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Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis

Neurosurgical Review volume 41, pages 755–770 (2018)Cite this article

Abstract

The surgical procedures used for arthrodesis in the lumbar spine for degenerative lumbar diseases remain controversial. This systematic review aims to assess and compare clinical outcomes along with the complications and fusion of each technique (minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or minimally invasive lateral lumbar interbody fusion (MIS LLIF)) for treatment of degenerative lumbar diseases. Relevant studies were identified from Medline and Scopus from inception to July 19, 2016 that reported Oswestry Disability Index (ODI), back and leg pain visual analog score (VAS), postoperative complications, and fusion of either technique. Fifty-eight studies were included for the analysis of MIS-TLIF; 40 studies were included for analysis of LLIF, and 1 randomized controlled trial (RCT) study was included for comparison of MIS-TLIF to LLIF. Overall, there were 9506 patients (5728 in the MIS-TLIF group and 3778 in the LLIF group). Indirect meta-analysis, MIS-TLIF provided better postoperative back and leg pain (VAS), disabilities (ODI), and risk of having complications when compared to LLIF technique, but the fusion rate was not significantly different between the two techniques. However, direct meta-analysis between RCT study and pooled indirect meta-analysis of MIS-TLIF have better pain, disabilities, and complication but no statistically significant difference when compared to LLIF. In LLIF, the pooled mean ODI and VAS back pain were 2.91 (95% CI 2.49, 3.33) and 23.24 (95% CI 18.96, 27.51) in MIS approach whereas 3.14 (95% CI 2.29, 4.04) and 28.29 (95% CI 21.92, 34.67) in traditional approach. In terms of complications and fusion rate, there was no difference in both groups. In lumbar interbody fusion, MIS-TLIF had better ODI, VAS pain, and complication rate when compared to LLIF with direct and indirect meta-analysis methods. However, in terms of fusion rates, there were no differences between the two techniques.

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All authors declare no funding source or sponsor involvement in the study design, collection, analysis, and interpretation of the data, in writing the manuscript, and in submission of the manuscript for publication.

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  1. Orthopedics Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Gun Keorochana & Patarawan Woratanarat

  2. Orthopedics Department, Police General Hospital, Bangkok, Thailand

    Kitipong Setrkraising & Alisara Arirachakaran

  3. Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand

    Jatupon Kongtharvonskul

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  1. Gun Keorochana
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Conflict of interests

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable as no new patients were involved in this research.

Informed consent

Not applicable as no new patients were involved in this research.

Electronic supplementary material

Supplementary Table 1

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Supplementary Table 2

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Supplementary Table 3

(DOCX 21 kb)

Supplementary Table 4

(DOCX 20 kb)

ESM 1

(DOC 67 kb)

Appendix

Appendix

Search term

#1 degenerative spine.

#2 LLIF.

#3 DLIF.

#4 XLIF.

#5 lateral lumbar interbody fusion.

#6 transpsoas lumbar interbody fusion.

#7 extreme lateral interbody fusion.

#8 direct lateral interbody fusion.

#9 #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8.

#10 minimally invasive.

#11 MIS.

#12 MI-TLIF.

#13 transforaminal lumbar interbody fusion.

#14 #10 OR #11.

#15 #12 OR #13.

#16 #14 AND #15.

#17 #9 OR #16.

#18 oswestry disability index.

#19 ODI.

#20 VAS pain.

#21 revisions.

#22 fusions.

#23 complications.

#24 #18 OR #19 OR #20 OR #21 OR #22 OR #23.

#25 #1 AND #17 AND #24.

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Keorochana, G., Setrkraising, K., Woratanarat, P. et al. Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis. Neurosurg Rev 41, 755–770 (2018). https://doi.org/10.1007/s10143-016-0806-8

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  • DOI: https://doi.org/10.1007/s10143-016-0806-8

Keywords

  • Systematic review
  • MIS-TLIF
  • LLIF
  • XLIF
  • DDD