Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis
- 1.9k Downloads
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.
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.
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).
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.
KeywordsMinimally invasive Transforaminal lumbar interbody fusion TLIF Lumbar Spine Degenerative
Conflict of interest
The authors have no conflict of interest whatsoever in the conduct of the study or its results.
- 12.Wong AP, Smith ZA, Stadler JA 3rd, Hu XY, Yan JZ, Li XF, Lee JH, Khoo LT (2014) Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF): surgical technique, long-term 4-year prospective outcomes, and complications compared with an open TLIF cohort. Neurosurg Clin N Am 25:279–304. doi: 10.1016/j.nec.2013.12.007 CrossRefPubMedGoogle Scholar
- 21.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 Off J North Am Spine Soc 14:1694–1701. doi: 10.1016/j.spinee.2013.10.053 CrossRefGoogle Scholar
- 22.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. doi: 10.1016/j.wneu.2013.01.041 CrossRefPubMedGoogle Scholar
- 26.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 Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22:2857–2863. doi: 10.1007/s00586-013-2853-y CrossRefGoogle Scholar
- 29.Brodano GB, Martikos K, Lolli F, Gasbarrini A, Cioni A, Bandiera S, Di Silvestre M, Boriani S, Greggi T (2013) Transforaminal lumbar interbody fusion in degenerative disc disease and spondylolisthesis grade I: minimally invasive versus open surgery. J Spinal Disord Tech. doi: 10.1097/BSD.0000000000000034 PubMedGoogle Scholar
- 30.Archavlis E, Carvi y Nievas M (2013) Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22:1731–1740. doi: 10.1007/s00586-013-2732-6 CrossRefGoogle Scholar
- 31.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100. doi: 10.1371/journal.pmed.1000100 CrossRefPubMedCentralPubMedGoogle Scholar
- 32.Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefPubMedGoogle Scholar
- 37.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 Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 19:1780–1784. doi: 10.1007/s00586-010-1404-z CrossRefGoogle Scholar