Total and Hidden Blood Loss in Biportal Endoscopic Versus Tubular-Based Minimally Invasive Transforaminal Lumbar Interbody Fusion

Traditional open posterior lumbar interbody fusion pro-cedures are associated with significant disadvantages including substantial blood loss, extensive muscle damage, and prolonged recovery periods. 1)The evolution toward minimally invasive spine surgery has led to techniques such as minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), which utilizes tubular retractors and microscopic visualization to significantly reduce muscle trauma and blood loss while maintaining adequate visualization for safe decompression and fusion. 2,3)More recently, biportal endoscopic transforaminal lumbar in-