Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of one-level lumbar disease: a meta-analysis

English Keywords:Transforaminal lumbar interbody fusion  Minimally invasive surgery  Open surgery  One-level  Meta-analysis

English Abstract:

  【Abstract】 Objectives: This is a meta-analysis to compare the clinical results between minimally invasive and open transforaminal lumbar interbody fusion (TLIF) for one-level lumbar disease. Methods: Studies were identified from PubMed, Web of Science, Cochrane Library, China Biological Medicine Database, China National Knowledge Infrastructure and Wanfang Database, by using the keywords "minimally invasive, MIS or mini-open", "open" and "transforaminal lumbar interbody fusion". The published studies with no language and year restrictions were included. Only studies comparing minimally invasive and open TLIF for the treatment of one-level lumbar disease were included. The Newcastle-Ottawa Scale(NOS) was used to evaluate the risk of bias of the included studies. All data were analyzed by Review Manager 5.1. The outcomes were surgery related indexes(operation time, blood loss, postoperative drainage, intraoperative radiation time, bedridden time, hospital stay and hospital expenses), visual analogue score(VAS) of postoperative back pain and leg pain, postoperative Oswestry Disability Index(ODI), complications, reoperation rate and fusion rate. Results: Eighteen studies(five prospective cohort studies, twelve retrospective cohort studies, only one randomized controlled trial) with 1437 patients were included in this meta-analysis(691 patients for minimally invasive group, 746 patients for open group). Quality evaluation indicated that all of included studies were high quality cohort studies(NOS range: 5-9). The blood loss(P＜0.00001), postoperative drainage(P＜0.003), bedridden time (P=0.002), hospital stay(P＜0.00001), hospital expenses (P=0.0008), VAS of back pain at 3 days after surgery and the final follow-up(P＜0.00001) were significantly lower in minimally invasive group than those in open group; intraoperative radiation time in minimally invasive group was significantly higher(P＜0.0001); there were no significant differences between minimally invasive and open group in operation time, complications, reoperation rate, fusion rate, VAS of leg pain and ODI(P＞0.05). Conclusions: Compared with traditional open surgery, minimally invasive transforaminal lumbar interbody fusion reduces blood loss, allows early postoperative recovery, relieves postoperative back pain, and increases intraoperative radiation time, while achieves comparable postoperative leg pain improvement and complication rates.