Minimally invasive versusopen transforaminal lumbar interbody fusion for lumbar degenerative disease：a meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND:A large number of studies have confirmed that minimaly invasive and open transforaminal lumbar interbody fusion approaches for single-segment and multi-segment lumbar degenerative diseases were effective, but their advantages and disadvantages remain inconclusive. OBJECTIVE:To systematicaly evaluate the effectiveness and safety of minimaly invasive versus open transforaminal lumbar interbody fusion for lumbar degenerative disease. METHODS: Databases including The Cochrane Library (Issue 2, 2014), PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, Wanfang Data were searched to colect the randomized controled trails and non-randomized controled trails about minimaly invasive and open transforaminal lumbar interbody fusion for lumbar degenerative disease. The retrieval time was from foundation to February 2014. The studies were screened according to inclusion and exclusion criteria. The data were extracted and the quality was evaluated by two reviewers independently. Meta-analysis was conducted using RevMan 5.2 software. RESULTS AND CONCLUSION:A total of 1 randomized controled trail and 18 non-randomized controled trails involving 1 400 patients were included. The results of meta-analysis showed that compared with open transforaminal lumbar interbody fusion, minimaly invasive transforaminal lumbar interbody fusion had many advantages, such as smal paraspinal muscle injury, less blood loss, short hospital stay, good early effects and high long-period remission rate of lumbago. However, minimaly invasive transforaminal lumbar interbody fusion was not superior to open transforaminal lumbar interbody fusion in improving long-period motor function, long-term remission rate of leg pain and in reducing complications. Moreover, the operation time of minimaly invasive transforaminal lumbar interbody fusion was longer. Therefore, under the premise of strict indications, minimaly invasive transforaminal lumbar interbody fusion could better solve the complaint of patients with lumbar degenerative disease. For the quantitative and qualitative limitation of the included studies, this conclusion stil requires to be further proved by performing a larger scale and a higher quality of randomized controled trails. It suggests that doctors should choose a best therapy for patients according to an integrative disease assessment.