Meta-analysis of clinical efficacy and safety of percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusions in the treatment of lumbar degenerative diseases

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

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacies of percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF) and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative diseases(LDD) by meta-analysis. Methods: The databases of PubMed, Cochrane Library, Web of science, Embase, Medline, CNKI, Wanfang and VIP were searched for the relative studies of the clinical prognosis and complications of PE-TLIF and MIS-TLIF in LDD treatment. The outcome data were extracted, including visual analog scale(VAS), Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) score, operative time, fluoroscopy time, intraoperative blood loss, postoperative drainage volume, leaving bed time, length of hospital stay, fusion rate, and operation-related complications. Meta-analysis was carried out by Review Manager 5.3 software. Results: A total of 10 articles(2 RCT studies, 1 prospective cohort study and 7 retrospective studies) were included, involving a total sample size of 696 cases, including 345 cases in PE-TLIF group and 351 cases in MIS-TLIF group. Meta-analysis showed that the length of hospital stay[MD=-1.45, 95%CI(-2.17, -0.74), P＜0.0001], intraoperative blood loss[MD=-56.39, 95%CI(-77.50, -35.29), P＜0.00001], postoperative drainage volume[MD=-46.27, 95%CI(-67.68, -24.85), P＜0.0001], leaving bed time[MD=-2.84, 95%CI(-4.97, -0.71), P=0.009] of the PE-TLIF group were better than those of MIS-TLIF group; And the MIS-TLIF group was better in operative time[MD=35.89, 95%CI(16.82, 54.95), P=0.0002], intraoperative fluoroscopy time[MD=15.42, 95%CI(15.28, 15.55), P＜0.00001] and leg pain VAS score[MD=0.10, 95%CI(0.01, 0.19), P=0.02] than those of the PE-TLIF group; There were no significant differences in postoperative back pain VAS score[MD=-0.02, 95%CI(-0.10, 0.06), P=0.68], ODI[MD=-0.14, 95%CI(-0.71, 0.43), P=0.62], JOA score[MD=-0.11, 95%CI(-0.48, 0.26), P=0.55], complication rate[OR=1.69, 95%CI(0.81, 3.54), P=0.16] or fusion rate [OR=0.56, 95%CI(0.23, 1.37), P=0.20] between the two groups. Conclusions: As minimally invasive operations for LDD, both PE-TLIF and MIS-TLIF have obvious clinical efficacies and safety with certain advantages and disadvantages each; The results of this meta-analysis show that although no significant difference between the two procedures in terms of the mid- and long-term clinical efficacy, surgical complications and fusion rate, PE-TLIF is superior in length of hospital stay, intraoperative blood loss, postoperative drainage volume, and leaving bed time, and that PE-TLIF has the advantages of less surgical trauma, faster recovery and less early postoperative low back and leg pain.