A Meta-analysis of the clinical efficacy of oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease

English Keywords:Lumbar degenerative disease  Oblique lumbar interbody fusion  Minimally invasive transforaminal lumbar interbody fusion  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical efficacy of oblique lumbar interbody fusion(OLIF) versus minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative disease(LDD) systematically. Methods: Literature of clinical comparative studies of OLIF and MIS-TLIF for LDD were searched from the databases of CNKI, VIP, WANFANG DATA, SinoMed, PubMed, Cochrane Library, Embase, and Web of Science from inception to December 2021. The Newcastle-Ottawa scale(NOS) was used to assess the quality of the included studies. The data of outcome indicators including operation duration, intraoperative blood loss, ambulation time, hospital stay, visual analog scale(VAS) score, Oswestry disability index(ODI), disc height(DH), lumbar lordosis angle(LLA), complication incidence, and fusion rate were extracted, and a Meta-analysis was completed with Review Manager 5.3. Results: A total of 16 cohort studies of medium or high quality according to NOS criteria were included in our Meta-analysis, which involved 1220 patients(572 in the OLIF group and 648 in the MIS-TLIF group). And the result of Meta-analysis showed that the OLIF group had a shorter operation duration(MD=-26.00, 95％CI: -38.69--13.32, P＜0.0001) and hospital stay(MD=-2.81, 95％CI: -3.71--1.92, P＜0.00001), an earlier ambulation time(MD=-0.54, 95％CI: -0.70--0.37, P＜0.00001), and a less intraoperative blood loss(MD=-44.04, 95％CI: -46.97--41.12, P＜0.00001) than did in the MIS-TLIF group. The OLIF group had a significantly better VAS improvement(MD= -0.37, 95％CI: -0.67--0.06, P=0.02) and ODI improvement(MD=-4.48, 95％CI: -8.75--0.20, P=0.04) than the MIS-TLIF group. The restorations of DH(MD=1.08, 95％CI: 0.73-1.43, P＜0.00001) and LLA(MD=3.00, 95％CI: 1.61-4.38, P＜0.0001) were better in the OLIF group than those in the MIS-TLIF group. There was no significanct difference between the two groups in the incidence of complications(OR=1.38, 95％CI: 0.96-2.00, P=0.09) and the fusion rate(OR=2.13, 95％CI: 0.91-4.97, P=0.08). Conclusions: OLIF is superior to MIS-TLIF in shortening operation duration, hospital stay, and ambulation time, reducing intraoperative blood loss, relieving pain and dysfunction, and improving DH and LLA. In the meantime, it′s not significantly different from MIS-TLIF in terms of the incidence of complications and fusion rate.