Biportal endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis
Year: 2026
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: Transforaminal lumbar interbody fusion (TLIF) has undergone significant evolution toward minimally invasive and endoscopic techniques designed to reduce soft tissue damage while preserving clinical efficacy. The objective of this systematic review and meta-analysis is to compare clinical outcomes and complication rates of biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of degenerative lumbar disease. Methods: We systematically performed a search using PubMed, Ovide MEDLINE, Web of Science, the Cochrane Library, and Google Scholar for peer-reviewed studies up to December 2025. All studies comparing the outcomes between BE-TLIF and MIS-TLIF were included in the Meta-analysis. Quality was assessed using Newcastle-Ottawa Scale. Results: Twenty- two eligible studies including a total of 1,841 patients were included in our meta-analysis. Of these, 881 patients undergoing BE-TLIF and 960 patients undergoing MIS-TLIF. We found that both BE-TLIF and MIS-TLIF procedures had comparable effectiveness with respect to Oswestry Disability Index (ODI) score [standardized mean difference (SMD) -0.12; 95% confidence interval (CI): -0.26 to 0.02, P=0.08], Visual Analog Scale (VAS) Leg score [SMD 0.10 (95% CI: -0.05 to 0.26), P=0.18], fusion rate [OR, 1.33 (95% CI: 0.95 to 1.85), P=0.09], and incidence of overall complications [OR 0.90 (95% CI: 0.64 to 1.26), P=0.55]. However, BE-TLIF was associated with higher risk of dural tear [OR 2.62 (95% CI: 1.34 to 5.12), P=0.005], shorter hospital stays [SMD -0.53 (95% CI: -0.76 to -0.31), P<0.001], and less intraoperative bleeding [SMD -1.56, 95% CI: -2.05 to -1.06), P<0.001], compared to MIS-TLIF. Conclusions: This meta-analysis demonstrates that (BE-TLIF) and (MIS-TLIF) yield comparable clinical efficacy regarding ODI scores, VAS leg scores, fusion rates, and overall complication incidence rate. BE-TLIF was associated with higher risk of dural tear, reduced blood loss and a shorter hospital stay, whereas MIS-TLIF was associated with a shorter operative time. BE-TLIF may therefore be considered for appropriately selected patients, particularly those prioritizing faster postoperative recovery and earlier discharge, while recognizing the potential increased risk of dural tear.
Source: Journal of Spine Surgery
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223938628