Comparison Of Clinical Outcomes And Safety Between Minimally Invasive TLIF Versus Open TLIF: A Meta-analysis

Objective:A quantitative meta-analysis was conducted on published and unpublished studies toassess the efficacy and safety of minimally invasive TLIF compared with open TLIF.Methods:A systematic search of all studies published about minimally invasive TLIF and openTLIF before June2012was conducted using the Pubmed, EMBASE，ScienceDirect，OVID，Cochrane CENTRAL database and Google Scholar. Unpublished literatures weresearched from the WHO International Clinical Trials Registry Platform and UK NationalResearch Register Archive to2012. Some international spine conference proceedings werealso searched. The prospective and retrospective comparative studies about clinicaloutcomes and complications between minimally invasive TLIF and open TLIF wereincluded and identified. Demographic characteristics, duration of surgery, blood loss,fluoroscopy time, ambulation, length of hospitalization, VAS and ODI scores ofpreoperative and postoperative, and complications rate were manually extracted from all ofthe selected studies. The methodological quality of studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) form.Results:9studies of340patients underwent minimally invasive TLIF and338patientsunderwent open TLIF met the inclusion criteria finally. All the studies were assessed ofClass III evidence. The average MINORS score was13.9(13-17). The VAS and ODI scoresbetween2groups preoperative,6months and2years postoperative were equivalent. Thecomplications rates between2groups were equivalent. Compared with open group, theminimally invasive group was identified with similar duration of surgery, lessintraoperative blood loss, similar postoperative blood loss, more fluoroscopy time, shorterlength of hospitalization, earlier ambulation.Conclusion:The minimally invasive TLIF has similar long term clinical outcomes and safetycompared with open TLIF, with several perioperative advantages including less blood loss,earlier ambulation and shorter length of hospitalization, and disadvantage of morefluoroscopy time.