Short-term clinical efficacy of arthroscopic-assisted uni-portal spinal surgery- transforaminal lumbar interbody fusion for the treatment of single-segment low-grade degenerative lumbar spondylolisthesis: A retrospective cohort study.

ObjectiveA retrospective cohort study was conducted to evaluate the short-term clinical efficacy and technical advantages of arthroscopic-assisted uni-portal spinal surgery (AUSS) combined with transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis.MethodsThis study included 73 patients with low-grade degenerative lumbar spondylolisthesis who underwent surgical treatment in September 2023 and December 2024. Among these, 33 patients underwent AUSS-TLIF, and 40 underwent open TLIF. Preoperative and postoperative assessments were conducted using the visual analogue scale for low back pain and leg pain, Oswestry Disability Index, and surgery-related parameters, including operation time, intraoperative blood loss, postoperative drainage volume, slip reduction rate, and length of hospital stay. Additionally, the surgical outcomes and postoperative fusion status were compared between the two groups. Baseline data were collected and analyzed for confounding factors, including body mass index, duration of symptoms, preoperative medication history, and comorbidities (hypertension and diabetes). All patient data were anonymized to protect privacy. Normality and homogeneity of variance tests were performed for measurement data. Repeated measures analysis of variance was used for visual analog scale scores and Oswestry Disability Index values at different time points.ResultsAll 73 patients successfully underwent the surgical procedure and were followed up for 6 months. Preoperative comparisons of visual analog scale scores and Oswestry Disability Index values between the two groups revealed no statistically significant differences (p > 0.05). Both groups demonstrated significantly reduced visual analog scale scores for low back pain and leg pain as well as significantly lower Oswestry Disability Index values after the surgery. At 6 months postoperatively, there were no significant differences in the visual analog scale scores, Oswestry Disability Index values, or imaging parameters between the two groups (p > 0.05). The AUSS-TLIF group exhibited significantly lower visual analog scale scores for low back pain at the 3-day and 3-month follow-ups than the open TLIF group (p < 0.05). However, no difference was observed at the 6-month follow-up (p > 0.05). Additionally, there were no differences in the visual analog scale scores for leg pain between the two groups at 3 days, 3 months, or 6 months postoperatively (p > 0.05). At the 3-month follow-up, the Oswestry Disability Index values of the AUSS-TLIF group were significantly lower than those of the OPEN-TLIF group (p < 0.05), with no significant difference observed at the 6-month follow-up (p > 0.05). Intraoperative blood loss, postoperative drainage volume, and hospital stay were significantly lower in the AUSS-TLIF group than in the open TLIF group (p < 0.05). The operation time in the AUSS-TLIF group was longer than that in the open TLIF group, and this difference was statistically significant (p < 0.05). No significant differences were observed in the slip reduction rate or the total incidence of complications between the two groups (p > 0.05). At the final follow-up, there were no significant differences in the MacNab criteria or the imaging fusion rate between the two groups (p > 0.05). The fusion rates were 96.97% (32/33) in the AUSS-TLIF group and 95.00% (38/40) in the open TLIF group. Postoperative analgesic usage was lower in the AUSS-TLIF group (mean 2.5 ± 1.1 administrations) than in the open TLIF group (mean 3.9 ± 1.1 administrations) at the same postoperative times.ConclusionBoth AUSS-TLIF and open TLIF can achieve excellent clinical outcomes in the treatment of degenerative lumbar spondylolisthesis. As an endoscopic procedure, AUSS-TLIF offers distinct advantages, such as improved visualization of the surgical field, enhanced surgical maneuverability, reduced paraspinal muscle damage, reduced intraoperative blood loss, and shortened hospitalization duration. Its short-term efficacy surpasses that of open surgery.