Endoscopic Lumbar Interbody Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Structured Debate and International Practice Patterns

Lumbar fusion has evolved from open transforaminal lumbar interbody fusion (TLIF) to minimally invasive TLIF (MIS-TLIF), the current minimally invasive benchmark. Endoscopic techniques, proven in discectomy and decompression, have been extended to fusion (uniportal endoscopic TLIF and biportal endoscopic TLIF), offering an alternative to MIS-TLIF. This structured debate-style review critically compares both techniques across 7 domains to clarify their respective roles in lumbar degenerative disease. It combined independent advocacy drafts with an international survey of 106 respondents across 35 countries, capturing procedural preferences and case-based reasoning. Using a prespecified 70% agreement threshold, domains were classified as domains with ≥70% panel agreement, whereas domains falling below this threshold were categorized as domains below the prespecified agreement threshold. This represents structured international survey agreement, not a formal Delphi process. Endoscopic fusion offers advantages in decreased blood loss, soft-tissue preservation, early postoperative back pain, and early recovery, with comparable mid-term clinical outcomes (long-term insufficiently established) to MIS-TLIF, which remains more reproducible and familiar. Complication rates are similar but technique-sensitive for endoscopic fusion. Panel responses favored endoscopic approaches for morbidity-related domains (soft-tissue preservation 89.6%, visualization 81.1%, recovery 74.5%), while fusion stability, short- to mid-term clinical outcomes, complications, and revision remained context-dependent without clear agreement. Endoscopic fusion is a credible option for selected single-level lumbar degenerative disease, offering perioperative advantages with comparable mid-term outcomes to MIS-TLIF; core endpoints, including fusion rate and revision rate, did not reach 70% panel agreement, even among endoscopy-favorable panelists. MIS-TLIF retains reproducibility advantages. The debate has shifted from feasibility to implementation, training standardization, cost-effectiveness, and long-term durability.

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Publication Details

Journal
Neurospine
Published
2026-10-29
DOI
https://doi.org/10.14245/ns.26521616.0808
Citations
3
Primary Topic
Spine and Intervertebral Disc Pathology
Type
article
Field-Weighted Citation Impact
13.72

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article

Endoscopic Lumbar Interbody Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Structured Debate and International Practice Patterns

Alberto Ofenhejm Gotfryd, Zubair Khalid, Jae‐Joong Kim, Mazda Farshad et al.
3 citations
Neurospine
Spine and Intervertebral Disc Pathology
13.72
article

Endoscopic Lumbar Interbody Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Structured Debate and International Practice Patterns

Alberto Ofenhejm Gotfryd, Zubair Khalid, Jae‐Joong Kim, Mazda Farshad, Xavier A. Santander, Don Young Park, Khanathip Jitpakdee, Rizwan Akram, Asrafi Rizki Gatam, Win Boonsirikamchai, José Miguel Spirig, Roger Härtl, Ariel Matias Kaen, Vit Kotheeranurak, Christoph Johannes Laux, Avelino Parajon, Koichi Sairyo, Cheul Woong Park, Akarawit Asawasaksakul, Xuexiao Ma, Ahmed Ibrahim, John Choi
article en
3 citations

Abstract

Lumbar fusion has evolved from open transforaminal lumbar interbody fusion (TLIF) to minimally invasive TLIF (MIS-TLIF), the current minimally invasive benchmark. Endoscopic techniques, proven in discectomy and decompression, have been extended to fusion (uniportal endoscopic TLIF and biportal endoscopic TLIF), offering an alternative to MIS-TLIF. This structured debate-style review critically compares both techniques across 7 domains to clarify their respective roles in lumbar degenerative disease. It combined independent advocacy drafts with an international survey of 106 respondents across 35 countries, capturing procedural preferences and case-based reasoning. Using a prespecified 70% agreement threshold, domains were classified as domains with ≥70% panel agreement, whereas domains falling below this threshold were categorized as domains below the prespecified agreement threshold. This represents structured international survey agreement, not a formal Delphi process. Endoscopic fusion offers advantages in decreased blood loss, soft-tissue preservation, early postoperative back pain, and early recovery, with comparable mid-term clinical outcomes (long-term insufficiently established) to MIS-TLIF, which remains more reproducible and familiar. Complication rates are similar but technique-sensitive for endoscopic fusion. Panel responses favored endoscopic approaches for morbidity-related domains (soft-tissue preservation 89.6%, visualization 81.1%, recovery 74.5%), while fusion stability, short- to mid-term clinical outcomes, complications, and revision remained context-dependent without clear agreement. Endoscopic fusion is a credible option for selected single-level lumbar degenerative disease, offering perioperative advantages with comparable mid-term outcomes to MIS-TLIF; core endpoints, including fusion rate and revision rate, did not reach 70% panel agreement, even among endoscopy-favorable panelists. MIS-TLIF retains reproducibility advantages. The debate has shifted from feasibility to implementation, training standardization, cost-effectiveness, and long-term durability.

NeurospineVol. 23(4)
Thai Red Cross Society (TH), NewYork–Presbyterian Hospital (US), Imperial College Healthcare NHS Trust (GB), Chulalongkorn University (TH), University of Zurich (CH), University of California, Irvine (US), Hospital Israelita Albert Einstein (BR), King Chulalongkorn Memorial Hospital (TH), Affiliated Hospital of Qingdao University (CN), Universitätsklinik Balgrist (CH), Bhumibol Adulyadej Hospital (TH), Hospital Universitario Virgen del Rocío (ES), The Catholic University of Korea Seoul St. Mary's Hospital (KR), Hospital Universitario Ramón y Cajal (ES), Fatmawati Hospital (ID), Weill Cornell Medicine (US), Daejeon Woori Hospital (KR), Weill Cornell Medical Center (US), Kasemrad Ramkhamhaeng Hospital (TH), Queen Savang Vadhana Memorial Hospital (TH), Catholic University of Korea (KR), Tokushima University (JP)
National Key Research and Development Program of China
Good health and well-being
Openalex Percentile: Top 1%
Spine and Intervertebral Disc Pathology
13.72
DOIOpen Access PDFOpenAlex
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