February 2025. Our keywords are as follows: (MIS-TLIF) AND ((PE-TLIF) OR (P-TLIF)) OR (Endo TLIF). Researchers did not restrict the language of the retrieved articles.
The PICOS principle was strictly followed by researchers during the retrieval process:(1)Population: Patients with degenerative spinal changes such as lumbar disc herniation, lumbar spondylolisthesis, spinal instability, and spinal stenosis.(2)Intervention (PE-TLIF): The patient underwent a single segment of PE-TLIF surgery due to degenerative spinal disease.(3)Comparison (MIS-TLIF): The patient underwent a single segment of MIS-TLIF surgery due to degenerative spinal disease.(4)Outcome: Surgical duration, Intraoperative blood loss, Hospital stays, Fusion rate, Incidence of complications, VAS (Back), VAS(Leg), ODI.(5)Study design: Randomized controlled trials or cohort studies.
2.2 Data collection
Two researchers independently conducted research using keywords and checked for missing references to obtain as much eligible literature as possible. When two researchers had different opinions on whether the literature can be included, they should seek the help of a third researcher and ultimately reach a consensus.
Two researchers used Microsoft Excel (Microsoft, Redmond, WA) to extract the following data from the included literature: (1) first author, publication year, country, research type, and quality evaluation. (2) Surgical duration, hospital stay, intraoperative blood loss, fusion rate, incidence of complications, VAS (B), VAS (L) and ODI. Any disagreements related to data extraction were resolved through discussion and consensus with the third researcher. Given the nature of published studies, blinding of study information was not feasible.
2.3 Quality assessment
Two researchers used the 9-point Newcastle Ottawa Scale (NOS) to evaluate the quality of cohort studies. The higher the score, the higher the quality of the article. We conducted Egger’ test and the Begg’ test on the primary and secondary indicators using Stata18.0 to quantitatively evaluate publication bias.
2.4 Data analysis
We conducted statistical analysis on the collected data using Review Manager 5.4 (Cochrane Collaboration). The main outcomes were analyzed separately for baseline and follow-up data, with follow-up dates set as subgroups (three months after surgery, six months after surgery, and 12 months after surgery). The size of I2 represented the level of heterogeneity, and the effect model was selected based on I2. When I2 < 50 %, chose the fixed effects model, and when I2 ≥ 50 %, chose the random effects model. Continuous variables were reported in the form of weighted mean difference (MD) and 95 % confidence interval (CI), while binary variables were reported in the form of odd ratio (OR) and 95 % CI. If the P-value was less than 0.05, it was considered statistically significant.
3 Results
3.1 Search results
We searched four databases and retrieved a total of 749 articles. The literature retrieved from each database is as follows: PubMed (n = 239), Embase (n = 500), Cochrane (n = 17), CNKI (n = 3). After reading the titles and abstracts, researchers excluded 738 duplicate articles, meta-analyses, reviews, case reports, and other non-targeted studies. Subsequently, after reading the entire text, 5 articles on interlaminar approach surgery and 2 articles on multi-segment surgery were excluded. The final 14 articles13–26 were included in this study, all of which were cohort studies, and the PRISMA flowchart of this study is shown in Fig. 1.
3.2 Demographic characteristics
This study included 1102 patients undergoing single segment PE-TLIF and MIS-TLIF, with 543 in the PE-TLIF group and 559 in the MIS-TLIF group. The inclusion of research and demographic characteristics was shown in Table 1.
