Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion

An Updated Systematic Review and Meta-analysis

Nickalus R. Khan, Aaron J. Clark, Siang Liao Lee, Garrett T. Venable, Nicholas B. Rossi, Kevin Foley

Research output: Contribution to journalReview article

47 Citations (Scopus)

Abstract

Background: Minimally invasive transforaminal lumbar interbody fusion (TLIF) - or MI-TLIF - has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. Objective: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. Methods: During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type. Results: Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P <.001), length of stay (P <.001), and complications (P .001) but increased radiation exposure (P <.001). No differences were found in fusion rate (P .61) and operative time (P .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P <.001), but no differences were found in early VAS-back, early ODI, and late ODI. Conclusion: MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.

Original languageEnglish (US)
Pages (from-to)847-874
Number of pages28
JournalNeurosurgery
Volume77
Issue number6
DOIs
StatePublished - Jan 1 2015

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Back Pain
Operative Time
Visual Analog Scale
Meta-Analysis
Length of Stay
Randomized Controlled Trials
Research
Radiation Exposure

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion : An Updated Systematic Review and Meta-analysis. / Khan, Nickalus R.; Clark, Aaron J.; Lee, Siang Liao; Venable, Garrett T.; Rossi, Nicholas B.; Foley, Kevin.

In: Neurosurgery, Vol. 77, No. 6, 01.01.2015, p. 847-874.

Research output: Contribution to journalReview article

Khan, Nickalus R. ; Clark, Aaron J. ; Lee, Siang Liao ; Venable, Garrett T. ; Rossi, Nicholas B. ; Foley, Kevin. / Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion : An Updated Systematic Review and Meta-analysis. In: Neurosurgery. 2015 ; Vol. 77, No. 6. pp. 847-874.
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title = "Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion: An Updated Systematic Review and Meta-analysis",
abstract = "Background: Minimally invasive transforaminal lumbar interbody fusion (TLIF) - or MI-TLIF - has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. Objective: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. Methods: During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type. Results: Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P <.001), length of stay (P <.001), and complications (P .001) but increased radiation exposure (P <.001). No differences were found in fusion rate (P .61) and operative time (P .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P <.001), but no differences were found in early VAS-back, early ODI, and late ODI. Conclusion: MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.",
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T2 - An Updated Systematic Review and Meta-analysis

AU - Khan, Nickalus R.

AU - Clark, Aaron J.

AU - Lee, Siang Liao

AU - Venable, Garrett T.

AU - Rossi, Nicholas B.

AU - Foley, Kevin

PY - 2015/1/1

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N2 - Background: Minimally invasive transforaminal lumbar interbody fusion (TLIF) - or MI-TLIF - has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. Objective: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. Methods: During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type. Results: Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P <.001), length of stay (P <.001), and complications (P .001) but increased radiation exposure (P <.001). No differences were found in fusion rate (P .61) and operative time (P .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P <.001), but no differences were found in early VAS-back, early ODI, and late ODI. Conclusion: MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.

AB - Background: Minimally invasive transforaminal lumbar interbody fusion (TLIF) - or MI-TLIF - has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. Objective: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. Methods: During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type. Results: Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P <.001), length of stay (P <.001), and complications (P .001) but increased radiation exposure (P <.001). No differences were found in fusion rate (P .61) and operative time (P .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P <.001), but no differences were found in early VAS-back, early ODI, and late ODI. Conclusion: MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.

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