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. 2024 Feb 23;27(4):162.
doi: 10.3892/etm.2024.12450. eCollection 2024 Apr.

Comparison between minimally invasive and open transforaminal lumbar interbody fusion for the treatment of multi‑segmental lumbar degenerative disease: A systematic evaluation and meta‑analysis

Wan-Jing Zhai  1 , Zhan-Kui Wang  1 , Hua-Lv Liu  1 , Shi-Lei Qin  2   3 , Peng-Fei Han  4 , Yun-Feng Xu  2   3
Affiliations

Comparison between minimally invasive and open transforaminal lumbar interbody fusion for the treatment of multi‑segmental lumbar degenerative disease: A systematic evaluation and meta‑analysis

Wan-Jing Zhai et al. Exp Ther Med. .

Abstract

The present study aimed to compare the differences between minimally invasive transforaminal lumbar fusion (MIS-TLIF) and open transforaminal lumbar fusion (TLIF) for multi-segmental lumbar degenerative disease regarding intraoperative indices and postoperative outcomes. PubMed, Web of Science, Embase, CNKI, Wanfang and VIP databases were searched for literature on MIS-TLIF and open TLIF in treating multi-segmental lumbar degenerative diseases. Of the 1,608 articles retrieved, 10 were included for final analysis. The Newcastle-Ottawa Scale and Review Manager 5.4 were used for quality evaluation and data analysis, respectively. The MIS-TLIF group was superior to the open TLIF group regarding intraoperative blood loss [95% confidence interval (CI): -254.33,-157.86; P<0.00001], postoperative in-bed time (95%CI: -3.49,-2.76; P<0.00001), hospitalization time (95%CI: -5.14,-1.78; P<0.0001) and postoperative leg pain Visual Analog Scale score (95%CI: -0.27,-0.13; P<0.00001). The fluoroscopy frequency for MIS-TLIF (95%CI: 2.07,6.12; P<0.0001) was significantly higher than that for open TLIF. The two groups had no significant differences in operation time, postoperative drainage volume, postoperative complications, fusion rate, or Oswestry Disability Index score. In treating multi-segmental lumbar degenerative diseases, MIS-TLIF has the advantages of less blood loss, shorter bedtime and hospitalization time and improved early postoperative efficacy; however, open TLIF has a lower fluoroscopy frequency.

Keywords: lumbar degenerative disease; meta-analysis; minimally invasive transforaminal lumbar fusion; multi-segment; open transforaminal lumbar fusion.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow diagram of study identification and selection.
Figure 2
Figure 2
Forest plot for the operation time. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval.
Figure 3
Figure 3
Forest plot for the blood loss. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval.
Figure 4
Figure 4
Forest plot for the postoperative drainage volume. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval.
Figure 5
Figure 5
Forest plot for the fluoroscopy frequency. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval.
Figure 6
Figure 6
Forest plot for the postoperative in-bed time. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval.
Figure 7
Figure 7
Forest plot for the hospitalization time. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval.
Figure 8
Figure 8
Forest plot for the postoperative complications. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval; M-H, Mantel-Haenszel.
Figure 9
Figure 9
Forest plot for the fusion rate. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval; M-H, Mantel-Haenszel.
Figure 10
Figure 10
Forest plot for the overall fusion rate. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval; M-H, Mantel-Haenszel.
Figure 11
Figure 11
Forest plot for the Oswestry Disability Index scores. MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval.
Figure 12
Figure 12
Forest plot for the VAS scores. VAS, Visual Analog Scale; MIS, minimally invasive transforaminal lumbar fusion; Open, Open, transforaminal lumbar fusion; SD, standard deviation; CI, confidence interval.
Figure 13
Figure 13
Funnel plots created to assess publication bias for (A) operation time, (B) intraoperative blood loss, (C) postoperative drainage volume, (D) fluoroscopy frequency, (E) postoperative in-bed time, (F) hospitalization time, (G) postoperative complications, (H) fusion rate, (I) overall fusion rate, (J) Oswestry Disability Index scores, (K) Visual Analog Scale scores. SE, standard error; MD, mean difference; CI, confidence interval.
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