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Meta-Analysis
. 2016 Aug 20;129(16):1969-86.
doi: 10.4103/0366-6999.187847.

Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion: An Updated Meta-analysis

Lei Xie  1 , Wen-Jian Wu  1 , Yu Liang  1
Affiliations
Meta-Analysis

Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion: An Updated Meta-analysis

Lei Xie et al. Chin Med J (Engl). .

Abstract

Background: The previous studies agree that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures.

Methods: Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database (the literature search comprised Medical Subject Heading terms and key words or Emtree term). The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios (RR s) and weighted mean differences (WMDs) with 95% confidence intervals were calculated for the clinical outcomes and perioperative data.

Results: Twenty-four studies (n = 1967 patients) were included in this review (n = 951, open-TLIF, n = 1016, MIS-TLIF). MIS-TLIF was associated with a significant decrease in the visual analog score (VAS)-back pain score (WMD = -0.44; P = 0.001), Oswestry Disabilities Index (WMD = -1.57; P = 0.005), early ambulation (WMD = -1.77; P = 0.0001), less blood loss (WMD = -265.59; P < 0.00001), and a shorter hospital stay (WMD = -1.89; P < 0.0001). However, there were no significant differences in the fusion rate (RR = 0.99; P = 0.34), VAS-leg pain (WMD = -0.10; P = 0.26), complication rate (RR = 0.84; P = 0.35), operation time (WMD = -5.23; P = 0.82), or reoperation rate (RR = 0.73; P = 0.32).

Conclusions: MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.

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Figures

Figure 1
Figure 1
Flow diagram for the selection of studies.
Figure 2
Figure 2
Forest plot: postoperative VAS-BP/LP and ODI. MIS: Minimally invasive surgery; Open: Open surgery; VAS-BP/LP: Visual analog score-back pain/leg pain; ODI: Oswestry Disabilities Index; CI: Confidence interval; SD: Standard deviation.
Figure 3
Figure 3
Forest plot: Operation time, mean blood loss, hosptial stay, and ambulation time. MIS: Minimally invasive surgery; Open: Open surgery; CI: Confidence interval; SD: Standard deviation.
Figure 4
Figure 4
Forest plot: Fusion rate, complication rate, and reoperation rate. MIS: Minimally invasive surgery; Open: Open surgery; CI: Confidence interval.
Figure 5
Figure 5
Forest plot: Complication rate and reoperation rate. MIS: Minimally invasive surgery; Open: Open surgery; CI: Confidence interval.
See this image and copyright information in PMC

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