Comparing Outcome Between Minimal Invasive And Open Transforaminal Lumbar Interbody Fusion:Systematic Review

Purpose.The aim of this study is to compare between minimally invasive TLIF(MTLIF)and open TLIF(OTLIF),while OTLIF remains the mainstay approach,MTLIF may offer potential advantages of reduced trauma to paraspinal muscles,minimized perioperative blood loss,quicker recovery and reduced risk of infection at surgical sites.This systematic review was conducted to provide an updated assessment of the relative benefits and risks between MTLIF and OTLIF.Methods.Electronic searches were performed using five databases from their inception to November 2016.Relevant studies comparing MTLIF and OTLIF were included.Data were collected using the National Center for Biotechnology Information database and Pub Med/MEDLINE and summarized for discussion.Results.Eighteen studies were included in this systematic review.The total number of subjects included was 1375,of which 746 underwent MTLIF(54 %)and 629 underwent OTLIF(46 %).The operating time for the MTLIF was ranged from 104 to 456 minutes,compared with 113.6 to312 minutes for OTLIF,the operating time tended to be longer in theMTLIF group than the OTLIF group.The estimated blood loss was lower in the MTLIF group,ranging from 55 to 399.8 ml.in MTLIF and 125 to961 ml.in OTLIF,respectively.The length of hospital stay was short for the MTLIF with a 2.3 to 10.6 days hospitalization compared to 2.9 to 14.6days for OTLIF.However,the fluoroscopic time was consistently higher in the MTLIF group with 49 to 106 seconds of fluoroscopy compared to 16.4to 44 seconds for OTLIF.The complications divided into technical complications and infection complications.The main technical and infection complications included dural tears,screw malposition,and wound infection.Systemic complications included pneumonia,urinary tract infection,and DVT.The numbers of patients with complication were 73 out of 489(14.92 %)in the MTLIF and 77 out of 385(20 %)in the OTLIF.Postoperative Visual Analogue Scale(VAS)for the MTLIF was ranged from 0.3 to 4.8 mean scores,compared with 0.3 to 5.6 mean scores for OTLIF,the VAS score tended to be smaller and improved in the MTLIF group than the OTLIF group.The mean Postoperative Oswestry Disability Index(ODI)scores for MTLIF were comparatively lower than OTLIF with mean scores 7.23 to 24.7 and 8.24 to 32 respectively.Conclusion.In summary,the present systematic review demonstrated that MTLIF appears to be a safe and efficacious approach compared to OTLIF.MTLIF offers several advantages in decreasing blood loss,the length of hospital stay and infection rates in patients,although it requiredmuch more operative time and high-risk radiation exposure for the surgical team.Class I evidence and high-quality randomized controlled trials are needed for further study.