Introduction: Transforaminal lumbar interbody fusion (TLIF) is a well-established surgical approach for treating spinal pathologies such as degenerative disc disease, spondylolisthesis, and spinal stenosis. While the traditional open TLIF (OTLIF) method has shown efficacy in spinal fusion, it involves extensive muscle dissection, significant blood loss, and prolonged recovery times, often resulting in extended hospital stays and delayed return to daily activities. Minimally invasive TLIF (MITLIF) has been introduced as an alternative, aiming to reduce tissue damage and enhance postoperative recovery. Despite MITLIF's growing popularity due to its perceived benefits in minimizing perioperative morbidity, questions remain about its relative clinical efficacy, safety, and long-term outcomes compared to the traditional approach. This study systematically compares the clinical outcomes, fusion rates, and complication profiles of MITLIF and OTLIF to determine the optimal approach for patients.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases including PubMed, Cochrane Central, Scopus, and Web of Science were searched up to August 2024. Studies screened, and data were extracted, with the risk of bias assessed using the Cochrane Collaboration tool. Primary outcomes included changes in the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) pre- and post-operatively. Relevant randomized controlled trials (RCTs) were analyzed using RevMan software.
Results: Twenty-seven RCTs involving 2,415 patients met the eligibility criteria for final analysis. In terms of VAS scores, the mean difference (MD) between pre- and post-operative values favoured MITLIF. Specifically, the standardized mean difference (SMD) for pre-operative VAS was -0.70 (95% CI, -0.34 to 0.21; P=0.64), while for post-operative VAS, it was -0.47 (95% CI, -0.79 to 0.15; P=0.004). Regarding ODI scores, the MD between pre- and post-operative values also favoured MITLIF, with a pre-operative SMD of -0.06 (95% CI, -0.15 to 0.03; P=0.20) and a post-operative ODI SMD of -0.12 (95% CI, -0.21 to -0.03; P=0.01).
Conclusion : The findings indicate that minimally invasive TLIF may offer better postoperative outcomes than traditional open TLIF, particularly in reducing pain and disability as measured by VAS and ODI scores.
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