A Meta-analysis: Clinical Efficacy And Safety Of TLIF Versus PLIF For The Treatment Of Mild-moderate Degenerative Lumbar Spondylolisthesis

Objectives:Comprehensive evaluation the clinical efficacy and safety of transforaminal lumbar interbody fusion(TLIF)and posterior lumbar interbody fusion with pedide(PLIF)screw fixation for the treatment of degenerative lumbar spondylollsthesis(DLS),and to provide evidence for clinical procedure.Methods:Databases including CNKI,CBM,Wanfang Database,PubMed,The Cochrane Library(Issue 8,2017),ELSEVIER ScienceDirect(SDOS)were searched up for studies of TLIF versus PLIF for degenerative lumbar spondylolisthesis from the inception respectively to August 2017.Include studies contains at least the following two indicators:operative time,intraoperative blood loss,fusions,visual analogue score(VAS),Oswestry disability index(ODI)and complications,disc space height,reoperations.Review Manager 5.3 software was used for data analysis.Results: Two randomized controlled trials(RCT)and eight cohort studies including 757 patients were included in the Meta-analysis:386 patients for TLIF group,371 patients for PLIF group.The results of meta-analysis showed that there was no statistical difference in VAS[WMD=-0.29,95%CI(-0.72,0.13),p=0.18],ODI[WMD=-0.70,95%CI(-1.96,0.56),p=0.27],fusions[0R=0.86,95%CI(0.26,2.86),p=0.80],disc space height[WMD=-0.01,95%CI(-0.31,0.30),p=0.97],and reoperations[OR= 0.55,95%CI(0.18,1.66),p=0.29].There was statistical difference in operative time [WMD=-8.85,95%CI(-11.97,-5.72),p<0.05],intraoperative blood loss[WMD=-147.62,95%CI(-225.81,-69.43),p<0.05],and complications[OR=0.32,95%CI(0.20,0.53),p<0.05]between two groups,and TLIF group were less than PLIF group.Conclusion:Two different methods has no statistical difference in VAS,ODI,fusions,disc space height.They has similar clinical efficacy.And,TLIF has less operative time,intraoperative blood loss,and complications than PLIF,TLIF safer than PLIF.However,there was no statistical difference in reoperations between two subgroups.