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European Spine Journal

, Volume 24, Issue 5, pp 1017–1030 | Cite as

Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis

  • Kevin PhanEmail author
  • Prashanth J. Rao
  • Andrew C. Kam
  • Ralph J. Mobbs
Review Article

Abstract

Purpose

While open TLIF (O-TLIF) remains the mainstay approach, minimally invasive TLIF (MI-TLIF) may offer potential advantages of reduced trauma to paraspinal muscles, minimized perioperative blood loss, quicker recovery and reduced risk of infection at surgical sites. This meta-analysis was conducted to provide an updated assessment of the relative benefits and risks of MI-TLIF versus O-TLIF.

Methods

Electronic searches were performed using six databases from their inception to December 2014. Relevant studies comparing MI-TLIF and O-TLIF were included. Data were extracted and analysed according to predefined clinical end points.

Results

There was no significant difference in operation time noted between MI-TLIF and O-TLIF cohorts. The median intraoperative blood loss for MI-TLIF was significantly lower than O-TLIF (median: 177 vs 461 mL; (weighted mean difference) WMD, −256.23; 95 % CI −351.35, −161.1; P < 0.00001). Infection rates were significantly lower in the minimally invasive cohort (1.2 vs 4.6 %; relative risk (RR), 0.27; 95 %, 0.14, 0.53; I 2 = 0 %; P = 0.0001). VAS back pain scores were significantly lower in the MI-TLIF group compared to O-TLIF (WMD, −0.41; 95 % CI −0.76, −0.06; I 2 = 96 %; P < 0.00001). Postoperative ODI scores were also significantly lower in the minimally invasive cohort (WMD, −2.21; 95 % CI −4.26, −0.15; I 2 = 93 %; P = 0.04).

Conclusions

In summary, the present systematic review and meta-analysis demonstrated that MI-TLIF appears to be a safe and efficacious approach compared to O-TLIF. MI-TLIF is associated with lower blood loss and infection rates in patients, albeit at the risk of higher radiation exposure for the surgical team. The long-term relative merits require further validation in prospective, randomized studies.

Keywords

Minimally invasive Transforaminal lumbar interbody fusion TLIF Lumbar Spine Degenerative 

Notes

Conflict of interest

The authors have no conflict of interest whatsoever in the conduct of the study or its results.

Supplementary material

586_2015_3903_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)
586_2015_3903_MOESM2_ESM.doc (64 kb)
Supplementary material 2 (DOC 63 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Kevin Phan
    • 1
    • 2
    Email author
  • Prashanth J. Rao
    • 1
    • 2
  • Andrew C. Kam
    • 2
  • Ralph J. Mobbs
    • 1
  1. 1.Neurospine Clinic and Neurospine Surgery Research Group (NSURG)Prince of Wales Private HospitalSydneyAustralia
  2. 2.Department of NeurosurgeryWestmead HospitalSydneyAustralia

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