# Comparative Analysis of Clinical and Radiological Outcomes of Unilateral Biportal Endoscopic Transforaminal Lumbar Interbody Fusion (UBE-TLIF) With Dual-Direction Expandable Cages Versus Anterior Lumbar Interbody Fusion at L5/S1

## TL;DR

This study compares two spinal fusion techniques at L5/S1 and finds that the minimally invasive UBE-TLIF approach offers similar outcomes to traditional ALIF with less tissue disruption.

## Contribution

The study introduces UBE-TLIF with dual-direction expandable cages as a viable, minimally invasive alternative to ALIF for L5/S1 fusion.

## Key findings

- UBE-TLIF showed significant improvements in pain scores and disability index compared to preoperative values.
- Radiological parameters like disc and foraminal height increased significantly after UBE-TLIF.
- UBE-TLIF had shorter operative times and less blood loss compared to traditional ALIF.

## Abstract

Objectives

The main objective of this study is to compare clinical and radiological outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) with dual-direction expandable cages, versus anterior lumbar interbody fusion (ALIF) at L5/S1.

Summary of literature review

Traditional ALIF and TLIF approaches have limitations. UBE-TLIF with dual-direction expandable cages represents an emerging, minimally invasive alternative with potential advantages in tissue preservation and anatomical restoration.

Materials and methods

Six patients underwent UBE-TLIF at L5/S1 using expandable titanium cages. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Radiological parameters included disc height and neural foraminal height. Results were compared with ALIF outcomes from 11 literature studies.

Results

VAS decreased from 7.7 ± 1 to 4 ± 2 (back pain) and 8.2 ± 0.9 to 3 ± 2.1 (leg pain). ODI improved from 59 ± 5.8 to 27.5 ± 15. Disc height increased from 5.6 ± 1.5 mm to 15.8 ± 0.6 mm, and foraminal height from 8.8 ± 4 mm to 16.8 ± 3.4 mm (p < 0.05). Mean operative time was 269.5 minutes, with blood loss of 152 ± 30 mL.

Conclusions

UBE-TLIF demonstrates outcomes comparable to ALIF, with the advantages of single-position surgery and minimal tissue disruption, representing a viable, minimally invasive alternative for L5/S1 degenerative pathology.