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2014 ; 472
(6
): 1727-37
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Comparative outcomes of minimally invasive surgery for posterior lumbar fusion: a
systematic review
#MMPMID24464507
Goldstein CL
; Macwan K
; Sundararajan K
; Rampersaud YR
Clin Orthop Relat Res
2014[Jun]; 472
(6
): 1727-37
PMID24464507
show ga
BACKGROUND: Although minimally invasive surgical (MIS) approaches to the lumbar
spine for posterior fusion are increasingly being utilized, the comparative
outcomes of MIS and open posterior lumbar fusion remain unclear.
QUESTIONS/PURPOSES: In this systematic review, we compared MIS and open
transforaminal or posterior lumbar interbody fusion (TLIF/PLIF), specifically
with respect to (1) surgical end points (including blood loss, surgical time, and
fluoroscopy time), (2) clinical outcomes (Oswestry Disability Index [ODI] and VAS
pain scores), and (3) adverse events. METHODS: We performed a systematic review
of MEDLINE(®), Embase, Web of Science, and Cochrane Library. Reference lists were
manually searched. We included studies with 10 or more patients undergoing MIS
compared to open TLIF/PLIF for degenerative lumbar disorders and reporting on
surgical end points, clinical outcomes, or adverse events. Twenty-six studies of
low- or very low-quality (GRADE protocol) met our inclusion criteria. No
significant differences in patient demographics were identified between the
cohorts (MIS: n = 856; open: n = 806). RESULTS: Equivalent operative times were
observed between the cohorts, although patients undergoing MIS fusion tended to
lose less blood, be exposed to more fluoroscopy, and leave the hospital sooner
than their open counterparts. Patient-reported outcomes, including VAS pain
scores and ODI values, were clinically equivalent between the MIS and open
cohorts at 12 to 36 months postoperatively. Trends toward lower rates of surgical
and medical adverse events were also identified in patients undergoing MIS
procedures. However, in the absence of randomization, selection bias may have
influenced these results in favor of MIS fusion. CONCLUSIONS: Current evidence
examining MIS versus open TLIF/PLIF is of low to very low quality and therefore
highly biased. Results of this systematic review suggest equipoise in surgical
and clinical outcomes with equivalent rates of intraoperative surgical
complications and perhaps a slight decrease in perioperative medical
complications. However, the quality of the current literature precludes firm
conclusions regarding the comparative effectiveness of MIS versus open posterior
lumbar fusion from being drawn and further higher-quality studies are critically
required.