A Decade of Lumbar Tubular Minimally Invasive Spine Surgery: Analyzing Complication Trends Through a Systematic Review and Meta-analysis

Introduction: Tubular Minimally Invasive Spine Surgery (MISS) is an effective approach for treating lumbar spine disorders. This study aimed to comprehensively quantify the incidence of overall and specific complications associated with tubular lumbar MISS through a systematic review and proportional meta-analysis of studies published over the last decade.

Methods: A systematic search of PubMed, Medline, Embase, and the Cochrane Library (January 2013 to March 2024) was conducted following PRISMA guidelines. Studies were included if they involved ten adult patients undergoing tubular lumbar MISS and provided extractable complication data. A random-effects model was used to pool complication rates, and study quality was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. All analyses were done using R studio.

Results: Seventy-five studies involving approximately 12,600 patients were included in the analysis. The complication rate was 10% (95% CI: 8%–14%, I² = 93%). Specific complication rates were: dural tears 4% (95% CI: 3%–5%, I² = 69%) in 56 studies (6,651 patients); nerve injuries 1% (95% CI: 1%–3%, I² = 70%) in 41 studies (5,278 patients); postoperative hematoma 1% (95% CI: 1%–2%, I² = 31%) in 19 studies (2,454 patients); surgical site infections 1% (95% CI: 0%–1%, I² = 27%) in 46 studies (10,439 patients); revision surgeries 2% (95% CI: 2%–3%, I² = 77%) in 43 studies (8,948 patients); and disc re-herniation 3% (95% CI: 1%–7%, I² = 84%) in 14 studies (1,928 patients).

Conclusion : This meta-analysis provides a comprehensive overview of complication rates in tubular lumbar MISS, revealing generally low rates but significant heterogeneity across studies. These findings offer valuable insights for patient counseling and surgical planning, though individual patient factors and surgeon experience should be considered. Standardized complication reporting and research into outcome variability are needed to improve future studies.