Objectives:To compare the clinical efficacy and safety of uni-portal endoscopic lumbar interbody fusion by using larger-diameter endoscope for single-level lumbar disease via transforaminal approach versus transfacet approach.Methods:46 patients underwent single-level uni-portal endoscopic lumbar interbody fu-sion from June 2018 to February 2022 were enrolled.18 of the patients were male and 28 were female.The mean age was 60.9±10.5 years old(40-80 years).The follow-up time was 3-47 months.Patients were divided into two groups according to the surgical approach,18 of which were included in the transforaminal group,and the remaining 28 were included in the transfacet group,and a full spinal endoscope of 7.1mm inner-di-ameter working-channel was applied to all the patients.The clinical result was evaluated before surgery,at 3d after surgery and the final follow-up,by Oswestry disability index(ODI),visual analogue scale(VAS)for back pain and leg pain,and Japanese Orthopaedic Association(JO A)score.The decompression and implant were evaluated by anteroposterior and lateral X-ray plain film and lumbar CT at 3d after operation.Bridwell criteria were used to evaluate the fusion rate based on CT images for patients followed up for more than 6 months after surgery.Results:No significant differences were found in age,gender,diagnosis,preoperative in-tervertebral height,surgical segment,preoperative ODI,VAS and JOA score between the two groups(P＞0.05).72.2％of the patients in transforaminal group complained unilateral radicular symptom,while 64.3％of the patients in transfacet group suffered from bilateral radicular symptoms(P=0.020).The average operation time was 327.7±89.9min in the transforaminal group,significantly longer than the 385.9±96.7min in the transfacet group(P=0.047),and the mean length of hospital stay in the transforaminal group was 14.8±6.0d,shorter than that of 19.5±7.8d in the transfacet group(P=0.038).75％of the patients in transfacet group underwent unilater-al laminotomy with bilateral spinal canal decompression(ULBD).The ODI scores,back and leg pain VAS scores and JOA score were significantly improved postoperatively and at the final follow-up in both groups(P＜0.05),while no statistical differences between groups(P＞0.05).Postoperative intervertebral height significantly increased in both group(P＜0.001),but no statistical difference was found between groups(P＞0.05).The compli-cation rate was comparable between two groups,without severe intraoperative or postoperative complication.A-mong the 21 patients who were followed up for more than 6 months and received CT examinations,20(95.2％)presented bony fusion at surgical segment,and there was no statistical difference between the two groups in fusion rate.Conclusions:Both the transforaminal approach and the transarticular protrusion ap-proach are safe and effective for the single-level lumbar interbody fusion under single-hole coaxial large channel endoscopy,and the transforaminal approach results in shorter operation time and shorter hospital stay.
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