title: Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: a meta-analysis.
abstract: BACKGROUND
  Transforaminal lumbar interbody fusion (TLIF) through a minimally invasive approach (mTLIF) was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF (oTLIF), but inconsistent outcomes were reported.
  
  
  METHODS
  We conducted a meta-analysis to evaluate the effectiveness of mTLIF and oTLIF in the treatment of degenerative lumbar disease. We searched PubMed, Embase and Cochrane Database of Systematic Reviews in March 2013 for studies directly comparing mTLIF and oTLIF. Patient characteristics, interventions, surgical-related messages, early recovery parameters, long-term clinical outcomes, and complications were extracted and relevant results were pooled.
  
  
  RESULTS
  Twelve cohort studies with a total of 830 patients were identified. No significant difference regarding average operating time was observed when comparing mTLIF group with oTLIF group (-0.35 minute, 95% confidence interval (CI): -20.82 to 20.13 minutes). Intraoperative blood loss (-232.91 ml, 95% CI: -322.48 to -143.33 ml) and postoperative drainage (-111.24.ml, 95% CI: -177.43 to -45.05 ml) were significantly lower in the mTLIF group. A shorter hospital stay by about two days was observed in patients who underwent mTLIF (-2.11 days, 95% CI: -2.76 to -1.45 days). With regard to long-term clinical outcomes, no significant difference in visual analog scale score (-0.25, 95% CI: -0.63 to 0.13) was observed; however, there was a slight improvement in Oswestry Disability Index (-1.42, 95% CI: -2.79 to -0.04) during a minimum of 1-year follow-up between the two groups. The incidence of complications did not differ significantly between the procedures (RR = 1.06, 95% CI: 0.7 to 1.59). Reoperation was more common in patients in mTLIF group than in oTLIF group (5% vs. 2.9%), but this difference was not significant (RR = 1.62, 95% CI: 0.75 to 3.51).
  
  
  CONCLUSIONS
  Current evidence suggests that, compared with traditional open surgery, mTLIF reduces blood loss and allows early postoperative recovery, while achieving comparable or slightly better long-term outcomes, and with a comparable risk of complications.
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Zhi-jian
authors.initials: ZJ
authors.lastname: Sun
authors.forename: Wen-jing
authors.initials: WJ
authors.lastname: Li
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhao
authors.forename: Gui-xing
authors.initials: GX
authors.lastname: Qiu
mesh_terms: D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D019636:Neurodegenerative Diseases / Q000601:surgery; D013123:Spinal Fusion; D016896:Treatment Outcome