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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

European Spine Journal (2022)Cite this article

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.

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Data availability

The meta-analytic datasets are available from the corresponding author on reasonable request.

References

  1. 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

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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

  6. Haynes R, Sackett D, Guyatt G, Tugwell P (2006) Clinical epidemiology: how to do clinical practice research. Lippincott Williams & Wilkins, Philadelphia, PA

    Google Scholar 

  7. Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine (Phila Pa 1976). https://doi.org/10.1097/00007632-200011150-00017

    Article  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. No authors listed. Scottish Intercollegiate Guidelines Network. www.sign.ac.uk/assets/sign50_2011.pdf. Accessed 10 March 2021

  10. 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

    Article  PubMed  PubMed Central  Google Scholar 

  11. Büttner-Janz K (2013) Büttner-Janz Spinefoundation, Meta-analyses-DataBase. https://spinefoundation.info/en/meta-analyses-database. Accessed 09 July 2021

  12. 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

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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

  14. 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

    CAS  Article  PubMed  Google Scholar 

  15. 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

  16. 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

    PubMed  Google Scholar 

  17. 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

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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

    CAS  PubMed  PubMed Central  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Google Scholar 

  21. 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

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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

    CAS  Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. 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

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    CAS  Article  Google Scholar 

  29. 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

    Article  PubMed  PubMed Central  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. 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

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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

    Article  PubMed  PubMed Central  Google Scholar 

  33. 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

    Article  PubMed  Google Scholar 

  34. 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

    PubMed  Google Scholar 

  35. 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

    Article  PubMed  Google Scholar 

  36. 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

    CAS  Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  Google Scholar 

  38. 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

    Google Scholar 

  39. 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

    Article  PubMed  PubMed Central  Google Scholar 

  40. 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

    Article  PubMed  PubMed Central  Google Scholar 

  41. 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

    Article  PubMed  Google Scholar 

  42. 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

    Article  PubMed  Google Scholar 

  43. 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

    Article  PubMed  PubMed Central  Google Scholar 

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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.

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Authors and Affiliations

  1. Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Max Kunadt, Luisa Barleben & Karin Büttner-Janz

  2. Büttner-Janz Spinefoundation, Meinekestraße 6, 10719, Berlin, Germany

    Karin Büttner-Janz

Authors
  1. Max Kunadt
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  2. Luisa Barleben
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  3. Karin Büttner-Janz
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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.

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Correspondence to Max Kunadt.

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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 (2022). https://doi.org/10.1007/s00586-022-07223-w

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  • DOI: https://doi.org/10.1007/s00586-022-07223-w

Keywords

  • Transforaminal lumbar interbody fusion
  • Minimally invasive
  • Degenerative disk disease
  • Meta-analysis