This retrospective study compared biportal endoscopic TLIF (BE-TLIF, n=32) against microscope-assisted minimally invasive TLIF (MI-TLIF, n=55) in patients with single-level degenerative or isthmic spondylolisthesis. The central question: does the two-portal endoscopic approach offer clinical advantages over the established tubular-retractor technique? All patients had minimum 1-year follow-up.
Surgeons choosing between minimally invasive TLIF techniques have lacked direct comparative data — prior literature focused on MI-TLIF vs. Open TLIF, leaving the endoscopic vs. Tubular-retractor question unanswered.
For patients with single-level degenerative or isthmic spondylolisthesis (grade 1-2), BE-TLIF delivers a measurable early recovery edge: roughly 5 fewer hours to walking and 3 fewer hospital days compared to MI-TLIF. When rapid mobilization matters. Frail patients, high readmission risk, or resource-limited settings. BE-TLIF earns consideration as the primary approach rather than a fallback.
The tradeoff is technique availability and the learning curve: BE-TLIF requires triangulation skills analogous to arthroscopy and is not yet universally available. At 1 year, outcomes are identical, so the benefit window is strictly perioperative.
This retrospective study compared biportal endoscopic TLIF (BE-TLIF, n=32) against microscope-assisted minimally invasive TLIF (MI-TLIF, n=55) in patients with single-level degenerative or isthmic spondylolisthesis. The central question: does the two-portal endoscopic approach offer clinical advantages over the established tubular-retractor technique? All patients had minimum 1-year follow-up.
Surgeons choosing between minimally invasive TLIF techniques have lacked direct comparative data — prior literature focused on MI-TLIF vs. Open TLIF, leaving the endoscopic vs. Tubular-retractor question unanswered.
For patients with single-level degenerative or isthmic spondylolisthesis (grade 1-2), BE-TLIF delivers a measurable early recovery edge: roughly 5 fewer hours to walking and 3 fewer hospital days compared to MI-TLIF. When rapid mobilization matters. Frail patients, high readmission risk, or resource-limited settings. BE-TLIF earns consideration as the primary approach rather than a fallback.
The tradeoff is technique availability and the learning curve: BE-TLIF requires triangulation skills analogous to arthroscopy and is not yet universally available. At 1 year, outcomes are identical, so the benefit window is strictly perioperative.