| Author | Year | Country | Study type | Patients | Age | Time points |
| Ao | 2020 | China | Cohort study | 35:40 | 52.80 ± 7.5053.68 ± 7.24 | 3,6,12m |
| Xue | 2021 | China | Cohort study | 20:20 | 46.3 ± 17.248.4 ± 13.6 | 3m |
| Zhang | 2021 | China | Cohort study | 32:30 | 53.1 ± 12.855.7 ± 14.2 | 6,12m |
| Zhao | 2021 | China | Cohort study | 40:38 | 56.93 ± 1.6657.01 ± 0.95 | 3,12,24m |
| Ge | 2022 | China | Cohort study | 41:43 | / | / |
| Han | 2022 | China | Cohort study | 39:43 | 60.35 ± 8.0460.98 ± 6.62 | 1,3,6m |
| Lv | 2022 | China | Cohort study | 54:48 | / | 3m |
| Shi | 2022 | China | Cohort study | 32:32 | 59.3 ± 6.259.2 ± 5.5 | 1,12m |
| Zhang | 2022 | China | Cohort study | 20:23 | 61.85 ± 10.8558.65 ± 8.57 | 3m |
| Sim | 2023 | Singapore | Cohort study | 12:34 | 67.4 ± 7.166.3 ± 9.9 | 12m |
| Yin | 2024 | China | Cohort study | 18:18 | 63.44 ± 7.6360.50 ± 7.58 | 3m |
| Song | 2024 | China | Cohort study | 114:98 | 63.3 ± 8.864.1 ± 8.5 | 6,12m |
| Xu | 2024 | China | Cohort study | 55:55 | 60.23 ± 7.7960.96 ± 8.80 | 3,12m |
| Yuan | 2024 | China | Cohort study | 31:36 | 60 ± 1165 ± 9 | 1m |
| Lv | 2022 | China | Cohort study | 32:32 | 59.3 ± 6.259.2 ± 5.5 | / |
| Shi | 2022 | China | Cohort study | 20:23 | 61.85 ± 10.8558.65 ± 8.57 | 1,3,6m |
| Zhang | 2022 | Singapore | Cohort study | 12:34 | 67.4 ± 7.166.3 ± 9.9 | 3m |
3.3 Quality analysis
We used the Newcastle Ottawa Scale to evaluate the treatment of cohort study, and all studies scored>6 points, indicating that the quality of the literature we included was high. The specific results are shown in Table 2.
| Author (Publication date) | Selection | Comparability | Outcome | Total |
| Ao (2020)13 | 4 | 1 | 2 | 7 |
| Xue (2021)21 | 4 | 1 | 3 | 8 |
| Zhang(2021)25 | 4 | 0 | 3 | 7 |
| Zhao (2021)26 | 4 | 2 | 3 | 9 |
| Ge (2022)14 | 4 | 1 | 3 | 8 |
| Han (2022)15 | 4 | 1 | 3 | 8 |
| Lv (2022)16 | 3 | 1 | 3 | 7 |
| Shi (2022)17 | 3 | 2 | 3 | 8 |
| Zhang(2022)24 | 4 | 2 | 3 | 9 |
| Sim(2024)18 | 4 | 1 | 3 | 8 |
| Yin(2024)22 | 4 | 2 | 3 | 9 |
| Song (2024)19 | 4 | 1 | 3 | 8 |
| Xu (2024)20 | 4 | 1 | 3 | 8 |
| Yuan(2024)23 | 4 | 1 | 3 | 8 |
3.4 Meta-analysis results
3.4.1 VAS(B)
Ten studies involving VAS (B) were included, with heterogeneity test results of P = 0.55 and I2 = 0 %, P = 0.0003 and I2 = 75 %, P = 0.51 and I2 = 0 % and P = 0.80 and I2 = 0 %. There was no statistically significant difference between PE-TLIF and MIS-TLIF at baseline [SMD = −0.09, 95 % CI(−0.23, 0.05),P = 0.21] and 6 months postoperatively [SMD = −0.04, 95 %CI(−0.25, 0.16),P = 0.68], and there was a statistically significant difference between the two at 3 months [SMD = −0.45, 95 %CI(−0.56, −0.34),P < 0.00001] and 12 months [SMD = −0.16, 95 %CI(−0.30, −0.02),P = 0.02] postoperatively. The results were shown in Fig. 2.
3.4.2 VAS(L)
A total of ten studies involving VAS (L) were included, with heterogeneity test results of P = 0.04 and I2 = 49 %, P = 0.28 and I2 = 18 %, P = 0.44 and I2 = 0 % and P = 0.19 and I2 = 38 %. There was no statistically significant difference between PE-TLIF and MIS-TLIF at baseline [SMD = −0.05, 95 % CI(−0.19, 0.10),P = 0.51], 3 months[SMD = 0.08, 95 % CI(−0.03, 0.18),P = 0.17] and 12 months postoperatively [SMD = −0.03, 95 %CI(−0.19, 0.13),P = 0.72]. There was a statistically significant difference between the two at 6 months postoperatively[SMD = −0.19, 95 %CI(−0.37, −0.01),P = 0.03]. The results were shown in Fig. 3.
