Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 3;9(6):536-555.
doi: 10.1530/EOR-23-0167.

Is endoscopic technique an effective and safe alternative for lumbar interbody fusion? A systematic review and meta-analysis

Miguel Relvas-Silva  1   2 , Bernardo Sousa Pinto  3   4 , António Sousa  1 , Miguel Loureiro  1   5 , André Rodrigues Pinho  1   6 , Pedro Pereira  2   4   6
Affiliations

Is endoscopic technique an effective and safe alternative for lumbar interbody fusion? A systematic review and meta-analysis

Miguel Relvas-Silva et al. EFORT Open Rev. .

Abstract

Study design: Systematic review; meta-analysis.

Purpose: Lumbar degenerative disease is frequent and has a tremendous impact on patients' disability and quality-of-life. Open and minimally invasive procedures have been used to achieve adequate decompression and fusion. Endoscopic lumbar interbody fusion (Endo-LIF) is emerging as an alternative, trying to reduce morbidity, while achieving comparable to superior clinical outcomes. The aim of this work is to perform a systematic review and meta-analysis to investigate how Endo-LIF compares to open or minimally invasive procedures.

Methods: Electronic databases (MEDLINE, Scopus, Web of Science, Cochrane) were systematically reviewed using the query: '(percutaneous OR endoscop*) AND (open OR minimal* invasive) AND lumbar AND fusion'. PRISMA guidelines were followed.

Results: Twenty-seven articles were included (25 cohort study, 1 quasi-experimental study, and 1 randomized control trial; for meta-analytical results, only observational studies were considered). Endo-LIF conditioned longer operative time, with significantly lower blood loss, bedtime, and hospital length of stay. Early post-operative back pain favored endoscopic techniques. Endo-LIF and non-Endo-LIF minimally invasive surgery displayed comparable results for most back and leg pain or disability outcomes, despite Endo-LIF having been associated with higher disability at late follow-up (versus Open-LIF). No differences were found regarding fusion rates, cage subsidence, or adverse events. Definitive conclusions regarding fusion rate cannot be drawn due to low number of studies and unstandardized fusion definition.

Conclusion: Endo-LIF is an effective and safe alternative to conventional lumbar interbody fusion procedures. Evidence shortcomings may be addressed, and future randomized control trials may be performed to compare techniques and to validate results.

Keywords: endoscopic surgery; lumbar degenerative disease; lumbar interbody fusion; minimally invasive surgery; open surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the study reported here.

Figures

Figure 1
Figure 1
PRISMA flow diagram regarding literature search.
Figure 2
Figure 2
Endo-LIF vs MIS-LIF: forest plots with the mean difference for surgical- and hospital-related outcomes (6, 14, 15, 16, 18, 20, 21, 22, 23, 25, 29, 34, 35, 36, 38).
Figure 3
Figure 3
Endo-LIF vs Open-LIF: forest plots with the mean difference for surgical- and hospital-related outcomes (13, 19, 24, 36, 30, 31, 32, 33, 37).
Figure 4
Figure 4
Endo-LIF vs MIS-LIF: forest plots with the mean difference for post-operative back pain (6, 14, 15, 16, 18, 21, 22, 23, 29, 35, 36, 38).
Figure 5
Figure 5
Endo-LIF vs Open-LIF: forest plots with the mean difference for post-operative back pain (13, 19, 24, 26, 31, 32, 33, 37).
Figure 6
Figure 6
Endo-LIF vs MIS-LIF: forest plots with the mean difference for post-operative leg pain (6, 15, 16, 18, 21, 22, 23, 29, 35, 36).
Figure 7
Figure 7
Endo-LIF vs Open-LIF: forest plots with the mean difference for post-operative leg pain (13, 19, 24, 26, 31, 32, 33, 37).
Figure 8
Figure 8
Endo-LIF vs MIS-LIF: forest plots with the mean difference for post-operative disability (6, 14, 15, 16, 18, 21, 22, 23, 29, 35, 36, 38).
Figure 9
Figure 9
Endo-LIF vs Open-LIF: forest plots with the mean difference for post-operative disability (13, 19, 24, 26, 31, 32, 33, 37).
Figure 10
Figure 10
Endo-LIF vs MIS-LIF: forest plots with risk ratio for fusion, cage subsidence, and adverse events (6, 14, 15, 16, 18, 20, 21, 22, 23, 25, 27, 28, 29, 34, 35, 36).
Figure 11
Figure 11
Endo-LIF vs Open-LIF: forest plots with risk ratio for fusion, cage subsidence, and adverse events (13, 24, 26, 30, 31, 32, 33, 37).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Fehlings MG Tetreault L Nater A Choma T Harrop J Mroz T Sntaguida C & Smith JS. The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery 201577(Supplement1) S1–S5. (10.1227/NEU.0000000000000953) - DOI - PubMed
    1. Ravindra VM Senglaub SS Rattani A Dewan MC Härtl R Bisson E Park KB & Shrime MG. Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Global Spine Journal 20188784–794. (10.1177/2192568218770769) - DOI - PMC - PubMed
    1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, et al.What low back pain is and why we need to pay attention. The Lancet 20183912356–2367. (10.1016/S0140-6736(1830480-X) - DOI - PubMed
    1. Mobbs RJ Phan K Malham G Seex K & Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. Journal of Spine Surgery 201512–18. (10.3978/j.issn.2414-469X.2015.10.05) - DOI - PMC - PubMed
    1. Momin AA & Steinmetz MP. Evolution of minimally invasive lumbar spine surgery. World Neurosurgery 2020140622–626. (10.1016/j.wneu.2020.05.071) - DOI - PubMed

LinkOut - more resources