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Objective:A quantitative meta-analysis was conducted on published and unpublished studies to assess the efficacy and safety of minimally invasive TLIF compared with open TLIF.Methods:A systematic search of all studies published about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 open TLIF before June2012was conducted using the Pubmed, EMBASE, ScienceDirect, OVID, Cochrane CENTRAL database and Google Scholar. Unpublished literatures were searched from the WHO International Clinical Trials Registry Platform and UK National Research Register Archive to2012. Some international spine conference proceedings were also searched. The prospective and retrospective comparative studies about clinical outcomes and complications between minimally invasive TLIF and open TLIF were included and identified. Demographic characteristics, duration of surgery, blood loss, fluoroscopy time, ambulation, length of hospitalization, VAS and ODI scores of preoperative and postoperative, and complications rate were manually extracted from all of the 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 and338patients underwent open TLIF met the inclusion criteria finally. All the studies were assessed of Class III evidence.The average MINORS score was13.9(13-17). The VAS and ODI scores between2groups preoperative,6months and2years postoperative were equivalent. The complications rates between2groups were equivalent. Compared with open group, the minimally invasive group was identified with similar duration of surgery, less intraoperative blood loss, similar postoperative blood loss, more fluoroscopy time, shorter length of hospitalization, earlier ambulation.Conclusion:The minimally invasive TLIF has similar long term clinical outcomes and safety compared with open TLIF, with several perioperative advantages including less blood loss, earlier ambulation and shorter length of hospitalization, and disadvantage of more fluoroscopy time.