3.4.3 ODI
A total of ten studies involving ODI were included, with heterogeneity test results of P = 0.02 and I2 = 53 %, P < 0.00001 and I2 = 83 %, P < 0.00001 and I2 = 92 % and P = 0.97 and I2 = 0 %. There was no statistically significant difference between PE-TLIF and MIS-TLIF at baseline [SMD = −0.35, 95 % CI(−1.41, 0.70),P = 0.51], 6 months[SMD = −1.64, 95 % CI(−5.22, 1.93),P = 0.37] and 12 months postoperatively [SMD = −0.32, 95 %CI(−1.32, 0.68),P = 0.53]. There was a statistically significant difference between the two at 3 months postoperatively[SMD = −1.75, 95 %CI(−2.94, −0.56),P = 0.004]. The results were shown in Fig. 4.
3.4.4 Operative time
A total of fourteen studies involving Operative time were included. The Heterogeneity analysis results for the total effect size were ChI2 = 882.62, df = 13 (p < 0.00001), I2 = 99 %. WMD = 18.37, 95 % CI: 3.89 to 32.84, P = 0.01, The combined effect size had statistical significance. The results were shown in Fig. 5.
3.4.5 Intraoperative blood loss
A total of nine studies involving intraoperative blood loss were included. The Heterogeneity analysis results for the total effect size were ChI2 = 148.86, df = 8 (p < 0.00001), I2 = 95 %. WMD = −42.51, 95 % CI: 57.25 to −27.77, P < 0.00001, The combined effect size had statistical significance. The results were shown in Fig. 6.
3.4.6 Hospital stay
A total of nine studies involving hospital stays were included. The Heterogeneity analysis results for the total effect size were ChI2 = 43.49, df = 8 (p < 0.00001), I2 = 82 %. WMD = −1.08, 95 % CI: 1.65 to −0.50, P = 0.0002, The combined effect size had statistical significance. The results were shown in Fig. 7.
3.4.7 Complication
A total of eleven studies involving complication were included. The Heterogeneity analysis results for the total effect size were ChI2 = 7.31, df = 10 (p = 0.70), I2 = 0 %. WMD = 1.12, 95 % CI: 0.67 to 1.84, P = 0.67, The combined effect size did not have statistical significance. The results were shown in Fig. 8.
3.4.8 Fusion rate
A total of nine studies involving fusion rate were included. The Heterogeneity analysis results for the total effect size were ChI2 = 3.12, df = 7 (p = 0.87), I2 = 0 %. WMD = 0.79, 95 % CI: 0.48 to 1.31, P = 0.37, The combined effect size did not have statistical significance. The results were shown in Fig. 9.
4 Sensitivity analysis
We conducted sensitivity analysis on the outcomes with a combined effect size I2>50 %. In order to identify the source of heterogeneity, we excluded the included literature one by one and found that in the VAS (B) outcome, after excluding the article by Lv16 et al. at the 3-month postoperative time point, the intra group heterogeneity decreased from 59 % to 22 %, and the inter group heterogeneity decreased from 87.1 % to 17.2 %. The results were shown in Fig. 10. After excluding articles one by one, there was no significant decrease in heterogeneity in other outcomes. We believed that there may be two reasons: (1) differences in medical conditions between regions and differences in the proficiency of surgeons. (2) The number of patients included in the study was insufficient.
5 Publication bias
We conducted Egger's and Begg's tests on the important research outcomes included in the article using Stata18.0, and the results showed that most of the data did not have publication bias. However, interestingly, publication bias was observed in the follow-up of VAS (L) and ODI at three months after surgery. Considering that the P values for other follow-up times were greater than 0.05, we believed that the reason for this phenomenon was that a small sample size may result in a larger effect size, leading to publication bias at a certain follow-up time point. Additionally, there was a significant risk of deviation in terms of hospital stay duration and intraoperative blood loss.The test results were shown in Table 3.
