Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence

Tian, Naifeng; Wu, Yaosen; Zhang, Xiaolei; Xu, Huazi; Chi, Yong-Long; Mao, Fang-Min

doi:10.1007/s00586-013-2747-z

Cited by 136 publications

(112 citation statements)

References 24 publications

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“…Both total and specified complication rates were extracted. We referred to the previous published review to categorize specified complication types [25]. Data were extracted from each of the selected papers independently by two evaluators (JAR, GSS); there was complete agreement regarding inclusion or exclusion in all cases.…”

Section: Data Extractionmentioning

confidence: 99%

Minimally Invasive versus Open Posterior Lumbar Interbody Fusion: A Systematic Review

Sidhu

Henkelman

Vaccaro

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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BackgroundAlthough conventional open posterior lumbar interbody fusion (open PLIF) is efficacious in management of lumbar spinal instability, concerns exist regarding lengthy hospital stays, blood loss, and postoperative complications. Minimally invasive posterior lumbar interbody fusion (MIS PLIF) may be able to address these concerns, but the research on this topic has not been systematically reviewed. Questions/purposes We performed a systematic review to determine whether MIS PLIF or open PLIF results in (1) better perioperative parameters, including blood loss, operative times, and length of hospital stay; (2) improved patient-reported outcome scores; and (3) improved disc distraction and (4) frequency of reoperation and complications when compared with open PLIF procedures. Methods A literature search of the MEDLINE database identified seven studies that met our inclusion criteria. A total of seven articles were included; quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) scale. Descriptive statistics were used to describe the included articles.

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Section: Data Extractionmentioning

confidence: 99%

Minimally Invasive versus Open Posterior Lumbar Interbody Fusion: A Systematic Review

Sidhu

Henkelman

Vaccaro

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…1,2 However, in other studies there are marked differences between the surgical times, such as 216. 4 5,9,11 Several studies reported inverted results with 161 minutes for MIS TLIF versus 227.4 minutes for OPEN TLIF, however, because of the heterogeneity detected, the difference was not significant. 12 Hospital stay: In most studies, the duration of the hospital stay for patients who underwent MIS TLIF was significantly shorter than OPEN TLIF, 4.7 days for MIS TLIF versus 8 days for OPEN TIF, as well as a difference of 1 day between MIS TLIF and OPEN TLIF, 3 days for MIS TLIF versus 5 days for OPEN TLIF, 6.1 days versus 8.2 days for MIS TLIF versus OPEN TLIF, respectively, and 3.2 days for MIS TLIF versus 6.8 days for OPEN TLIF.…”

Section: Introductionmentioning

confidence: 97%

“…Equality is reported in the case of tearing of the dura mater without significant difference, as well as for the improper positioning of the graft, poor screw placement, neurological deficit, hematoma, delayed consolidation, and leakage of cerebrospinal fluid, but the presence of infection was 2% versus 4.6% for MIS TLIF and OPEN TLIF, respectively. 1,11 Complication rates of 8.1% in MIS TLIF versus 16.2% in the open technique have been reported, evaluating the incidence of infection of the wounds, poor implant position, leakage of cerebrospinal fluid, urinary tract infection, and mild neurological deficit. 12 One study reported a more serious complication in the open technique (myocardial infarction) and in MIS TLIF (poor screw placement requiring revision surgery) and two lesser complications for each (OPEN: pneumonia and postoperative anemia; MIS: pneumonia and incidental durotomy).…”

