Abstract
Purpose
To determine whether the open or the minimally invasive transforaminal lumbar interbody fusion (O-TLIF, MI-TLIF) is the favored treatment, we provide first meta-analyses using prospective studies with at least two years follow-up only and present the clinical relevance of statistical results for the first time.
Methods
After a systematic review of six databases, we conducted 10 meta-analyses of randomized controlled trials (RCTs) and 10 meta-analyses of eligible prospective studies (EPSs) to compare fusion rate, patient-reported outcome measures (back pain (B-VAS), leg pain, Oswestry Disability Index (ODI)), for the first time safety outcome measures as operative and postoperative complications per case, and the perioperative outcome measures estimated blood loss (EBL), operation time and length of hospital stay (LOS). The clinical relevance was assessed by overall effect sizes (OESs) of statistically significant meta-analytic results.
Results
In our meta-analyses of RCTs, MI-TLIF is statistically significantly superior in ODI, EBL and LOS, with clinically meaningful OESs only in EBL and LOS. In meta-analyses of EPSs, MI-TLIF is statistically significantly superior in B-VAS, postoperative complications per case, EBL and LOS, all with clinically meaningful OESs except for B-VAS. The meta-analyses of remaining outcome measures present statistically nonsignificant results. In a descriptive analysis of complications, postoperative wound infections predominate in O-TLIF and hardware malposition in MI-TLIF.
Conclusion
After at least two years, O-TLIF and MI-TLIF can be considered equally efficacious, which simplifies surgeons’ decision between both treatments, however, with the safety outcome measure postoperative complications per case and the perioperative outcome measures EBL and LOS in favor of MI-TLIF.
Level of evidence I
Well conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias.
Similar content being viewed by others
Data availability
The meta-analytic datasets are available from the corresponding author on reasonable request.
References
Li A, Li X, Zhong Y (2018) Is minimally invasive superior than open transforaminal lumbar interbody fusion for single-level degenerative lumbar diseases: a meta-analysis. J Orthop Surg Res 13:241. https://doi.org/10.1186/s13018-018-0941-8
Qin R, Liu B, Zhou P, Yao Y, Hao J, Yang K, Xu TL, Zhang F, Chen X (2019) Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of single-level spondylolisthesis grades 1 and 2: a systematic review and meta-analysis. World Neurosurg 122:180–189. https://doi.org/10.1016/j.wneu.2018.10.202
Miller LE, Bhattacharyya S, Pracyk J (2020) Minimally invasive versus open transforaminal lumbar interbody fusion for single-level degenerative disease: a systematic review and meta-analysis of randomized controlled trials. World Neurosurg. https://doi.org/10.1016/j.wneu.2019.08.162
Heemskerk JL, Oluwadara Akinduro O, Clifton W, Quinones-Hinojosa A, Abode-Iyamah KO (2021) Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases: a meta-analysis. Spine J. https://doi.org/10.1016/j.spinee.2021.07.006
Büttner-Janz Spinefoundation (2021) Systematic review and advanced meta-analytic assessment of one-level open vs. minimally invasive transforaminal lumbar interbody fusion after at least two years follow-up. https://spinefoundation.info/medaba/studyprotocols?u=48. Accessed 20 November 2021
Haynes R, Sackett D, Guyatt G, Tugwell P (2006) Clinical epidemiology: how to do clinical practice research. Lippincott Williams & Wilkins, Philadelphia, PA
Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine (Phila Pa 1976). https://doi.org/10.1097/00007632-200011150-00017
Hemanta D, Jiang XX, Feng ZZ, Chen ZX, Cao YW (2016) Etiology for degenerative disc disease. Chin Med Sci J 31:185–191. https://doi.org/10.1016/s1001-9294(16)30049-9
No authors listed. Scottish Intercollegiate Guidelines Network. www.sign.ac.uk/assets/sign50_2011.pdf. Accessed 10 March 2021
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hrobjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The prisma 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71
