A Meta-analysis Of The Efficacy Of Minimally Invasive Transforaminal Interbody Fusion And Posterior Lumbar Interbody Fusion In The Treatment Of Lumbar Degenerative Diseases

Objective:Spinal fusion surgery has a long history in the treatment of lumbar degenerative diseases caused by different causes.At present,spinal fusion is the main method for the treatment of lumbar degenerative diseases caused by low back pain.Posterior and transforaminal lumbar interbody fusion(PLIF,TLIF)is the standard procedure in spine surgery.With the development and application of spinal endoscopic technology,a new minimal invasive posterior transforamen lumbar interbody fusion(MIS-TLIF)has been developed in order to reduce the occurrence of similar complications with traditional open surgery(PLIF,TLIF).Relevant literature was collected and Meta analysis was used to analyze the advantages and disadvantages of minimally invasive transforaminal interbody fusion and posterior lumbar interbody fusion in the treatment of lumbar degenerative diseases.The purpose of this study was to analyze from the perspective of evidence-based medicine and provide evidence support for clinicians when choosing different surgical methods.Methods:Randomized controlled trials(RTC)prospective trials comparing The efficacy and complications of minimally invasive transforaminal lumbar interbody fusion versus posterior lumbar interbody fusion were retrieved from Pub Med(Medline),Ovid,The Cochrane Library,CNKI,Wanfang database,from January 2001 to December 2020,and followed up for >6 months.Grade guidelines were used to evaluate the quality of the retrospective and prospective randomized controlled studies collected and included,and the data needed in the literature were extracted and analyzed.The Rev Man 5.3 software was used to conduct Meta-analysis on postoperative complications such as VAS pain score,ODI blood loss during surgery,postoperative drainage and other indicators.Results:After retrieval and strict screening by researchers,a total of 11 retrospective studies were included,and no randomized controlled studies or prospective trials that met the inclusion and exclusion criteria were screened.In this meta-analysis,postoperative complications were in the MIS-TLIF surgery group and the PLIF surgery group,respectively,and the incidence of complications in the minimally invasive group was significantly lower than that in the open group,there was significant statistical difference between the two groups(OR=0.39,95%CI=0.29-0.68,P=0.0002).The operative time of the first group was significantly different from that of the second group,and the data analysis of the two groups was statistically significant(MD=14.46,95%CI=0.92-28.00,P=0.04).The amount of intraoperative blood loss in group MIS-TLIF and group PLIF was statistically significant(MD=-201.51,95%CI=-247.69—-155.34.00,P<0.00001).There was statistical significance in the study of postoperative drainage volume(MD=-184.38,95%CI=-283.91—-84.85,P<0.0003).The low back VAS pain score was lower in MIS-TLIF than in PLIF,and the difference between them was statistically significant(MD=-0.25,95%CI=-0.40—-0.10,P=0.001).There was no significant difference between the MIS-TLIF and PLIF ODI scale data,which was not statistically significant(MD=-0.48,95%CI=-1.94—0.99,P=0.52).The postoperative bed time of group MIS-TLIF was significantly reduced compared with group PLIF,and the difference between the two groups was statistically significant(MD=-2.36,95%CI=-2.98—-1.73,P<0.00001).Conclusions:To sum up,domestic and foreign literatures on minimally invasive transforaminal lumbar interbody fusion and traditional posterior open surgery in recent years were collected and compared.Mis-TLIF and PLIF showed no significant difference in postoperative ODI index scores,indicating no significant difference in postoperative recovery of normal lumbar activities in patients,it can be seen from the operation time that PLIF is shorter than MIS-TLIF,this may be related to the learning curve,but in terms of postoperative complications VAS score,intraoperative blood loss,postoperative drainage volume and postoperative bed time,minimally invasive transforaminal lumbar interbody fusion is more advantageous than traditional surgery,which can bring considerable benefits to patients after surgery and long-term recovery,and also provides a new choice for clinicians.Postoperative and long-term recovery has brought considerable benefits,also provide new options for clinical doctors Will different literature,of course,there is a certain bias on the data and conclusions,if you can collect more documents and more data and higher quality of randomized controlled trials,and after a rigorous trial design,to match the evidence-based medical research,finally draw the right conclusions.