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Abstract
BackgroundIn recent years, the minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly used to manage the lumbar degenerative disease. However, whether MI-TLIF was superior than open transforaminal lumbar interbody fusion (O-TLIF) was controversial. The aim of this meta-analysis was to compare the clinical outcomes between the MI-TLIF and O-TLIF in single-level degenerative lumbar diseases.MethodsTwo reviewers independently searched EMBASE, PubMed, Web of Science, and Google database from inception to February 2018 for studies comparing the MI-TLIF and O-TLIF approach for single-level lumbar degenerative disease. The data were extracted and analyzed for primary outcomes such as total blood loss, visual analog score (VAS), and other secondary outcomes (length of hospital stay, operation time, fluroscopic time, and Oswestry Disability Index (ODI)). Meta-analysis was performed by Stata 12.0.ResultsSeven RCTs were finally included in this meta-analysis. Compared with O-TLIF, MI-TLIF was associated with significantly less blood loss (weighted mean difference (WMD) = − 291.46; 95% confidence interval (CI) − 366.66 to − 216.47; P = 0.000,). There was no significant difference between the length of hospital stay, postoperative VAS, and ODI. Compared with O-TLIF, MI-TLIF was associated with an increase of the fluroscopic time (P < 0.05).ConclusionThe MI-TLIF showed significantly less blood loss compared with O-TLIF and more fluroscopic time. There was no significant difference between the length of hospital stay, postoperative VAS, and ODI. More high-quality studies and subsequent meta-analyses are needed in the future.
Highlights
In recent years, the minimally invasive transforaminal lumbar interbody fusion (MI-Transforaminal lumbar interbody fusion (TLIF)) is increasingly used to manage the lumbar degenerative disease
minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been used increasingly in lumbar degenerative diseases for decades based on the shorter length of hospital stay and blood loss than open TLIF (O-TLIF) [2,3,4]
Meta-analysis showed that MI-TLIF was associated with a reduction of the total blood loss than open transforaminal lumbar interbody fusion (O-TLIF) (WMD = − 291.46; 95% confidence interval (CI) − 366.66 to − 216.47; P = 0.000; Fig. 4)
Summary
The minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly used to manage the lumbar degenerative disease. Whether MI-TLIF was superior than open transforaminal lumbar interbody fusion (O-TLIF) was controversial The aim of this meta-analysis was to compare the clinical outcomes between the MI-TLIF and O-TLIF in single-level degenerative lumbar diseases. Invasive transforaminal lumbar interbody fusion (MI-TLIF) was first introduced by Harms and Rolinger in the year of 1982 [1]. O-TLIF requires wide dissection of the sacral spinalis, which causes severe soft tissue injuries and more perioperative blood loss [5]. Several studies show that MI-TLIF could reduce the injury of the iatrogenic soft tissue caused by muscle stripping and traction in surgery [8]. For patients with severe spinal stenosis, the central tube decompression could not be performed
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