Long term clinical outcomes of minimally invasive transforaminal interbody fusion (MIS-TLIF) for lumbar spondylolisthesis in a geriatric (>65 years) population: a systematic review and meta-analysis

Abstract

Introduction: The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique has become a popular and effective option for treating lumbar degenerative spondylolisthesis, especially in elderly patients. This systematic review and meta-analysis is to evaluate the long-term results of MIS-TLIF for patients with degenerative spondylolisthesis.

Methods: We thoroughly reviewed and analyzed studies from databases like PubMed, Web of Science, Scopus, and Google Scholar, covering research published from 2015-2024. We used random-effects models to estimate overall prevalence, and we conducted sensitivity analyses and assessed publication bias to understand the variability in results. All analyses were done using the "meta" and "metafor" packages in RStudio.

Results: According to the random-effects model, the pooled standardized mean difference of the VAS back score dynamics at 12 months post-operative in geriatric MIS-TLIF patients was -4.30, 95% CI [-10.02; 1.42]; the VAS leg pain score dynamics at 12 months post-operative was -2.46, 95% CI [-5.61; 0.68]; the ODI score dynamics at 12 months post-operative was -3.01, 95% CI [-6.02; -0.01]. The VAS back pain score dynamics at 24 months post-operative was -1.77, 95% CI [-2.33; -1.21]; the VAS leg pain score dynamics at 24 months post-operative was -2.29, 95% CI [-3.22; -1.37]; and the ODI score dynamics at 24 months post-operative was -1.92, 95% CI [-2.57; -1.27].

Conclusion: Our study provides compelling evidence supporting the long-term efficacy of MIS-TLIF for managing lumbar spondylolisthesis in geriatric patients. The findings suggest that MIS-TLIF is associated with significant reductions in back and leg pain, as well as improvements in disability scores over 12 months post-operatively. However, these improvements in pain and functional disability decline at 24 months postoperatively, which could be explained by the physiological nature of degenerative changes in the geriatric population.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024538220, PROSPERO (CRD42024538220).

Keywords: MIS-TLIF; geriatric patients; lumbar spondylolisthesis; meta-analysis; systematic review.

Figure 1

PRISMA flow chart of study selection.

Figure 2

Meta-analysis of 12-month post-operative outcomes in MIS-TLIF patients: (A) VAS back pain; (B) VAS leg pain; (C) ODI scores.

Figure 3

Meta-regression analysis of the VAS back and leg pain, ODI scores in MIS-TLIF patients. (A) VAS back pain score; (B) VAS leg pain score; (C) ODI score dynamics at 12 months post-operative in MIS-TLIF patients.

Figure 4

Publication bias assessment of outcomes at 12 months post-operatively in MIS-TLIF patients: (A) VAS back pain score; (B) VAS leg pain score; (C) ODI score dynamics at 12 months post-operative in MIS-TLIF patients.

Figure 5

Meta-analysis of 24-month post-operative outcomes in MIS-TLIF patients: (A) VAS back pain; (B) VAS leg pain; (C) ODI scores.

Figure 6

Meta-regression analysis of the VAS back and leg pain, ODI scores in MIS-TLIF patients. (A) VAS back pain score; (B) VAS leg pain score; (C) ODI score dynamics at 24 months post-operative in MIS-TLIF patients.

Figure 7

Publication bias assessment of outcomes at 24 months post-operatively in MIS-TLIF patients: (A) VAS back pain score; (B) VAS leg pain score; (C) ODI score dynamics at 12 months post-operative in MIS-TLIF patients.