A new article published in Journal of Neurosurgery: Spine compares minimally invasive and open posterior lumbar fusion.
The study examines adverse events and complications. The researchers reviewed the Medline, EBASE, PubMed, Web of Science and Cochrane databases to examine patients who participated in randomized controlled trials or comparative studies for open or minimally invasive TLIF/PLIF for degenerative lumbar spinal disorders.
There were 3,301 articles identified and 26 that met the study inclusion criteria, but all studies were of low or very low quality. There were 856 patients in the minimally invasive cohort and 806 patients in the open cohort.
The researchers found:
1. The changes in the perioperative outcomes for the average estimated blood loss, time to ambulation and length of stay favored the minimally invasive approach. The blood loss was 260 mL less, the time to ambulation was 3.5 days less and the length of stay at the hospital was 2.9 days less for the minimally invasive patients.
2. There weren't significant differences in operative time or adverse events between the two techniques. There wasn't any difference in non-union or reoperation rates.
3. The minimally invasive cases were significantly less likely to result in medical adverse events.
4. The average Oswestry Disability Index scores were slightly better in the minimally invasive patient group compared with the open group. There was a difference in ODI score of 3.32 between the two patient groups at the 24 month follow-up.
5. The results suggest equipoise in the patient-reported outcomes and further meta-analysis of adverse event data suggest equivalent rates of surgical complications with lower medical complication rates in patients undergoing the minimally invasive procedure.