Evaluation of the Outcomes of Biportal Endoscopic Lumbar Interbody Fusion Compared with Conventional Fusion Operations: A Systematic Review and Meta-Analysis

OBJECTIVE: In recent years, biportal endoscopic lumbar interbody fusion (BE-LIF) has been increasingly used in the treatment of lumbar degenerative diseases. BE-LIF combines the benefits of minimally invasive fusion with endoscopic spine surgery. However, there is little evidence on whether BE-LIF is superior to posterolateral lumbar interbody fusion (PLIF). The purpose of this meta-analysis is to compare the clinical outcomes, complications, and fusion rates of BE-LIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)/PLIF in treating lumbar degenerative diseases. METHODS: A comprehensive assessment of the literature was conducted, and the quality of the retrieved studies was evaluated using the Newcastle-Ottawa Scale. Clinical parameters were investigated using a visual analog scale (VAS) for pain levels and the Oswestry Disability Index for disability levels. The operative times, estimated blood loss, fusion rates, and complications were also analyzed. RESULTS: This meta-analysis comprised 5 studies with a total of 444 participants. No significant differences between the techniques were seen in VAS scores for legs, Oswestry Disability Index, complications, or fusion rates. There were significantly lower VAS scores for back pain in the BE-LIF group than the MI-TLIF/PLIF group, postoperatively. In addition, BE-LIF resulted in significantly less blood loss but required a longer operative time than did MI-TLIF/PLIF. CONCLUSIONS: The benefits of BE-LIF and MI-TLIF/PLIF were approximately equivalent in terms of clinical outcomes and achievement of fusion, and complication rates were similar in both groups. However, BE-LIF reduced postoperative back pain and blood loss, despite longer operative times.