Abstract
ObjectiveThe purpose of this study is to compare fusion rate, clinical outcomes, complications among transforaminal lumbar interbody fusion (TLIF), and other techniques for lumbar spine diseases.DesignThis is a systematic review and meta-analysis.Data SourcesPubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases were searched from January 2013 through December 2019.Eligibility Criteria for Selecting StudiesRandomized controlled trials (RCTs) that compare lumbar interbody fusion with posterolateral fusion (PLF) and/or other lumbar interbody fusion were included for the review.Data Extraction and SynthesisTwo independent reviewers extracted relevant data and assessed the risk of bias. Meta-analysis was performed using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complications in TLIF and other techniques for lumbar spinal diseases.ResultsOf 3,682 potential studies, 15 RCTs (915 patients) were included in the meta-analysis. Compared to other surgical techniques, TLIF had slightly lower fusion rate [RR = 0.84 (95% CI = 0.72–0.97), p = 0.02, I2 = 0.0%] at 1-year follow-up whereas there was no difference on fusion rate at 2-year follow-up [RR = 1.06 (95% CI = 0.96–1.18), p = 0.27, I2 = 69.0%]. The estimated RR of total adverse events [RR = 0.90 (95% CI = 0.59–1.38), p = 0.63, I2 = 0.0%] was similar to no fusion, PLF, PLIF, and XLIF groups, and revision rate [RR = 0.78 (95% CI = 0.34–1.79), p = 0.56, I2 = 39.0%] was similar to PLF and XLIF groups. TLIF had approximately half an hour more operative time than other techniques (no fusion, ALIF, PLF, PLIF, XLIF) [MD = 31.88 (95% CI = 5.33–58.44), p = 0.02, I2 = 92.0%]. There was no significant difference between TLIF and other techniques in terms of blood loss (no fusion, PLIF, PLF) and clinical outcomes (PLF).ConclusionsBesides fusion rate at 1-year follow-up and operative time, TLIF has a similar fusion rate, clinical outcomes, parameters concerning operation and complications to no fusion, PLF, and other interbody fusion (PLIF, ALIF, XLIF).Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42020186858.
Highlights
Surgical treatment is mandatory in some patients with lumbar spine diseases
The spinal fusion procedures could be categorized into posterior fusion (PF), posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), extreme lateral interbody fusion (XLIF), the so-called lateral lumbar interbody fusion (LLIF), and oblique lumbar interbody fusion (OLIF)
A number of 2 randomized controlled trials (RCTs) were considered the same population of the TLIF group; one study was excluded from the analysis
Summary
Surgical treatment is mandatory in some patients with lumbar spine diseases. Cases without clinical or radiographic instability require only decompression, most lumbar spine diseases with instability especially the degenerative condition further proceed to spinal arthrodesis. The purpose of the treatment is to achieve solid fusion, correction of deformity, indirect nerve decompression, and stabilization. Many operative techniques have been developed with different fusion rates and clinical results. The spinal fusion procedures could be categorized into posterior fusion (PF), posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), extreme lateral interbody fusion (XLIF), the so-called lateral lumbar interbody fusion (LLIF), and oblique lumbar interbody fusion (OLIF). Total disc replacement (TDR) is an alternative option for patients to preserve spinal mobility
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