title: Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis.
abstract: OBJECTIVE
  While open TLIF (O-TLIF) remains the mainstay approach, minimally invasive TLIF (MI-TLIF) may offer potential advantages of reduced trauma to paraspinal muscles, minimized perioperative blood loss, quicker recovery and reduced risk of infection at surgical sites. This meta-analysis was conducted to provide an updated assessment of the relative benefits and risks of MI-TLIF versus O-TLIF.
  
  
  METHODS
  Electronic searches were performed using six databases from their inception to December 2014. Relevant studies comparing MI-TLIF and O-TLIF were included. Data were extracted and analysed according to predefined clinical end points.
  
  
  RESULTS
  There was no significant difference in operation time noted between MI-TLIF and O-TLIF cohorts. The median intraoperative blood loss for MI-TLIF was significantly lower than O-TLIF (median: 177 vs 461 mL; (weighted mean difference) WMD, -256.23; 95% CI -351.35, -161.1; P < 0.00001). Infection rates were significantly lower in the minimally invasive cohort (1.2 vs 4.6%; relative risk (RR), 0.27; 95%, 0.14, 0.53; I2) = 0%; P = 0.0001). VAS back pain scores were significantly lower in the MI-TLIF group compared to O-TLIF (WMD, -0.41; 95% CI -0.76, -0.06; I2 = 96%; P < 0.00001). Postoperative ODI scores were also significantly lower in the minimally invasive cohort (WMD, -2.21; 95% CI -4.26, -0.15; I2 = 93%; P = 0.04).
  
  
  CONCLUSIONS
  In summary, the present systematic review and meta-analysis demonstrated that MI-TLIF appears to be a safe and efficacious approach compared to O-TLIF. MI-TLIF is associated with lower blood loss and infection rates in patients, albeit at the risk of higher radiation exposure for the surgical team. The long-term relative merits require further validation in prospective, randomized studies.
authors: Neurospine Clinic and Neurospine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Randwick, Sydney, NSW, 2031, Australia, kphan.vc@gmail.com.
authors: Kevin
authors: K
authors: Phan
authors: Prashanth J
authors: PJ
authors: Rao
authors: Andrew C
authors: AC
authors: Kam
authors: Ralph J
authors: RJ
authors: Mobbs
mesh_terms: D016063:Blood Loss, Surgical; D004185:Disability Evaluation; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D013123:Spinal Fusion / Q000379:methods*; D013530:Surgical Wound Infection; D064232:Visual Analog Scale