Minimally Invasive Versus Traditional Open Transforaminal Lumbar Interbody Fusion for the Treatment of Single-Level Spondylolisthesis Grades 1 and 2: A Systematic Review and Meta-Analysis

Objective To compare the clinical efficacy and safety between minimally invasive and traditional open transforaminal lumbar interbody fusion in the treatment of single-level spondylolisthesis grades 1 and 2. Methods This was a systematic review and meta-analysis. A comprehensive literature retrieval was performed in 3 electronic databases (PubMed, Embase, and Cochrane library). Randomized or nonrandomized controlled studies published from January 2000 to April 2018 that compared minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with traditional open transforaminal lumbar interbody fusion (TO-TLIF) for treating single-level spondylolisthesis grades 1 and 2 were retrieved. Quality of included studies were evaluated by the modified Jadad scale. Data were extracted according to the predefined clinical outcome measures, including preoperative and postoperative back pain visual analogue scale and Oswestry Disability Index score; operation time and estimated intraoperative blood loss; length of hospitalization; and the complications, reoperation, and fusion rate. Results Six studies ( n  = 394 patients) were finally included. Two were randomized controlled trials and the remaining 4 were prospective or retrospective cohort studies. The pooled data revealed that both techniques had similar preoperative and last follow-up back pain visual analogue scale scores, complication rate, reoperation rate, and fusion rate. However, with the exception of more operation time, MIS-TLIF was associated with less intraoperative blood loss, shorter hospital stay, and better long-term functional outcome when compared with TO-TLIF. Conclusions Based on the available evidence, MIS-TLIF appears to be a more efficacious and safe technique with reduced tissue trauma, quicker postoperative recovery, and better long-term functional outcome for the treatment of single-level spondylolisthesis grades 1 and 2.