Sergical Outcomes and adverse effects for Minimally Invasive versus Open Posterior Lumbar Interbody Fusion A Systematic Review and Meta-Analysis

Abstract

Minimal invasive techniques for lumbar interbody fusion is a novel surgical procedure developed to reduce approach- related morbidity associated with traditional open techniques. Our review showed that MIS provides good long-term clinical outcomes and is associated with less blood loss, and less postoperative pain with significantly less narcotic medications use, which lead to shorter LOS, earlier ambulation, and earlier return to work. Operative time remains a controversial parameter, with many studies showing longer operative time for MIS technique, some studies showing longer operative time for open technique, and still others showing no significant difference between both techniques. This heterogeneity is explained by the finding that our reviewed studies included MITLIF cases performed by surgeons during their initial learning curve, which required longer operative times. We suggest that MITLIF has a steep learning curve, but once adequate surgical experience is gained, the surgical time could be significantly reduced. This applies also to the complication rate, which is another controversial item. Complications associated with MIS techniques included primarily screw misplacement and cage migration, attributed to the steep learning curve and the technical demands of MIS procedure.