Minimally invasive versus open transforaminal lumbar interbody fusion for single segmental lumbar disc herniation: A meta-analysis

Abstract

Background: Numerous studies on the comparison of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open-transforaminal lumbar interbody fusion (O-TLIF) for the treatment of lumbar disc herniation (LDH) have been published, but there is no clear conclusion.

Objective: The aim of this study was to evaluate the efficacy of MIS-TLIF compared with O-TLIF in the treatment of LDH in the Chinese population by meta-analysis.

Methods: Studies on the treatment of LDH by MIS-TLIF versus O-TLIF were searched in Pubmed, Web of Science, Medline, Embase, CNKI, VIP and China Wanfang databases from the establishment of the databases to January 2020. The meta-analysis was used to analyze the pooled operation time, intraoperative blood loss, postoperative drainage, postoperative ground movement time, Waist and leg Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score and Japanese orthopaedic association (JOA) score. Mean difference (MD) and standard mean difference (SMD) were used as the effect size.

Results: Eleven studies with 1132 patients were included. The results showed that MIS-TLIF compared with O-TLIF, MD =-133.82 (95% CI: -167.10 ∼-100.53, P< 0.05) in intraoperative blood loss, MD =-114.43 (95% CI: -141.12 ∼-87.84, P< 0.05) in postoperative drainage, MD =-3.30 (95% CI: -4.31 ∼-2.28, P< 0.05) in postoperative ground movement time, SMD =-1.44 (95% CI: -2.63 ∼-0.34, P< 0.05) in postoperative low back pain VAS score, SMD = 0.41 (95% CI: 0.15 ∼ 0.66, P< 0.05) in postoperative JOA score, MD = 4.12 (95% CI: -11.64 ∼ 19.87, P> 0.05) in the average operation time, SMD =-0.00 (95% CI: -0.36 ∼ 0.36, P> 0.05) in leg pain VAS score, and SMD =-0.59 (95% CI: -1.22 ∼ 0.03, P> 0.05) in ODI score.

Conclusion: MIS-TLIF was superior to O-TLIF in the treatment of LDH, especially in the intraoperative blood loss, postoperative drainage, postoperative ground movement time and low back pain in the Chinese population.

Keywords: Lumbar disc herniation (LDH); meta-analysis; minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF); open-transforaminal lumbar interbody fusion (O-TLIF); randomized controlled trials.

Figure 1.

Flow diagram of the study.

Figure 2.

Forest plots with effect index of MD (A: average operation time; B: intraoperative blood loss; C: postoperative drainage; D: postoperative ground movement time).

Figure 3.

Forest plots with effect index of SMD (A: postoperative low back pain VAS score; B: postoperative leg pain VAS score; C: postoperative ODI score; D: postoperative JOA score).

Figure 4.

Funnel plots with effect index of MD (A: average operation time; B: intraoperative blood loss; C: postoperative drainage; D: postoperative ground movement time).

Figure 5.

Funnel plots with the effect index of SMD (A: VAS score of postoperative low back pain; B: VAS score of postoperative leg pain; C: postoperative ODI score).

Figure 6.

The results of sensitivity analysis with effect index of MD (A: average operation time; B: intraoperative blood loss; C: postoperative drainage; D: postoperative ground movement time).

Figure 7.

Sensitivity analysis with the effect index of SMD (A: postoperative low back pain VAS score; B: postoperative leg pain VAS score; C: postoperative ODI score; D: postoperative JOA score).