Büttner-Janz K (2013) Büttner-Janz Spinefoundation, Meta-analyses-DataBase. https://spinefoundation.info/en/meta-analyses-database. Accessed 09 July 2021
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. https://doi.org/10.1136/bmj.327.7414.557
Deeks J, Higgins J, Altman D (2021) Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds). Cochrane Handbook for systematic reviews of interventions version 6.2 (updated February 2021). Cochrane, Available from www.training.cochrane.org/handbook
Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10:407–415. https://doi.org/10.1016/0197-2456(89)90005-6
Boutron I, Page M, Higgins J, Altman D, Lundh A, Hróbjartsson A (2021) Chapter 7: Considering Bias and conflicts of interest among included studies. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds). Cochrane Handbook for systematic reviews of interventions version 6.2 (updated February 2021). Cochrane, Available from www.training.cochrane.org/handbook
Wang HL, Lu FZ, Jiang JY, Ma X, Xia XL, Wang LX (2011) Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial. Chin Med J 124:3868–3874
Rodriguez-Vela J, Lobo-Escolar A, Joven E, Munoz-Marin J, Herrera A, Velilla J (2013) Clinical outcomes of minimally invasive versus open approach for one-level transforaminal lumbar interbody fusion at the 3- to 4-year follow-up. Eur Spine J 22:2857–2863. https://doi.org/10.1007/s00586-013-2853-y
Yang Y, Liu B, Rong LM, Chen RQ, Dong JW, Xie PG, Zhang LM, Feng F (2015) Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: short-term and medium-term outcomes. Int J Clin Exp Med 8:21319–21326
Lv Y, Chen J, Chen J, Wu Y, Chen X, Liu Y, Chu Z, Sheng L, Qin R, Chen M (2017) Three-year postoperative outcomes between MIS and conventional TLIF in1-segment lumbar disc herniation. Minim Invasive Ther Allied Technol 26:168–176. https://doi.org/10.1080/13645706.2016.1273837
Zhang S, Chen H, Ge D, Yang K, Zhang Q, Cao X (2019) Mini-open transforaminal lumbar interbody fusion through a modified Wiltse paraspinal approach for recurrent lumbar disc herniation. Int J Clin Exp Med 12:2525–2531
Zhao H, Gao H, Zhou C, Qian S, Yuan Y, Xue W, Qian J (2019) A randomized controlled trial with >/=5 years of follow-up comparing minimally invasive and open transforaminal lumbar interbody fusion in disc herniation at single level. Exp Ther Med 17:3614–3620. https://doi.org/10.3892/etm.2019.7368
Wang J, Zhou Y, Feng Zhang Z, Qing Li C, Jie Zheng W, Liu J (2014) Comparison of the clinical outcome in overweight or obese patients after minimally invasive versus open transforaminal lumbar interbody fusion. J Spinal Disord Tech 27:202–206. https://doi.org/10.1097/BSD.0b013e31825d68ac
Shunwu F, Xing Z, Fengdong Z, Xiangqian F (2010) Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine 35:1615–1620. https://doi.org/10.1097/BRS.0b013e3181c70fe3
Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB (2012) Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 21:2265–2270. https://doi.org/10.1007/s00586-012-2281-4
Parker SL, Mendenhall SK, Shau DN, Zuckerman SL, Godil SS, Cheng JS, McGirt MJ (2014) Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis: comparative effectiveness and cost-utility analysis. World Neurosurg 82:230–238. https://doi.org/10.1016/j.wneu.2013.01.041
Zhang W, Li X, Shang X, Xu X, Hu Y, He R, Duan L, Ling X, Zhang F (2015) Modified minimally invasive transforaminal lumbar interbody fusion using a trans-multifidus approach: a safe and effective alternative to open-TLIF. J Orthop Surg Res 10:93. https://doi.org/10.1186/s13018-015-0234-4
Wu MH, Dubey NK, Li YY, Lee CY, Cheng CC, Shi CS, Huang TJ (2017) Comparison of minimally invasive spine surgery using intraoperative computed tomography integrated navigation, fluoroscopy, and conventional open surgery for lumbar spondylolisthesis: a prospective registry-based cohort study. Spine J 17:1082–1090. https://doi.org/10.1016/j.spinee.2017.04.002
Wu AM, Hu ZC, Li XB, Feng ZH, Chen D, Xu H, Huang QS, Lin Y, Wang XY, Zhang K, Zhao J, Ni WF (2018) Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up. Ann Transl Med 6(6):105
Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J (2010) Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J 19:1780–1784. https://doi.org/10.1007/s00586-010-1404-z
Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ (2011) Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech 24:479–484. https://doi.org/10.1097/BSD.0b013e3182055cac
Adogwa O, Johnson K, Min ET, Issar N, Carr KR, Huang K, Cheng J (2012) Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study. Surg Neurol Int 3:S355–361. https://doi.org/10.4103/2152-7806.103868
Archavlis E, Nievas MCY (2013) Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis. Eur Spine J 22:1731–1740. https://doi.org/10.1007/s00586-013-2732-6
Cheng JS, Park P, Le H, Reisner L, Chou D, Mummaneni PV (2013) Short-term and long-term outcomes of minimally invasive and open transforaminal lumbar interbody fusions: is there a difference? Neurosurg Focus 35:E6. https://doi.org/10.3171/2013.5.FOCUS1377
Saetia K, Phankhongsab A, Kuansongtham V, Paiboonsirijit S (2013) Comparison between minimally invasive and open transforaminal lumbar interbody fusion. J Med Assoc Thai 96:41–46
Seng C, Siddiqui MA, Wong KP, Zhang K, Yeo W, Tan SB, Yue WM (2013) Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine 38:2049–2055. https://doi.org/10.1097/BRS.0b013e3182a8212d
Zairi F, Arikat A, Allaoui M, Assaker R (2013) Transforaminal lumbar interbody fusion: comparison between open and mini-open approaches with two years follow-up. J Neurol Surg A Cent Eur Neurosurg 74:131–135. https://doi.org/10.1055/s-0032-1330956
Singh K, Nandyala SV, Marquez-Lara A, Fineberg SJ, Oglesby M, Pelton MA, Andersson GB, Isayeva D, Jegier BJ, Phillips FM (2014) A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion. Spine J 14:1694–1701. https://doi.org/10.1016/j.spinee.2013.10.053
Rečnik G, Milcić M, Fokter SK, Mirnik N, Moličnik A, Vogrin M (2015) Early benefits of minimally invasive transforaminal lumbar interbody fusion in comparison with the traditional open procedure. Zdravniski Vestn J 84:358–365
Kulkarni AG, Bohra H, Dhruv A, Sarraf A, Bassi A, Patil VM (2016) Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion. Indian J Orthop 50:464–472. https://doi.org/10.4103/0019-5413.189607
Serban D, Calina N, Tender G (2017) Standard versus minimally invasive transforaminal lumbar interbody fusion: a prospective randomized study. Biomed Res Int 2017:7236970. https://doi.org/10.1155/2017/7236970
Tian W, Xu YF, Liu B, Liu YJ, He D, Yuan Q, Lang Z, Han XG (2017) Computer-assisted minimally invasive transforaminal lumbar interbody fusion may be better than open surgery for treating degenerative lumbar disease. Clin Spine Surg 30:237–242. https://doi.org/10.1097/BSD.0000000000000165
Parker SL, Mendenhall SK, Shau DN, Adogwa O, Anderson WN, Devin CJ, McGirt MJ (2012) Minimum clinically important difference in pain, disability, and quality of life after neural decompression and fusion for same-level recurrent lumbar stenosis: understanding clinical versus statistical significance. J Neurosurg Spine 16:471–478. https://doi.org/10.3171/2012.1.SPINE11842
Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F (2019) Open versus minimally invasive TLIF: literature review and meta-analysis. J Orthop Surg Res 14:229. https://doi.org/10.1186/s13018-019-1266-y
Acknowledgements
We thank Robert Röhle, M.Sc. of the Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin Charitéplatz 1, 10117 Berlin, Germany for his statistical advice.
Author information
Authors and Affiliations
Contributions
MK was involved in methodology, conceptualization, formal analysis and investigation, writing-original draft preparation, and data extraction; MK and LB contributed to literature search; LB was involved in check of data extraction; LB and KBJ contributed to writing-review and editing; KBJ was involved in supervision of all parts.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
Using only published data, an ethical approval is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kunadt, M., Barleben, L. & Büttner-Janz, K. One-level open vs. minimally invasive transforaminal lumbar interbody fusion: a systematic review and advanced meta-analytic assessment of prospective studies with at least two years follow-up. Eur Spine J 31, 2557–2571 (2022). https://doi.org/10.1007/s00586-022-07223-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-022-07223-w