Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of single-level spondylolisthesis grades 1 and 2: a systematic review and meta-analysis.

OBJECTIVE: The purpose of the present study is to compare the clinical efficacy and safety between minimally invasive and traditional open transforaminal lumbar interbody fusion in the treatment of single-level spondylolisthesis grades 1 and 2.

STUDY DESIGN: Systematic review and meta-analysis.

METHODS: A comprehensive literature retrieval was performed in three electronic databases(Pubmed, Embase and Cochrane library). Randomized or non-randomized controlled studies published from January 2000 to April 2018 which compared minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) with traditional open transforaminal lumbar interbody fusion(TO-TLIF) for treating single-level spondylolisthesis grades 1 and 2 were achieved. Quality of included studies were evaluated by the modified Jadad scale. Data were extracted according to the predefined clinical outcome measures, including preoperative and postoperative back pain VAS(VAS-BP) and Oswestry Disability Index(ODI) score; operation time and estimated intraoperative blood loss; length of hospitalization; the complication, reoperation and fusion rate.

RESULTS: Six studies(n=394 patients) were finally included. Two of them were randomized controlled trials(RCTs) and the remaining four were prospective or retrospective cohort studies. The pooled data revealed that both techniques had similar preoperative and last follow-up VAS-BP, complication rate, reoperation rate, and fusion rate. However, with the exception of more operation time, MIS-TLIF was associated with less intraoperative blood loss, shorter hospital stay, and better long-term functional outcome when compared with TO-TLIF.

CONCLUSIONS: Based on the available evidence, MIS-TLIF appears to be an more efficacious and safe technique with reduced tissue trauma, quicker postoperative recovery and better long-term functional outcome for the treatment of single-level spondylolisthesis grades 1 and 2.