| Study content | Number of articles included | Egger’ test | Begg’ test | |
| VAS(B) | 3 months | 8 | 0.5677 | 0.5362 |
| 6 months | 4 | 0.1689 | 0.0894 | |
| 12 months | 5 | 0.1701 | 0.0864 | |
| VAS(L) | 3 months | 9 | 0.0131 | 0.0165 |
| 6 months | 4 | 0.9692 | 0.7341 | |
| 12 months | 4 | 0.3124 | 0.7341 | |
| ODI | 3 months | 8 | 0.0125 | 0.0635 |
| 6 months | 4 | 0.1757 | 1.0000 | |
| 12 months | 5 | 0.8368 | 0.8065 | |
| Complication | 11 | 0.8185 | 0.2831 | |
| Fusion rate | 9 | 0.9671 | 0.3865 | |
| Operative time | 20 | 0.0512 | 0.2058 | |
| Intraoperative blood loss | 17 | 0.0325 | 0.0010 | |
| Hospital stay | 17 | 0.0030 | 0.0912 | |
6 Discussions
Despite the emergence of various surgical techniques in recent decades, PE-TLIF and MIS-TLIF remain the main surgical methods for treating degenerative lumbar diseases in the elderly. In order to provide more evidence for clinical doctors in choosing surgical methods, we conducted a meta-analysis on the pain outcomes, disability outcome, intraoperative blood loss, hospital stays, fusion rate, and incidence of complications of PE-TLIF and MIS-TLIF in this study based on existing research.
This study indicated that the overall efficacy of VAS (B) and ODI in PE-TLIF was superior to MIS-TLIF, but VAS (L) did not show statistical differences. We believed that the reason for this phenomenon was the small amount of literature included, which may also be one reason why the VAS (L) results at 6 months post-surgery conflict with those from other months, and the publication bias results also confirmed our hypothesis. The marked heterogeneity in the postoperative 12 months ODI analysis may stem from differences in baseline patient characteristics, surgical techniques, and rehabilitation protocols among the included studies. Variations in ODI measurement methods and follow-up completeness could also have contributed to the inconsistency in long-term functional outcomes. The similaroutcome was also confirmed in another study.27
Compared to MIS-TLIF, PE-TLIF results in a shorter hospital stay. We believed that the field of view of the endoscope was limited,28,29 and the surgeon needed more time to find the surgical landmark for decompression and fusion. In addition, adjusting the mirror clarity of the endoscope may also prolong the operation time.
Although PE-TLIF had a longer operative time, a meta-analysis by Zhu30 et al., which included 28 studies (549 Endo-TLIF and 927 MIS-TLIF cases), showed that compared to MIS-TLIF, PE-TLIF can significantly reduce intraoperative blood loss (average intraoperative blood loss was 101.1 ml and 174 ml, respectively), which was consistent with our research findings. From a biomechanical perspective, both PE-TLIF and MI-TLIF maintain similar fusion stability postoperatively, which explains the comparable long-term VAS and ODI outcomes observed in this and previous studies. Clinically, these results suggest that for selected patients—particularly those at higher risk for blood loss or prolonged hospitalization—PE-TLIF may represent a preferable surgical alternative without compromising mid-to long-term functional outcomes.
Previous studies had shown that PE-TLIF can accelerate postoperative recovery time with less surgical trauma, and also reduced the incidence of complications such as low-grade pneumonia, deep vein thrombosis, and pulmonary embolism.31,32 However, unlike open surgery, the two-dimensional endoscopic view and anatomical orientation made PE-TLIF have a steeper learning curve, which was a challenge even for skilled physicians.33,34 Although PE-TLIF was more difficult, there was no significant difference in surgical safety compared to MIS-TLIF, which was confirmed in previous meta-analyses.27,35
In the literature we included, 3 articles14,21,23 believed that the interbody fusion rate of PE-TLIF was higher than that of MIS-TLIF, while 5 articles15,16,20,25,36 had the opposite view. After meta-analysis, our results and previous studies27 showed that the interbody fusion rate of the two surgeries was not statistically significant, indicating that we need more high-quality randomized controlled trials(RCT) for further confirmation.
