Biportal endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis.
7 affiliations
- 1John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
- 2Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA.
- 3Neuroscience Research Center, Lebanese University, Beirut, Lebanon.
- 4Independent Researcher, Pittsburg, PA, USA.
- 5Excel Health Neurosurgery and Spine, Honolulu, HI, USA.
- 6Department of Mathematics, Cornell University, Ithaca, NY, USA.
- 7Department of Neurological Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Abstract
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. 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. 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. 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.
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BibTeX
@article{bieschke2026biportal,
title = {{Biportal endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis.}},
author = {Victoria Bieschke and Ali Daoud and Zeina Nasser and Albert H W Jiang and Charbel Elias and Jeffrey Roh and Motoki Tsuneoka and Ma Magdalaine Anjeleigh Dela Cruz and Anna Peters and William J Lew and Sabrina Bhalla and Thomas Noh and Elias Elias},
journal = {Journal of spine surgery (Hong Kong)},
year = {2026},
month = oct,
doi = {10.21037/jss-2026-0209},
url = {https://europepmc.org/article/MED/42996526},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Biportal endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis.
AU - Victoria Bieschke
AU - Ali Daoud
AU - Zeina Nasser
AU - Albert H W Jiang
AU - Charbel Elias
AU - Jeffrey Roh
AU - Motoki Tsuneoka
AU - Ma Magdalaine Anjeleigh Dela Cruz
AU - Anna Peters
AU - William J Lew
AU - Sabrina Bhalla
AU - Thomas Noh
AU - Elias Elias
PY - 2026
DA - 2026/10/21
JO - Journal of spine surgery (Hong Kong)
DO - 10.21037/jss-2026-0209
UR - https://europepmc.org/article/MED/42996526
AB - 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. 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. 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. 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.
SN - 2414-469X
SN - 2414-4630
ER -