Clinical efficacy and safety of electronic flexible endoscope-assisted minimally invasive-transforaminal lumbar interbody fusion and conventional open transforaminal lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease: a retrospective study

Abstract Objective To compare the clinical efficacy and safety of electronic flexible endoscope-assisted non-expandable tubular minimally invasive transforaminal lumbar interbody fusion (MIS-TLF) and conventional open transforaminal lumbar interbody fusion (TLIF) for treating single-level lumbar degenerative disease. Methods This study included 76 patients with single-level lumbar degenerative disease who underwent surgical treatment between January 2024 and December 2025. The patients were divided into the flexible endoscope-assisted MIS-TLIF group (MIS-TLIF group) (n = 40) and the TLIF group (n = 36). Pre-operative and post-operative (1, 3, 6, and 12 months) assessments included the Visual Analogue Scale (VAS) for low back pain and leg pain, the Oswestry Disability Index (ODI), and the MacNab criteria. Results The MIS-TLIF group had significantly longer operative and fluoroscopy times but less intraoperative blood loss and a shorter hospital stay than the TLIF group ( P  P  < 0.05). At 6 and 12 months, the MIS-TLIF group showed lower VAS scores for low back pain than the open TLIF group. No significant difference in VAS scores for leg pain was observed between the two groups at each post-operative time point. Conclusions Flexible endoscope-assisted MIS-TLIF for lumbar degenerative disease achieves clinical outcomes comparable to those of open TLIF. This technique offers advantages including less paraspinal muscle stripping, reduced intraoperative blood loss, and faster early post-operative recovery. Nevertheless, this technique is associated with a longer operative time, increased intraoperative fluoroscopy exposure, and a steep learning curve.