Minimally invasive treatment for lumbar Brucella spondylitis: endoscopic lumbar interbody fusion versus oblique lumbar interbody fusion, a retrospective study

As the treatment paradigm for spinal infectious diseases shifts toward minimally invasive approaches, the comparative clinical efficacy of full endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) and oblique lateral interbody fusion (OLIF) in managing lumbar Brucella spondylitis (LBS) warrants urgent evidence-based investigation. This retrospective study aimed compare the infection control efficacy and radiographic outcomes of Endo-TLIF and OLIF in addressing lumbar BS. Between January 2021 and January 2024, 50 patients were divided into Endo-TLIF ( n = 22) and OLIF ( n = 28) groups. The primary outcomes, C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were infection control rate at 12 months and the time course of inflammatory marker resolution. Other outcomes included perioperative parameters, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and radiographic evaluation of disc height, segmental lordosis, cage subsidence, and fusion status. All surgeries in both groups were successfully completed without severe complications, with no significant differences in preoperative data. At final follow-up, both groups achieved infection control with no recurrence, and the normalization of CRP and ESR was comparable over time. The operative time was significantly longer in the Endo-TLIF group than in the OLIF group, while intraoperative blood loss was comparable. Linear mixed-model analysis revealed significant improvements over time in both groups for VAS, ODI, ESR, CRP, disc height, and segmental lordosis (all time effects P < 0.001), with no significant between-group differences or group-by-time interactions (all P > 0.05). Fusion rate and cage subsidence did not differ significantly between the groups. Under standardized anti-Brucella therapy, Endo-TLIF and OLIF provide comparable treatment outcomes for LBS. Procedure selection should be guided primarily by anatomical suitability, including the affected segment and retroperitoneal vascular anatomy, and surgeon experience. not applicable.