Minimally invasive procedure reduces adjacent segment degeneration and disease: New benefit-based global meta-analysis

Abstract

ObjectiveAdjacent segment pathology (ASP) is a common complication presenting in patients with axial pain and dysfunction, requiring treatment or follow-up surgery. However, whether minimally invasive surgery (MIS), including MIS transforaminal / posterior lumbar interbody fusion (MIS-TLIF/PLIF) decreases the incidence rate of ASP remains unknown. The aim of this meta-analysis was to compare the incidence rate of ASP in patients undergoing MIS versus open procedures.MethodsThis systematic review was undertaken by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We searched electronic databases, including PubMed, EMBASE, SinoMed, and the Cochrane Library, without language restrictions, to identify clinical trials comparing MIS to open procedures. The results retrieved were last updated on June 15, 2016.ResultsOverall, 9 trials comprising 770 patients were included in the study; the quality of the studies included 4 moderate and 5 low-quality studies. The pooled data analysis demonstrated low heterogeneity between the trials and a significantly lower ASP incidence rate in patients who underwent MIS procedure, compared with those who underwent open procedure (p = 0.0001). Single-level lumbar interbody fusion was performed in 6 trials of 408 patients and we found a lower ASP incidence rate in MIS group, compared with those who underwent open surgery (p = 0.002). Moreover, the pooled data analysis showed a significant reduction in the incidence rate of adjacent segment disease (ASDis) (p = 0.0003) and adjacent segment degeneration (ASDeg) (p = 0.0002) for both procedures, favoring MIS procedure. Subgroup analyses showed no difference in follow-up durations between the procedures (p = 0.93).ConclusionTherefore, we conclude that MIS-TLIF/PLIF can reduce the incidence rate of ASDis and ASDeg, compared with open surgery. Although the subgroup analysis did not indicate a difference in follow-up duration between the two procedures, larger-scale, well-designed clinical trials with extensive follow-up are needed to confirm and update the findings of this analysis.

Clinical and Radiographic Comparison Between Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion With Bilateral Facetectomies

“…21 In our study, there was 1 reoperation in the MIS cohort for adjacent segment disease (ASD), compared with 4 reoperations in the open cohort for ASD (1 case) and pseudarthrosis (3 cases). MIS techniques have also been shown to decrease the incidence of ASD following lumbar spine surgeries compared with open approaches because of less soft-tissue disruption, 22 although this conclusion was not observed in our study. During MIS TLIF, when pedicle screws are placed percutaneously, careful attention needs to be paid to avoid iatrogenic superior facet joint violation, which is a known risk factor for ASD.…”

Comparing Oblique Lumbar Interbody Fusion with Lateral Screw Fixation and Transforaminal Full-Endoscopic Lumbar Discectomy (OLIF-TELD) and Posterior Lumbar Interbody Fusion (PLIF) for the Treatment of Adjacent Segment Disease

“…According to the literature about the revision of spinal fusion for the management of ASD, the effective use of minimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) [21] and lateral lumbar interbody fusion (MIS-LLIF) [22] in ASD treatment has been reported. Besides, it has been concluded that MIS-TLIF/PLIF can reduce the incidence rate of ASD, compared with open surgery [23]. Minimally invasive OLIF can be performed safely in the lumbar spine from L1 to L5 and at L5-S1.…”

Distinct fusion intersegmental parameters regarding local sagittal balance provide similar clinical outcomes: a comparative study of minimally invasive versus open transforaminal lumbar interbody fusion

“…Some studies have suggested that MIS-TLIF is superior to Open-TLIF in reducing adjacent segment disease [34,35]. The smaller damage caused by MIS-TLIF to the surrounding soft tissue and the recovery of postoperative spinal stability may contribute to this difference.…”