Download PDF
J Neurol Surg A Cent Eur Neurosurg 2016; 77(01): 002-010
DOI: 10.1055/s-0035-1554809
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Comparison between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion: A Meta-Analysis of Clinical Results and Safety Outcomes

Yang Lin
1   Department of Orthopedics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
,
Wenjian Chen
1   Department of Orthopedics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
,
Anmin Chen
1   Department of Orthopedics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
,
Feng Li
1   Department of Orthopedics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
› Author Affiliations
Further Information

Publication History

24 August 2014

10 March 2015

Publication Date:
19 June 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Objective A meta-analysis comparing the efficacy and safety of minimally invasive and open transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar diseases.

Methods A literature search of PubMed, Embase, ScienceDirect, OVID, Google scholar, and Cochrane Library databases was conducted to identify relevant articles published before May 2013. Only studies that directly compared the efficacy and safety of minimally invasive and open TLIF in patients with degenerative lumbar diseases were selected. The main outcomes analyzed were the visual analog scale (VAS), Oswestry Disability Index (ODI), complications, and fusion rates. Also evaluated were intraoperative X-ray exposure, intra-postoperative blood loss, operating time, and hospitalization.

Results The selected 14 studies included 494 patients who received minimally invasive TLIF and 500 patients given open TLIF. According to the Methodological Index for Non-Randomized Studies, the quality scores of the studies ranged from 11 to 19. No significant differences in preoperative VAS or ODI scores, operating time, complication rate, or fusion rate were observed between these two procedures. Compared with open TLIF, minimally invasive TLIF was associated with significantly less blood loss, shorter hospitalization, and lower VAS during follow-up assessment. However, minimally invasive TLIF involved significantly more intraoperative X-ray exposure.

Conclusion Although the clinical efficacy, risk of complications and fusion rate were comparable between the two procedures, minimally invasive TLIF resulted in less blood loss, lower follow-up VAS score, and shorter perioperative hospitalization relative to open TLIF.

Keywords

degenerative lumbar disease - transforaminal lumbar interbody fusion - minimally invasive - clinical outcome - meta-analysis
 

  • References

  • 1 Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion (author's transl) [in German]. Z Orthop Ihre Grenzgeb 1982; 120 (3) 343-347
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Cutler AR, Siddiqui S, Mohan AL, Hillard VH, Cerabona F, Das K. Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg Spine 2006; 5 (6) 534-539
    CrossrefPubMedGoogle Scholar
  • 3 Houten JK, Post NH, Dryer JW, Errico TJ. Clinical and radiographically/neuroimaging documented outcome in transforaminal lumbar interbody fusion. Neurosurg Focus 2006; 20 (3) E8
    CrossrefPubMedGoogle Scholar
  • 4 Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U. Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results. Eur Spine J 2005; 14 (6) 551-558
    CrossrefPubMedGoogle Scholar
  • 5 Moskowitz A. Transforaminal lumbar interbody fusion. Orthop Clin North Am 2002; 33 (2) 359-366
    CrossrefPubMedGoogle Scholar
  • 6 Holly LT, Schwender JD, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus 2006; 20 (3) E6
    CrossrefPubMedGoogle Scholar
  • 7 Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine 2010; 35 (26, Suppl): S294-S301
    CrossrefPubMedGoogle Scholar
  • 8 Datta G, Gnanalingham KK, Peterson D , et al. Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction?. Neurosurgery 2004; 54 (6) 1413-1420 ; discussion 1420
    CrossrefPubMedGoogle Scholar
  • 9 Kim DY, Lee SH, Chung SK, Lee HY. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine 2005; 30 (1) 123-129
    CrossrefPubMedGoogle Scholar
  • 10 Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine 2003; 28 (15, Suppl): S26-S35
    CrossrefPubMedGoogle Scholar
  • 11 Kim KT, Lee SH, Suk KS, Bae SC. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine 2006; 31 (6) 712-716
    CrossrefPubMedGoogle Scholar
  • 12 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (9) 712-716
    CrossrefPubMedGoogle Scholar
  • 13 Peng CW, Yue WM, Poh SY, Yeo W, Tan SB. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine 2009; 34 (13) 1385-1389
    CrossrefPubMedGoogle Scholar
  • 14 Harris EB, Sayadipour A, Massey P, Duplantier NL, Anderson DG. Mini-open versus open decompression and fusion for lumbar degenerative spondylolisthesis with stenosis. Am J Orthop 2011; 40 (12) E257-E261
    PubMedGoogle Scholar
  • 15 Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Minimally invasive or open transforaminal lumbar interbody fusion as revision surgery for patients previously treated by open discectomy and decompression of the lumbar spine. Eur Spine J 2011; 20 (4) 623-628
    CrossrefPubMedGoogle Scholar
  • 16 Villavicencio AT, Burneikiene S, Roeca CM, Nelson EL, Mason A. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int 2010; 1: 12
    CrossrefPubMedGoogle Scholar
  • 17 Shunwu F, Xing Z, Fengdong Z, Xiangqian F. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine 2010; 35 (17) 1615-1620
    CrossrefPubMedGoogle Scholar
  • 18 Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech 2011; 24 (8) 479-484
    PubMedGoogle Scholar
  • 19 Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 2012; 21 (11) 2265-2270
    CrossrefPubMedGoogle Scholar
  • 20 Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine 2008; 9 (6) 560-565
    CrossrefPubMedGoogle Scholar
  • 21 Scheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery 2007; 60 (4) (Suppl. 02) 203-212 ; discussion 212–213
    PubMedGoogle Scholar
  • 22 Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J 2010; 19 (10) 1780-1784
    CrossrefPubMedGoogle Scholar
  • 23 Lau D, Lee JG, Han SJ, Lu DC, Chou D. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci 2011; 18 (5) 624-627
    CrossrefPubMedGoogle Scholar
  • 24 Wang HL, Lü FZ, Jiang JY, Ma X, Xia XL, Wang LX. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial. Chin Med J (Engl) 2011; 124 (23) 3868-3874
    PubMedGoogle Scholar
  • 25 Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop 2009; 33 (6) 1683-1688
    CrossrefPubMedGoogle Scholar
  • 26 Zairi F, Arikat A, Allaoui M, Assaker R. Transforaminal lumbar interbody fusion: comparison between open and mini-open approaches with two years follow-up. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (3) 131-135
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Wu RH, Fraser JF, Härtl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine 2010; 35 (26) 2273-2281
    CrossrefPubMedGoogle Scholar