Abstract
BackgroundMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases. In the present study, a meta-analysis was conducted to compare the clinical and radiographic efficacy of these two procedures.MethodsA systematic literature review was performed, and the quality of retrieved studies was evaluated with the Newcastle-Ottawa Scale (NOS). Clinical outcomes, including operation time, intraoperative blood loss, improvement in Visual Analogue Scale (VAS), improvement in Oswestry Disability Index (ODI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate and complications, in addition to radiographic outcomes, including restoration of disc height, disc angle, overall lumbar lordosis, fusion rate and subsidence, were extracted and input into a fixed or random effect model to compare the efficacy of MIS-TLIF and OLIF.ResultsSeven qualified studies were included. Clinically, OLIF resulted in less intraoperative blood loss and shorter operation time than MIS-TLIF. Improvement of VAS for leg pain was more obvious in the OLIF group (P < 0.0001), whereas improvement of VAS for back pain (P = 0.08) and ODI (P = 0.98) as well as JOABPEQ effectiveness rate (P = 0.18) were similar in the two groups. Radiographically, OLIF was more effective in restoring disc height (P = 0.01) and equivalent in improving the disc angle (P = 0.18) and lumbar lordosis (P = 0.48) compared with MIS-TLIF. The fusion rate (P = 0.11) was similar in both groups, while the subsidence was more severe in the MIS-TLIF group (P < 0.00001).ConclusionsThe above evidence suggests that OLIF is associated with a shorter operation time (with supplementary fixation in the prone position) and less intraoperative blood loss than MIS-TLIF and can lead to better leg pain alleviation, disc height restoration and subsidence resistance. No differences regarding back pain relief, functional recovery, complications, disc angle restoration, lumbar lordosis restoration and fusion rate were found. However, due to the limited number of studies, our results should be confirmed with high-level studies to fully compare the therapeutic efficacy of MIS-TLIF and OLIF.Trial registrationPROSPERO ID: CRD42020201903.
Highlights
Invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases
Lumbar interbody fusion is effective in enhancing arthrodesis, inducing lumbar lordosis and decompressing neural elements [1,2,3]; it has been widely used as the gold-standard treatment for a variety of end-stage lumbar degenerative disorders, including stenosis, disc disease, spondylolisthesis and deformity [4]
The inclusion criteria were as follows: (1) prospective or retrospective studies that compared single-level MIS-TLIF and OLIF for the treatment of lumbar degenerative disorders; (2) studies that provided information in regard to clinical and radiographic efficacy (including at least one of the following: operation time, intraoperative blood loss, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate, complications, disc height, disc angle, lumbar lordosis, fusion rate and subsidence); (3) studies with a mean follow-up of more than 6 months; and (4) studies published in English or Chinese
Summary
Invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases. As an alternative to conventional posterior-approach surgery [9], minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) reduces iatrogenic soft tissue injury during spinal exposure [10, 11] and minimizes the retraction of the dural sac and nerve root through its transforaminal corridor [12, 13]. OLIF preserves the posterior structures [16, 17] To date, both MIS-TLIF and OLIF are steadily gaining acceptance as the choice of fusion methods as their clinical and radiographic efficacy has been demonstrated by a growing body of evidence [9, 18,19,20,21,22,23]
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