PE-TLIF remains one of advanced and complex surgical methods currently available, and the proficiency of the surgeon and surgical preference may affect outcomes such as intraoperative blood loss and incidence of complications. This can lead to inconsistent assessments of surgical safety among researchers. The literature we include are all cohort studies, and different surgical indications can lead to patient selection bias. Although the included studies achieved relatively high NOS scores, these ratings do not eliminate inherent limitations of observational designs; thus, the findings should be interpreted with appropriate caution. Our research also suffers from a lack of high-quality randomized controlled trials and literature studies outside of China and Singapore. In addition, some outcomes have fewer literature included at a certain follow-up time, and a single article may have a larger effect size, which may result in publication bias for this outcome and explain our Egger's test. For some outcomes such as VAS-L and ODI at the 3-month follow-up, only a small number of studies were available. While the influence of a small study effect might partly explain the results of Egger's and Begg's tests, we acknowledge that true publication bias cannot be excluded. This potential bias has been explicitly stated, and readers are advised to interpret these results with caution, considering the possibility of selective reporting within the included literature. Due to some of the cited references not mentioning fusion standards, this article only conducts statistical analysis based on the data provided, which is also one of the limitations of this article. Finally, because of the limitation of the number of article searches, this article categorized both uniportal and biportal endoscopic approaches under PE-TLIF, which may be one of the sources of heterogeneity. However, most of the outcomes we studied had a large number of included literatures and did not show significant bias, indicating that this study has high credibility. However, we still need more high-quality clinical studies to further prove the viewpoint of this study.
7 Conclusions
Hospital stay Within the limitations of the present meta-analysis, this meta-analysis indicates that compared to MIS-TLIF, PE-TLIF has more advantages in pain relief and functional recovery in the lower back. Compared with MIS-TLIF, PE-TLIF shows certain advantages in perioperative outcomes, but evidence quality and heterogeneity limit definitive conclusions. As for the results of this study, these findings suggest that PE-TLIF may facilitate faster short-term recovery and reduced surgical trauma, but with potential trade-offs in operative time. Given the high heterogeneity observed in several outcomes and the predominance of non-randomized studies, further high-quality randomized controlled trials are warranted to confirm these results.
Consent for publication
Not applicable.
Availability of data and materials
The data of this study are included in the manuscript and supplementary materials. If further data is needed, please contact the corresponding author.
Trial registration
This review protocol was registered with PROSPERO(CRD420251101468).
Ethical statement
Not applicable.
Guardian patients consent
Not applicable.
Credit author statement
JG and DLX carried out the study design. The data collected was analyzed by JWL, JWZ and YGF. JG, DLX and ZCW carried out the data processing. DY and DLX interpreted the statistical results. The manuscript was completed by JG. TWS and YZ reviewed and corrected the manuscript. The final version was submitted after all authors had read and agreed on it.
Clinical trial number
Not applicable.
Funding statement
This work was supported by the Tianjin Municipal Science and Technology Project, grant number 22JCZDJC00250(sun tianwei); Tianjin Education Commission Research Program Project, grant number 2024ZXZD014 (sun tianwei); Tianjin Health Research Project, grant number TJWJ2022XK016(sun tianwei); Tianjin Health Research Project, grant number TJWJ2023ZD004(tang qiong).
References
- Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England). 2021;396:2006-2017.
- [Google Scholar]
- Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine J : Offic J North Am Spine Soci. 2021;21:2066-2077.
- [Google Scholar]
- Computed tomographic epidurography in patients with low back pain and leg pain: a single-center observational study. Diagnostics (Basel, Switzerland). 2022;12
- [Google Scholar]
- Pathology of lumbar nerve root compression. Part 1: intraradicular inflammatory changes induced by mechanical compression. J Orthop Res : Offic Pub Orthopaedic Res Soc. 2004;22:170-179.
- [Google Scholar]
- Pressure increase in the dorsal root ganglion following mechanical compression. Closed compartment syndrome in nerve roots. Spine. 1989;14:574-576.
- [Google Scholar]
- Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg (Hong Kong). 2015;1:2-18.
- [Google Scholar]
- Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J : Offic J North Am Spine Soci. 2006;6:435-443.
- [Google Scholar]
- Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus. 2017;43:E8.
- [Google Scholar]
- Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it? Int Orthop. 2013;37:1507-1510.
- [Google Scholar]
- Percutaneous endoscopic robot-assisted transforaminal lumbar interbody fusion (PE RA-TLIF) for lumbar spondylolisthesis: a technical note and two years clinical results. Pain Physician. 2022;25:E73-e86.
