Meta-analysis of prospective cohort studies that compare outcomes of minimally invasive and open transforaminal lumbar interbody fusion in surgical treatment of patients with lumbar spine degenerative disease

Byvaltsev V.A., Kalinin A.A., Stepanov I.A., Aliyev M.A., Shepelev V.V., Pestryakov Y.Y.

Abstract


Purpose
To conduct a meta-analysis based on the results of prospective cohort clinical studies that compare the outcomes of minimally invasive and open transforaminal lumbar interbody fusion in surgical treatment of patients with lumbar spine degenerative disease.
Material and methods
Pubmed, EMBASE, ELibrary and Cochrane Library databases were searched for randomized clinical trials published from 2008 to November 2018, which compared the results of minimally invasive (MIS-TLIF) and open (O-TLIF) techniques of transforaminal interbody fusion in treating patients with degenerative diseases of the lumbar spine. For dichotomous variables, the relative risk and 95% confidence interval were calculated; in turn, a standardized difference in mean values and their 95 % confidence intervals were used for continuous variables, using the random effects model.
Results
This meta-analysis included 14 prospective cohort studies, three of which were randomized controlled clinical trials. The results of surgical treatment of 1,324 patients with degenerative diseases of the lumbar spine were assessed. In the MIS-TLIF group, a reliably lower level of pain in the lumbar spine (p less 0.00001), better functional status by ODI (p less 0.0001), lower number of adverse effects (p = 0.01) were verified. At the same time, the rate of fusion (p = 0.98) and of secondary surgical procedures (p = 0.52) between the compared groups had no significant differences.
Conclusion
The MIS-TLIF method has significantly better long-term clinical outcomes in comparison with the O-TLIF method in terms of pain relief and functional status and a lower risk of consequences. There were no statistically significant differences in the rates of interbody fusion and repeated sur gical interventions between the compared groups of respondents.

Keywords


lumbar spine, degenerative diseases, transforaminal interbody spinal fusion, transpedicular stabilization, minimally-invasive spinal surgery, meta-analysis, prospective cohort studies, randomized controlled studies

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