Comparison between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion: A Meta-Analysis of Clinical Results and Safety Outcomes.

Abstract

A meta-analysis comparing the efficacy and safety of minimally invasive and open transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar diseases. A literature search of PubMed, Embase, ScienceDirect, OVID, Google scholar, and Cochrane Library databases was conducted to identify relevant articles published before May 2013. Only studies that directly compared the efficacy and safety of minimally invasive and open TLIF in patients with degenerative lumbar diseases were selected. The main outcomes analyzed were the visual analog scale (VAS), Oswestry Disability Index (ODI), complications, and fusion rates. Also evaluated were intraoperative X-ray exposure, intra-postoperative blood loss, operating time, and hospitalization. The selected 14 studies included 494 patients who received minimally invasive TLIF and 500 patients given open TLIF. According to the Methodological Index for Non-Randomized Studies, the quality scores of the studies ranged from 11 to 19. No significant differences in preoperative VAS or ODI scores, operating time, complication rate, or fusion rate were observed between these two procedures. Compared with open TLIF, minimally invasive TLIF was associated with significantly less blood loss, shorter hospitalization, and lower VAS during follow-up assessment. However, minimally invasive TLIF involved significantly more intraoperative X-ray exposure. Although the clinical efficacy, risk of complications and fusion rate were comparable between the two procedures, minimally invasive TLIF resulted in less blood loss, lower follow-up VAS score, and shorter perioperative hospitalization relative to open TLIF.