title: Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion: An Updated Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Minimally invasive transforaminal lumbar interbody fusion (TLIF)-or MI-TLIF-has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes.
  
  
  OBJECTIVE
  To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures.
  
  
  METHODS
  During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type.
  
  
  RESULTS
  Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P < .001), length of stay (P < .001), and complications (P = .001) but increased radiation exposure (P < .001). No differences were found in fusion rate (P = .61) and operative time (P = .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P < .001), but no differences were found in early VAS-back, early ODI, and late ODI.
  
  
  CONCLUSIONS
  MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.
  
  
  BACKGROUND
  CI, confidence intervalMCID, minimal clinically important differenceMI-TLIF, minimally invasive transforaminal lumbar interbody fusionODI, Oswestry Disability IndexO-TLIF, open transforaminal lumbar interbody fusionVAS, Visual Analog Scale.
authors.affiliation: *Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee; ‡Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee; §Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; ‖College of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee.
authors.forename: Nickalus R
authors.initials: NR
authors.lastname: Khan
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Clark
authors.forename: Siang Liao
authors.initials: SL
authors.lastname: Lee
authors.forename: Garrett T
authors.initials: GT
authors.lastname: Venable
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Rossi
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Foley
mesh_terms: D000328:Adult; D001416:Back Pain / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D010147:Pain Measurement; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D064232:Visual Analog Scale