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Comparative Outcomes of Minimally Invasive Surgery for Posterior Lumbar Fusion: A Systematic Review

  • Symposium: Minimally Invasive Spine Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Although minimally invasive surgical (MIS) approaches to the lumbar spine for posterior fusion are increasingly being utilized, the comparative outcomes of MIS and open posterior lumbar fusion remain unclear.

Questions/purposes

In this systematic review, we compared MIS and open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF), specifically with respect to (1) surgical end points (including blood loss, surgical time, and fluoroscopy time), (2) clinical outcomes (Oswestry Disability Index [ODI] and VAS pain scores), and (3) adverse events.

Methods

We performed a systematic review of MEDLINE®, Embase, Web of Science, and Cochrane Library. Reference lists were manually searched. We included studies with 10 or more patients undergoing MIS compared to open TLIF/PLIF for degenerative lumbar disorders and reporting on surgical end points, clinical outcomes, or adverse events. Twenty-six studies of low- or very low-quality (GRADE protocol) met our inclusion criteria. No significant differences in patient demographics were identified between the cohorts (MIS: n = 856; open: n = 806).

Results

Equivalent operative times were observed between the cohorts, although patients undergoing MIS fusion tended to lose less blood, be exposed to more fluoroscopy, and leave the hospital sooner than their open counterparts. Patient-reported outcomes, including VAS pain scores and ODI values, were clinically equivalent between the MIS and open cohorts at 12 to 36 months postoperatively. Trends toward lower rates of surgical and medical adverse events were also identified in patients undergoing MIS procedures. However, in the absence of randomization, selection bias may have influenced these results in favor of MIS fusion.

Conclusions

Current evidence examining MIS versus open TLIF/PLIF is of low to very low quality and therefore highly biased. Results of this systematic review suggest equipoise in surgical and clinical outcomes with equivalent rates of intraoperative surgical complications and perhaps a slight decrease in perioperative medical complications. However, the quality of the current literature precludes firm conclusions regarding the comparative effectiveness of MIS versus open posterior lumbar fusion from being drawn and further higher-quality studies are critically required.

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Acknowledgments

We thank Dr. Dorin Rabin and Dr. Sooyong Chua for their assistance with a preliminary review of the literature and Ms. Oma Persaud MSc for her assistance with the electronic literature search.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Christina L. Goldstein MD, FRCSC, Kevin Macwan BHSc, Kala Sundararajan BSc, MSc & Y. Raja Rampersaud MD, FRCSC

  2. Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada

    Christina L. Goldstein MD, FRCSC

  3. Division of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst Street, EW 1-441, Toronto, ON, M5T 2S8, Canada

    Kevin Macwan BHSc, Kala Sundararajan BSc, MSc & Y. Raja Rampersaud MD, FRCSC

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  1. Christina L. Goldstein MD, FRCSC
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  2. Kevin Macwan BHSc
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  3. Kala Sundararajan BSc, MSc
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  4. Y. Raja Rampersaud MD, FRCSC
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Corresponding author

Correspondence to Y. Raja Rampersaud MD, FRCSC.

Additional information

One of the authors (YRR) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, US from Medtronic, Inc (Memphis, TN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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Goldstein, C.L., Macwan, K., Sundararajan, K. et al. Comparative Outcomes of Minimally Invasive Surgery for Posterior Lumbar Fusion: A Systematic Review. Clin Orthop Relat Res 472, 1727–1737 (2014). https://doi.org/10.1007/s11999-014-3465-5

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