• Larry E Miller, Samir Bhattacharyya, and John Pracyk.
• Miller Scientific Consulting, Inc., Asheville, North Carolina, USA. Electronic address: larry@millerscientific.com.
• World Neurosurg. 2020 Jan 1; 133: 358-365.e4.

ObjectiveWe compared the safety and effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to open TLIF (O-TLIF) for lumbar degenerative disease.MethodsWe systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized trials of MI-TLIF versus O-TLIF. The perioperative outcomes included the procedure time, fluoroscopy time, blood loss, complications, and hospital stay. The midterm outcomes included pseudarthrosis, the Oswestry Disability Index, and pain severity-all reported at 1-year minimum follow-up.ResultsA total of 7 randomized trials including 496 patients (246 MI-TLIF; 250 O-TLIF) were included in our review. No statistically significant group differences in procedure time (mean difference [MD], -4 minutes; P = 0.70) were found. However, the fluoroscopy time was significantly longer with MI-TLIF (MD, 48 seconds; P < 0.001). MI-TLIF resulted in less perioperative blood loss (MD, -200 mL; P < 0.001) and shorter hospitalization (MD, -2.2 days; P < 0.001) compared with O-TLIF. The risk of perioperative complications was comparable between the 2 groups (risk ratio, 1.03; P = 0.94). No group differences were found in the incidence of pseudarthrosis at the 1-year minimum follow-up (risk ratio, 0.84; P = 0.67). Pain severity at midterm follow-up was comparable between the 2 groups (MD, -1; P = 0.59), and the ODI was slightly lower in the MI-TLIF group (MD, -3; P = 0.01).ConclusionRelative to O-TLIF, MI-TLIF was associated with less blood loss, a shorter hospital stay, and slightly less disability, at the expense of longer fluoroscopy times.Copyright © 2019 Elsevier Inc. All rights reserved.

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