Introduction: Degenerative spondylolisthesis (DLS), particularly at the L4/5 level, often results in severe back pain and disability. Current conservative treatments provide limited relief, underscoring the need for effective surgical interventions. Although various MIS fusion surgeries are available, their comparative efficacy is unclear due to limitations in traditional meta-analyses, which lack simultaneous comparison. Moreover, many reviews overlook the specific complexities at the L4-L5 level, where the psoas muscle and aortic bifurcation complicate surgical decisions. This study proposes a network meta-analysis (NMA) to compare clinical and radiological outcomes and assess evidence quality of various minimally invasive lumbar interbody fusion techniques for treating L4-L5 DLS.
Methods: This study follows PRISMA-P guidelines for systematic reviews and meta-analyses, using databases like Scopus, PubMed, and Cochrane through October 2024. Clinical and radiological outcomes are assessed, with risk of bias evaluated using the Cochrane tool.
Results: In this study, we analyzed one randomized controlled trial and six observational studies involving a total of 972 patients who underwent anterior approaches. The network evidence plot showed that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and minimally invasive lateral lumbar interbody fusion (MIS-LLIF) were the most used fusion techniques among the anterior, lateral, and posterior approaches. Regarding fusion rates, MIS-LLIF demonstrated the highest rate at 96.70%, while MIS-XLIF had the lowest at 84.68%. The cumulative ranking curve results indicated that MIS-TLIF had the highest likelihood of improving the Oswestry Disability Index (ODI) and visual analog scale for low back pain, with the order of pain relief being MIS-TLIF (96.1%) as the most effective, followed by MIS-ALIF (62.6%) as the least effective.
Conclusion : This NMA indicates that MIS-TLIF may offer superior outcomes in reducing disability and pain, while LLIF shows higher fusion rates.
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