Analysis of the efficacy of Endo-TLIF and OLIF-360 assisted by optical navigation in the treatment of degenerative lumbar spondylolisthesis lesions, a retrospective cohort study.

Abstract

Endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) and oblique lumbar interbody fusion with percutaneous fixation (OLIF-360) are both minimally invasive fusion techniques for degenerative lumbar spondylolisthesis (DLS). Endo-TLIF provides direct decompression under endoscopic visualization, whereas OLIF-360 restores disc height and lumbar lordosis through indirect decompression. However, their relative advantages remain uncertain, particularly regarding perioperative outcomes and radiographic efficacy. To compare the clinical and radiographic outcomes of Endo-TLIF and OLIF-360 assisted by optical navigation in the management of degenerative lumbar spondylolisthesis. Retrospective cohort study. One hundred and one patients treated by Endo-TLIF and ninety-three patients treated by OLIF-360. Clinical records including the visual analog scale (VAS) score of the lower back and leg and the Oswestry Disability Index (ODI). Radiological records including disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), the cross-sectional area (CSA) of the spinal canal, and fusion rate. Surgical-related information and complications were also recorded. A retrospective review was conducted of patients with degenerative lumbar spondylolisthesis who underwent surgical treatment between 2020 and 2022 with a minimum follow-up of 2 years. A total of 194 patients were included, comprising 101 cases treated with endoscopic transforaminal lumbar interbody fusion (Endo-TLIF group) and 93 cases treated with oblique lateral interbody fusion combined with percutaneous pedicle screw fixation (OLIF-360 group). Perioperative outcomes, radiographic parameters, and complications were compared to evaluate the relative advantages and limitations of the two approaches. The Endo-TLIF group had significantly less intraoperative blood loss, shorter incision length, and reduced hospital stay compared with the OLIF-360 group. Clinical scores improved significantly in both groups. The Endo-TLIF group showed better early postoperative mobilization, while functional outcomes were similar between groups at longer-term follow-up. CSA expansion was greater in the Endo-TLIF group, whereas improvements in DH and SL were more pronounced in the OLIF-360 group. Fusion rates at all postoperative time points were comparable between the two groups. The overall complication rates were 4.00% in the Endo-TLIF group and 9.68% in the OLIF-360 group, with Endo-TLIF showing a slightly lower incidence. Most complications in the OLIF-360 group were related to psoas muscle injury and recurrent same-level spinal canal stenosis. This study demonstrates that both Endo-TLIF and OLIF-360 achieve favorable outcomes in the treatment of degenerative lumbar spondylolisthesis. Compared with OLIF-360, Endo-TLIF offers advantages in earlier postoperative ambulation, shorter incision length, reduced intraoperative blood loss, and more direct spinal canal decompression.Conversely, OLIF-360 provides distinct benefits in restoring disc height, improving lumbar sagittal alignment, and promoting interbody fusion. Regarding complications, both approaches exhibited low incidence rates, with Endo-TLIF slightly lower than OLIF-360.