title: Minimally invasive versus open posterior lumbar interbody fusion: a systematic review.
abstract: BACKGROUND
  Although conventional open posterior lumbar interbody fusion (open PLIF) is efficacious in management of lumbar spinal instability, concerns exist regarding lengthy hospital stays, blood loss, and postoperative complications. Minimally invasive posterior lumbar interbody fusion (MIS PLIF) may be able to address these concerns, but the research on this topic has not been systematically reviewed.
  
  
  OBJECTIVE
  We performed a systematic review to determine whether MIS PLIF or open PLIF results in (1) better perioperative parameters, including blood loss, operative times, and length of hospital stay; (2) improved patient-reported outcome scores; and (3) improved disc distraction and (4) frequency of reoperation and complications when compared with open PLIF procedures.
  
  
  METHODS
  A literature search of the MEDLINE database identified seven studies that met our inclusion criteria. A total of seven articles were included; quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) scale. Descriptive statistics were used to describe the included articles.
  
  
  RESULTS
  In most studies, MIS PLIF was associated with decreased blood loss and shorter hospital stay but longer operative times. MIS PLIF resulted in better patient-related outcomes when compared with open PLIF in two studies in the short term, but most of the studies in this review found no short-term differences, and there was no difference at long-term followup in any studies. There was no significant difference in disc distraction. Both techniques appeared to have similar complication rates and reoperation rates.
  
  
  CONCLUSIONS
  Based on the available evidence, which we restricted to prospective and retrospective studies with control groups, but did not include any well-designed randomized trials, MIS PLIF might lead to better perioperative parameters, but there was little evidence for improved patient-reported outcomes in the MIS groups. Randomized controlled trials are needed to compare these two surgical techniques.
authors.affiliation: Rothman Institute & Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
authors.forename: Gursukhman S
authors.initials: GS
authors.lastname: Sidhu
authors.forename: Erik
authors.initials: E
authors.lastname: Henkelman
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.forename: Alan
authors.initials: A
authors.lastname: Hilibrand
authors.forename: D Greg
authors.initials: DG
authors.lastname: Anderson
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Rihn
mesh_terms: D001696:Biomechanical Phenomena; D016063:Blood Loss, Surgical; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D020127:Recovery of Function; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
references.citation: Spine (Phila Pa 1976). 2009 Aug 15;34(18):1923-8
references.pmid: 19652636
references.citation: J Neurosurg Spine. 2007 Jul;7(1):27-32
references.pmid: 17633484
references.citation: Spine (Phila Pa 1976). 2007 Mar 1;32(5):537-43
references.pmid: 17334287
references.citation: Neurosurgery. 2013 Mar;72(3):443-50; discussion 450-1
references.pmid: 23208069
references.citation: Spine (Phila Pa 1976). 1996 Nov 15;21(22):2683-8
references.pmid: 8961456
references.citation: Eur Spine J. 2005 Feb;14(1):55-60
references.pmid: 15197628
references.citation: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 May;24(5):517-20
references.pmid: 20540249
references.citation: Eur Spine J. 2011 Apr;20(4):623-8
references.pmid: 20927557
references.citation: Singapore Med J. 2012 Mar;53(3):183-7
references.pmid: 22434292
references.citation: J Neurosurg Spine. 2010 Jun;12(6):694-9
references.pmid: 20515357
references.citation: Eur Spine J. 2010 Feb;19(2):316-24
references.pmid: 19876659
references.citation: Minim Invasive Neurosurg. 2010 Feb;53(1):21-4
references.pmid: 20376740
references.citation: Spine (Phila Pa 1976). 1994 Nov 15;19(22):2590-7
references.pmid: 7855686
references.citation: Neurosurg Focus. 2001 Apr 15;10(4):E10
references.pmid: 16732626
references.citation: Spine (Phila Pa 1976). 1994 Nov 15;19(22):2598-602
references.pmid: 7855687
references.citation: J Korean Neurosurg Soc. 2011 Mar;49(3):163-6
references.pmid: 21556236
references.citation: Spine (Phila Pa 1976). 2005 Oct 1;30(19):E562-6
references.pmid: 16205329
references.citation: Spine (Phila Pa 1976). 1986 Jul-Aug;11(6):601-6
references.pmid: 3787326
references.citation: Chin Med Sci J. 2006 Mar;21(1):41-7
references.pmid: 16615284
references.citation: Clin Orthop Surg. 2009 Dec;1(4):214-21
references.pmid: 19956479
references.citation: Clin Neurosurg. 2000;47:514-27
references.pmid: 11197722
references.citation: Int Orthop. 2009 Dec;33(6):1683-8
references.pmid: 19023571
references.citation: Neurosurgery. 2010 Feb;66(2):296-304; discussion 304
references.pmid: 20087129
references.citation: Orthop Clin North Am. 2002 Apr;33(2):367-74
references.pmid: 12389282
references.citation: J Spinal Disord Tech. 2012 Aug;25(6):324-8
references.pmid: 21685806
references.citation: J Clin Neurosci. 2011 Mar;18(3):324-8
references.pmid: 21237659
references.citation: J Am Acad Orthop Surg. 2007 Jun;15(6):321-9
references.pmid: 17548881
references.citation: J Bone Joint Surg Am. 2003 Jan;85(1):1-3
references.pmid: 12533564
references.citation: J Spinal Disord Tech. 2005 Aug;18(4):332-6
references.pmid: 16021014
references.citation: J Am Acad Orthop Surg. 2012 May;20(5):283-91
references.pmid: 22553100
references.citation: Eur Spine J. 2013 Aug;22(8):1741-9
references.pmid: 23572345
references.citation: J Clin Neurosci. 2011 May;18(5):624-7
references.pmid: 21349719