Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis

Abstract

PurposeTo evaluate the efficacy of minimally invasive spinal fusion in comparison to open fusion for adult lumbar spondylolisthesis or spondylosis.Materials and MethodsThe present study was conducted as a meta-analysis of all estimates from studies that were selected after comprehensive literature search by two independent reviewers.ResultsOf 745 articles, nine prospective cohort studies were identifed. The quality of evidence was downgraded because of study design, inconsistency, imprecision, and publication bias. Greater Oswestry Disability Index score improvement [weighted mean difference (WMD), 3.2; 95% confdence interval (CI), 1.5 to 5.0; p=0.0003] and a lower infection rate (odds ratio, 0.3; 95% CI, 0.1 to 0.9; p=0.02) were observed in the minimally invasive group (low-quality evidence). The minimally invasive group had less blood loss (WMD, 269.5 mL; 95% CI, 246.2 to 292.9 mL; p<0.0001), a shorter hospital stay (WMD, 1.3 days; 95% CI, 1.1 to 1.5 days, p<0.0001), and longer operation time (WMD, 21.0 minutes; 95% CI, 15.9 to 26.2 minutes; p<0.0001) and radiation exposure time(WMD, 25.4 seconds; 95% CI, 22.0 to 28.8 seconds, p<0.0001) than the open group (low-quality evidence). There were no significant differences in pain improvement, fusion rate, complications, or subsequent surgeries between the two treatment groups (low-quality evidence).ConclusionAlthough present findings are limited by insufficient evidence and there is a lack of adequately powered high-quality randomized controlled trials to address this gap in evidence, our results support that minimally invasive lumbar fusion is more effective than open fusion for adult spondylolisthesis and other spondylosis in terms of functional improvement, reducing infection rate, and decreasing blood loss and hospital stay.

WITHDRAWN: Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

“…In the past few decades, lumbar interbody fusion has been considered as the standard procedure for the treatment of LSS, but the surgical trauma was great, accomplished by the destruction of bone, increasing the risk of postoperative intervertebral instability (32). Compared with minimally invasive surgery, patients with traditional open surgery showed longer time of lying in bed, and the incidence of complications was significantly higher, such as pulmonary infection, symptomatic deep venous thrombosis, urinary tract infection and so on (33,34). More importantly, most of the patients were elderly patients, the above complications would have a greater negative impact.…”

WITHDRAWN: Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

“…Still, the surgical trauma was great, accomplished by the destruction of bone, increasing the risk of postoperative intervertebral instability (32). Compared with minimally invasive surgery, patients with traditional open surgery showed a longer time of lying in bed, and the incidence of complications was signi cantly higher, such as pulmonary infection, symptomatic deep venous thrombosis, urinary tract infection and so on (33,34). More importantly, most of the patients were elderly patients; the above complications would have a greater negative impact.…”

Minimally Invasive Lumbar Arthrodesis and Percutaneous Pedicle Screws: A Systematic Review

“…The scarcity of clinical trials with a high level of evidence, verified through the preparation of this systematic review, was also the subject of discussion of Park et al, 39 in a meta-analysis that included nine prospective cohort studies published up until December 2017, involving the comparison between minimally invasive lumbar fusion and the conventional technique. The results found in this study show that minimally invasive lumbar fusion techniques are more effective than open techniques in the treatment of spondylolisthesis in terms of improving function and reducing rates of infection, blood loss, and hospitalization time.…”