Comparison of biportal endoscopic vs minimally invasive transforaminal lumbar interbody fusion for single-level low-grade lumbar spondylolisthesis: A retrospective cohort study

doi:10.5312/wjo.124542

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Oct 18, 2026; 17(10): 124542
Published online Oct 18, 2026. doi: 10.5312/wjo.124542

Comparison of biportal endoscopic vs minimally invasive transforaminal lumbar interbody fusion for single-level low-grade lumbar spondylolisthesis: A retrospective cohort study

Peng He, Jiao Sun, Xiao-Wei Liu, Qiang Gao, Bin Xu, Yu Cong, Wen-Long Zhao

Peng He, Xiao-Wei Liu, Qiang Gao, Bin Xu, Yu Cong, Wen-Long Zhao, Department of Orthopedics, Jinling Hospital, The Affiliated to Nanjing University, Nanjing 210002, Jiangsu Province, China

Peng He, Xiao-Wei Liu, Yu Cong, Wen-Long Zhao, Department of Orthopedics, Jinling Hospital, The Affiliated to Nanjing Medical University, Nanjing 210002, Jiangsu Province, China

Jiao Sun, Department of Outpatient, Jinling Hospital, The Affiliated to Nanjing University, Nanjing 210002, Jiangsu Province, China

Jiao Sun, Department of Outpatient, Jinling Hospital, The Affiliated to Nanjing Medical University, Nanjing 210002, Jiangsu Province, China

Co-first authors: Peng He and Jiao Sun.

Co-corresponding authors: Yu Cong and Wen-Long Zhao.

Author contributions: He P, Sun J, Zhao WL, and Cong Y contributed to the study conception and design; He P and Sun J contributed to conceptualization, data curation, formal analysis, methodology, writing and original draft, qualified as the co-first authors of the paper; Zhao WL contributed to methodology, software, validation, writing–review and editing; Xu B, Cong Y contributed to methodology; Liu XW, Cong Y, contributed to project administration; Zhao WL contributed to supervision; Gao Q contributed to software, visualization; Cong Y and Zhao WL played important and indispensable roles in the manuscript preparation as the co-corresponding authors.

AI contribution statement: AI tools were used for language polishing only. The authors assume full responsibility for all scientific content.

Supported by Jinling Hospital, No. 2024JCYJZD077.

Institutional review board statement: This study approved by the Research Ethics Committee of the Jinling Hospital (No. 2020DZSKTZX-019). All clinical data were fully de-identified before analysis to protect patient privacy.

Informed consent statement: All clinical data were fully de-identified before analysis to protect patient privacy. The ethics committee approved a waiver of written informed consent owing to the retrospective nature of this study with minimal risk to participants.

Conflict-of-interest statement: The authors have no conflict of interest to disclose.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The fully de-identified datasets and a data dictionary used in this study are available from the corresponding author upon reasonable request, subject to ethical and institutional approval.

Corresponding author: Wen-Long Zhao, Associate Chief Physician, MD, Department of Orthopedics, Jinling Hospital, The Affiliated to Nanjing University, East Zhongshan Road, Xuanwu District, Nanjing 210002, Jiangsu Province, China. valen_0924@163.com

Received: June 23, 2026
Revised: August 14, 2026
Accepted: October 13, 2026
Published online: October 18, 2026
Processing time: 116 Days and 4.6 Hours

Abstract

BACKGROUND

Lumbar spondylolisthesis is a common spinal disorder that often leads to low back pain, radiating leg pain, and intermittent claudication. Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been widely adopted as an effective surgical treatment for this condition. In recent years, biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) has emerged as a novel minimally invasive technique that offers enhanced visualization and may reduce paraspinal muscle injury. However, comparative studies with mid-term follow-up between BE-TLIF and MI-TLIF for single-level low-grade lumbar spondylolisthesis remain limited.

AIM

To compare the mid-term clinical and radiographic outcomes between BE-TLIF and MI-TLIF in the treatment of single-level lumbar spondylolisthesis.

METHODS

We conducted a retrospective comparative cohort study of 63 patients with single-level degree I or II lumbar spondylolisthesis who underwent surgery between December 2020 and December 2022. Thirty-two patients were treated with BE-TLIF and 31 with MI-TLIF. Patient demographics, operative parameters, complications, and clinical outcomes [assessed by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI)] were recorded. Radiographic assessments included disc height (DH), lumbar lordosis (LL), segmental lordosis angle (SLA), slip percentage (SP), and fusion rate (FR) on X-ray and computed tomography scans.

RESULTS

The BE-TLIF group had a significantly longer operative time (189.36 ± 20.94 minutes vs 150.35 ± 21.16 minutes, P < 0.001) but a shorter hospital stay (5.14 ± 1.28 days vs 6.19 ± 1.33 days, P = 0.005) compared to the MI-TLIF group. The BE-TLIF group demonstrated significantly lower low back VAS scores at 3 days postoperatively (3.65 ± 0.78 vs 4.32 ± 0.69, Bonferroni-corrected P = 0.005) and lower postoperative creatine kinase (CK) levels (251.21 ± 29.48 IU/L vs 316.52 ± 33.37 IU/L, P < 0.001). There were no statistically significant differences in ODI scores, DH, LL, SLA, SP, or FR (90.6% vs 90.3%, P = 0.979) between the two groups at the final follow-up. The complication rates did not differ significantly between the two groups.

CONCLUSION

BE-TLIF demonstrated favorable clinical and radiographic outcomes in this cohort, with no statistically significant difference observed compared to MI-TLIF in most mid-term measures; however, these comparisons were exploratory and do not establish equivalence. BE-TLIF was associated with a shorter hospital stay, lower early postoperative pain, and a lower postoperative CK level whose clinical significance requires further study.

Keywords: Spondylolisthesis; Spinal fusion; Unilateral biportal endoscopy; Minimally invasive surgery; Transforaminal lumbar interbody fusion; Retrospective cohort study

Core Tip: This retrospective study compared biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) and minimally invasive transforaminal lumbar interbody fusion for single-level lumbar spondylolisthesis. Despite longer operative time, BE-TLIF was associated with shorter hospital stay, less early postoperative pain, and lower creatine kinase levels, associations of uncertain clinical significance. At a mean follow-up of over 40 months, fusion rates, functional outcomes, radiographic parameters, and complication rates did not differ significantly between the groups. BE-TLIF is an effective minimally invasive alternative, with no statistically significant between-group differences in mid-term outcomes observed in this cohort.