Percutaneous endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a meta-analysis.

Abstract

Introduction: Transforaminal lumbar interbody fusion (TLIF) is commonly used in patients with lumbar degenerative disease (LDD). The most commonly used techniques include minimally invasive TLIF (MIS-TLIF) and percutaneous endoscopic TLIF (PE-TLIF).Aim: To compare the safety and clinical effectiveness of PE-TLIF and MIS-TLIF in treating LDD. Material and methods: We screened for related articles in multiple scientific databases, namely, PubMed, Embase, Cochrane Library, Wanfang, VIP, and CINK, and analyzed the relative outcomes. Results: Based on our inclusion criteria, we selected 8 studies for meta-analysis. There are a total of 229 patients who underwent PE-TLIF and 258 patients who underwent MIS-TLIF. MIS-TLIF and PE-TLIF have similar effectiveness in relieving leg pain and improving the Oswestry Disability Index. However, PE-TLIF is superior in relieving back pain. The pooled data of fusion rates, postoperative analgesic, and complication rates are comparable between the 2 groups. The pooled operation and intra-operative fluoroscopic time are both significantly higher in the PE-TLIF group than the MIS-TLIF group. The pooled intra-operative blood loss, incision length, duration from surgery to ambulation, and hospital stay are significantly lower in the PE-TLIF group than the MIS-TLIF group. Most of the endpoints reveal significant heterogeneity. The endpoints of operation time and intra-operative blood loss reveal significant publication bias. Conclusions: Both PE-TLIF and MIS-TLIF are safe and effective interventions for patients with LDD. When compared, although MIS-TLIF results in reduced operative time, less intra-operative blood loss and enhanced post-operative recovery can be achieved by PE-TLIF.

Is endoscopic technique an effective and safe alternative for lumbar interbody fusion? A systematic review and meta-analysis

“…Despite the increasing use of MIS and endoscopic techniques, there has been an ongoing debate on which surgical procedure is superior to manage LDD. While most of the existing systematic reviews and meta-analyses limit their comparison to a specific approach (MIS-TLIF) ( 40 , 41 , 42 , 43 ), we aimed to perform a systematic review and meta-analysis to provide an evidence-based judgment on the comparison between Endo-LIF and MIS-LIF or Open-LIF. This is one of the most extensive reviews on the topic (with 27 included articles) and, to the best of our knowledge, the first encompassing a comparison of Endo-LIF with both MIS and Open-LIF techniques.…”