Section: Introductionmentioning

confidence: 99%

Tlif-Mis vs Tlif-Open: Cost Evaluation

et al. 2018

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Objective: To evaluate the direct costs of transforaminal lumbar interbody fusion (TLIF) and minimally invasive surgery (MIS) or open technique (OPEN). Methods: The present study is descriptive and retrospective. Sixteen patients with degenerative spinal pathology operated on with the TLIF MIS technique and TLIF OPEN were included over a 13-month period. Days of hospital stay, blood loss, surgical time, medical care and costs were compared. Results: The mean number of days of hospital stay was 6.7 ± 4.3 days with TLIF MIS and 11.1 ± 6.5 days with TLIF OPEN. The blood loss was 307 ± 81.6 ml (range 200-400 ml) with TLIF MIS and 803 ± 701.3 ml (range 200-1800 ml) with TLIF OPEN. The surgical time was 320 ± 92.6 minutes (range 210-500 minutes) in TLIF MIS and 372 ± 95.2 minutes (280-540 minutes) in TLIF OPEN. Conclusions: The difference in surgical costs and time between the two procedures was not statistically significant. There was less bleeding during the TLIF-MIS surgery, as well as a correlation between shorter days of hospital stay proportional to bleeding and surgical time, which translates into a reduction in the cost of these items. Level of Evidence III; Analysis based on alternatives and limited costs.Keywords: Intervertebral disc degeneration; Spinal fusion; Arthrodesis. de 6,7 ± 4,3 días con TLIF MIS y de 11,1 ± 6,5 días con TLIF OPEN. La pérdida sanguínea fue de 307 ± 81, con TLIF MIS y de 803 ± 701,3 ml (rango 200-1800 ml) RESUMO Objetivo: Garantir benefícios econômicos diretos de cada procedimento cirúrgico. Metodologia: apresentar um estudo descritivo e retrospectivo. Dezesseis pacientes com patologia degenerativa de colônias operados com a técnica TLIF MIS e TLIF OPEN foram incluídos durante um período de 13 meses. Foram comparados os dias de internação RESUMEN Objetivo: Evaluar los costos directos de la fusión intersomática lumbar transforaminal (TLIF) de mínima invasión (MIS) o técnica abierta (OPEN). Métodos: El presente estudio es descriptivo y retrospectivo. Se incluyeron 16 pacientes con patología degenerativa de columna intervenidos con la técnica TLIF MIS y TLIF OPEN en un período de 13 meses. Se compararon días de estancia hospitalaria, pérdida sanguínea, tiempo quirúrgico, atención médica y costos. Resultados: La media de días de estancia hospitalaria fue

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confidence: 99%

“…Our review included both RCT and non-RCT, so the different study design, study quality, patients' characteristics, and the diverse technical specifications inevitably lead to the heterogeneity among studies. We have discussed this limitation in our original paper [1]. 5.…”

mentioning

confidence: 99%

Answer to the Letter to the Editor of Feng Li et al. entitled “Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence” by Nai-Feng Tian, Yao-Sen Wu, Xiao-Lei Zhang, Hua-Zi Xu, Yong-Long Chi, Fang-Min Mao (2013). Eur Spine J, doi:10.1007/s00586-013-2747-z

Tian

Mao

2014

Eur Spine J

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We thank the readers for their comments on our article entitled ''Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on current evidence'' (Eur Spine J 22:1741-1749) [1]. We would like to respond to the comments one by one.1. We searched only the MEDLINE database because most journals on orthopaedics and spinal surgery were included in this database. Searching only in this database might be insufficient. Therefore, we screened the references of the retrieved articles, but yielding no additional eligible studies. 2. Both RCT and non-RCT were included due to a small number of RCTs anticipated in the literature. Metaanalysis of non-RCT may be useful for clinical reference when there is lack of RCT [2]. Initially, we set the criteria of smallest sample size to ensure quality and comparability of data. Nevertheless, no studies were excluded due to the criteria. 3. The two papers by Wang and his colleagues [3,4] included in our analysis were two different studies. They enrolled two different populations: primary surgery and revision surgery. There were no overlapping patients between the two studies. Therefore, neither of them should be excluded. 4. The inverse-variance method is the calculation way rather than the mathematical model. In RevMan version 5, inverse-variance and Mantel-Haenszel methods are two ways of calculations for achieving DerSimonian and Laird random-effects model analysis. For continuous outcomes, RevMan 5 implements only one version of the DerSimonian and Laird random-effects model which is based on the inverse-variance approach [2]. We have detected significant heterogeneity among the studies particularly when we pooled the continuous outcomes. Therefore, we used random-effects models to pool these results. Our review included both RCT and non-RCT, so the different study design, study quality, patients' characteristics, and the diverse technical specifications inevitably lead to the heterogeneity among studies. We have discussed this limitation in our original paper [1]. 5. Searching only in English published papers is a generally accepted strategy due to restriction of various technique supports. It is a limitation of many published meta-analyses, not only ours. Because of potential publication bias, we further used a funnel plot to assess it. We do not use Egger's linear regression test or Begg's rank correlation test because they are usually suitable for meta-analysis including a large number of studies, and the sensitivity of both methods is generally low when the analysis was based on \20 trials [5]. We choose complication rate for assessing publication bias as it was one of the primary outcomes when we compared the two surgical methods. Furthermore, the complication rate was reported in the majority of the included studies.

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Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence

Cited by 136 publications

References 24 publications

Minimally Invasive versus Open Posterior Lumbar Interbody Fusion: A Systematic Review

Minimally Invasive versus Open Posterior Lumbar Interbody Fusion: A Systematic Review

Tlif-Mis vs Tlif-Open: Cost Evaluation

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