Biportal Endoscopic Transforaminal Interbody Fusion: Comparing Primary Versus Revision Cases

Background:The safety and efficacy of biportal endoscopic lumbar interbody fusion (BELIF) has been supported by many articles. Advantages include earlier rehabilitation and equal or superior fusion rates compared with other lumbar interbody fusion techniques.Purpose:To compare the clinical and radiological outcomes of primary and revision biportal endoscopic interbody fusion.Methods:Seventy-two consecutive patients who underwent primary and revision BELIF and had at least 2-year follow-up were investigated. Clinical outcomes, including Oswestry Disability Index, the visual analog system (VAS), MacNab's criteria, surgical time, and length of hospital stay, were recorded. Radiological outcome was assessed by CT and graded according to Bridwell system.Results:No notable difference was found in preoperative baselines between the groups. Both groups demonstrated similar clinical improvement in VAS, Oswestry Disability Index, and MacNab criteria. Durotomies were more common in the revision setting (4/33 vs. 0/39 in primary), and surgical time was statistically longer (121.4 ± 21.5 minutes primary versus 179 ± 23.7 minutes revision; P < 0.001). However, no difference was observed in fusion rates at all times points graded by CT scan (94.87% vs. 93.93% primary versus revision at the final follow-up, P = 0.51).Conclusion:Revision BELIF demonstrate similar clinical and radiographic outcomes compared with primary BELIF, yet surgical time and durotomy risks are increased.Study