- [Google Scholar]
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed). 2021;372:n71.
- [Google Scholar]
- Comparison of preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study. Int J Surg (London, England). 2020;76:136-143.
- [Google Scholar]
- Comparison of hidden blood loss and clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion. Int Orthop. 2022;46:2063-2070.
- [Google Scholar]
- Comparison between PE-TLIF and MIS-TLIF in the treatment of middle-aged and elderly patients with single-level lumbar disc herniation. J Pain Res. 2022;15:1271-1282.
- [Google Scholar]
- Endo-TLIF versus MIS-TLIF in 1-segment lumbar spondylolisthesis: a prospective randomized pilot study. Clin Neurol Neurosurg. 2022;212
- [Google Scholar]
- Comparison of the outcomes of minimally invasive transforaminal lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar degenerative diseases: a retrospective matched case-control study. World Neurosurg. 2022;167:e1231-e1240.
- [Google Scholar]
- Single-level endoscopic TLIF has decreased surgery duration, blood loss, and length of hospital stay while achieving similar 1-Year clinical and radiological outcomes compared with conventional minimally invasive TLIF. Int J Spine Surg. 2023;17:380-386.
- [Google Scholar]
- Clinical efficacy of bilateral decompression using biportal endoscopic versus minimally invasive transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases. World Neurosurg. 2023;173:e371-e377.
- [Google Scholar]
- Comparison of outcomes between endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in patients with single-level lumbar degenerative disease: a retrospective study. World Neurosurg. 2024;183:e98-e108.
- [Google Scholar]
- Lumbar degenerative disease treated by percutaneous endoscopic transforaminal lumbar interbody fusion or minimally invasive surgery-transforaminal lumbar interbody fusion: a case-matched comparative study. J Orthop Surg Res. 2021;16:696.
- [Google Scholar]
- Comparative efficacy of 3 methods of lumbar interbody fusion for lumbar degenerative diseases in a tertiary public hospital. World Neurosurg. 2024;194
- [Google Scholar]
- Percutaneous endoscopic transforaminal lumbar interbody fusion: technique note and comparison of early outcomes with minimally invasive transforaminal lumbar interbody fusion for lumbar spondylolisthesis. Int J Gen Med. 2021;14:549-558.
- [Google Scholar]
- Early clinical evaluation of percutaneous full-endoscopic transforaminal lumbar interbody fusion with pedicle screw insertion for treating degenerative lumbar spinal stenosis. Orthop Surg. 2021;13:328-337.
- [Google Scholar]
- Percutaneous endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a meta-analysis. Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques. 2022;17:591-600.
- [Google Scholar]
- Comparison of learning curves and clinical outcomes in unilateral biportal endoscopic spinal surgery versus percutaneous transforaminal endoscopic surgery: a cumulative sum analysis. J Pain Res. 2025;18:631-642.
- [Google Scholar]
- A novel endoscope-port unit for lumbar microendoscopic surgery: a single-center case series review. Neurosurg Rev. 2024;47:356.
- [Google Scholar]
- Comparison of clinical outcomes and complications between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar disease: a systematic review and meta-analysis. Pain Physician. 2021;24:441-452.
- [Google Scholar]
- Full percutaneous transforaminal lumbar interbody fusion using the facet-sparing, trans-kambin approach. Clinic Spine Surg. 2020;33:40-45.
- [Google Scholar]
- Percutaneous endoscopic lumbar discectomy: indications and complications. Pain Physician. 2020;23:49-56.
- [Google Scholar]
- Learning curve for biportal endoscopic transforaminal lumbar interbody fusion and 90-day postoperative complications during the learning phase: a multicenter retrospective cohort study. Eur Spine J : Offic Publ Europ Spine Soc, Europ Spinal Deformity Soc, Europ Sec Cervical Spine Res Soc 2025
- [Google Scholar]
- Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: a retrospective cohort study. J Orthop Surg Res. 2024;19:150.
- [Google Scholar]
- Comparison of clinical outcomes and complications between endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19:92.
- [Google Scholar]
- Comparison of short-term efficacy of MIS-TLIF and Endo-LIF in the treatment of single-segment degenerative lumbar diseases. Front Surg. 2022;9
- [Google Scholar]