Comparative analysis of unilateral biportal endoscopy and minimally invasive transforaminal lumbar interbody fusion in treating lumbar spinal tuberculosis

Objective: This study compared the efficacy of unilateral dual-channel endoscopy (UBE-TLIF) with minimally invasive transforaminal lumbar fusion (MIS-TLIF) in the treatment of lumbar tuberculosis. Methods: Thirty-eight patients from 2019 to 2024 were retrospectively analyzed and divided into UBE-TLIF group (20 patients) and MIS-TLIF group (18 patients). There was no statistically significant difference between the baseline data of the two groups. Results: The results showed that the UBE-TLIF group had shorter operation time (P < 0.05), less intraoperative bleeding (P < 0.05), and shorter hospitalization time (P < 0.05). For postoperative complications, two dural sac tears occurred in the UBE-TLIF group and two nerve root traction injuries in the MIS-TLIF group, both of which recovered with conservative treatment. At a mean follow-up of 16 months, The mean follow-up period was15.8 ± 3.1 months in the MIS-TLIF group and16.2 ± 2.9 months in the UBE group, with no statistically significant difference between the groups(P = 0.674),no tuberculosis recurrence or implant loosening was observed in either group. Postoperative VAS(Visual Analogue Scale) low back pain scores were significantly better in the UBE-TLIF group than in the MIS-TLIF group at 1 and 3 months (P < 0.05), but the difference between the two groups disappeared at 6 months and at the final follow-up. ODI(Oswestry Disability Index), intervertebral space height and inflammatory indexes (blood sedimentation, C-reactive protein, calcitoninogen) were significantly improved after surgery (P < 0.05), with no difference between groups. At the final follow-up, there was no statistically significant difference between the two groups in terms of bone fusion rate and MacNab efficacy evaluation (P > 0.05). Conclusion: Both surgical approaches proved effective, but UBE-TLIF demonstrated certain advantages in operative time, intraoperative blood loss, and early postoperative pain control, making it a preferred option for the surgical treatment of spinal tuberculosis. This study confirms the safety and feasibility of combining minimally invasive techniques with standardized anti-tuberculosis therapy, offering a new alternative for clinical practice.