• Lei Zhu, Tongchuan Cai, Yuzhou Shan, Wenjie Zhang, Liang Zhang, and Xinmin Feng.
• Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China.
• Pain Physician. 2021 Sep 1; 24 (6): 441-452.

BackgroundPercutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has been increasingly used to treat degenerative lumbar disease in recent years. However, there are still controversies about whether PE-TLIF is superior to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).ObjectivesTo compare clinical outcomes and complications of PE-TLIF and MIS-TLIF in treating degenerative lumbar disease.Study DesignA systematic review and meta-analysis.MethodsA comprehensive search of online databases including PubMed, Embase, and the Cochrane Library was performed to identify related studies reporting the outcomes and complications of PE-TLIF and MIS-TLIF for degenerative lumbar disease. The clinical outcomes were assessed by the Visual Analog Scale and Oswestry Disability Index. In addition, the operative time, intraoperative blood loss, time to ambulation, length of hospital stay, fusion rate, and surgery-related complications were summarized. Forest plots were constructed to investigate the results.ResultsA total of 28 studies involving 1,475 patients were included in this meta-analysis. PE-TLIF significantly reduced operative time, intraoperative blood loss, time to ambulation, and length of hospital stay compared to MIS-TLIF. Moreover, PE-TLIF was superior to MIS-TLIF in the early postoperative relief of back pain. However, there were no significant differences in medium to long-term clinical outcomes, fusion rate, and incidence of complications between PE-TLIF and MIS-TLIF.LimitationsThe current evidence is heterogeneous and most studies included in this meta-analysis are nonrandomized controlled trials.ConclusionsThe present meta-analysis indicates that medium to long-term clinical outcomes and complication rates of PE-TLIF were similar to MIS-TLIF for the treatment of degenerative lumbar disease. However, PE-TLIF shows advantages in less surgical trauma, faster recovery, and early postoperative relief of back pain.

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