Abstract / Summary
To investigate the perioperative blood loss distribution and independent risk factors for hidden blood loss (HBL) in three posterior minimally invasive lumbar interbody fusion techniques: minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF), unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF), and full-endoscopic transforaminal lumbar interbody fusion (Endo-LIF). A retrospective analysis was conducted on 158 patients who underwent posterior minimally invasive single-level lumbar interbody fusion between September 2018 and April 2023, including 38 Mis-TLIF, 67 Endo-LIF, and 53 UBE-LIF cases. The distribution characteristics and related risk factors of HBL were analyzed. HBL differed significantly among the three surgical approaches (Mis-TLIF: 414.80 ± 267.78 mL; Endo-LIF: 224.26 ± 175.41 mL; UBE-LIF: 359.55 ± 295.51 mL; P = 0.002). At lambda.1se, LASSO regression retained no continuous candidate variable. In the multivariable linear regression model adjusted for sex, Endo-LIF was associated with significantly lower HBL than Mis-TLIF (B = − 180.164 mL, 95% CI: − 278.365 to − 81.963; P < 0.001), whereas no significant difference was observed between UBE-LIF and Mis-TLIF ( P = 0.227). Sex was not independently associated with HBL ( P = 0.109). Among the variables evaluated in this study, HBL was primarily associated with the choice of surgical approach. When minimizing perioperative blood loss is an important consideration and different procedures are otherwise clinically appropriate, Endo-LIF may be preferentially considered over Mis-TLIF. Nevertheless, surgical selection should also account for individual indications, anatomical characteristics, and surgeon expertise, and these findings require prospective validation.