Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis
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Purpose: To evaluate the efficacy of minimally invasive spinal fusion in comparison to open fusion for adult lumbar spondylolisthesisor spondylosis. Materials and Methods: The present study was conducted as a meta-analysis of all estimates from studies that were selected aftercomprehensive literature search by two independent reviewers. Results: Of 745 articles, nine prospective cohort studies were identified. The quality of evidence was downgraded because ofstudy design, inconsistency, imprecision, and publication bias. Greater Oswestry Disability Index score improvement [weightedmean difference (WMD), 3.2; 95% confidence interval (CI), 1.5 to 5.0; p=0.0003] and a lower infection rate (odds ratio, 0.3; 95% CI,0.1 to 0.9; p=0.02) were observed in the minimally invasive group (low-quality evidence). The minimally invasive group had lessblood loss (WMD, 269.5 mL; 95% CI, 246.2 to 292.9 mL; p<0.0001), a shorter hospital stay (WMD, 1.3 days; 95% CI, 1.1 to 1.5 days,p<0.0001), and longer operation time (WMD, 21.0 minutes; 95% CI, 15.9 to 26.2 minutes; p<0.0001) and radiation exposure time(WMD, 25.4 seconds; 95% CI, 22.0 to 28.8 seconds, p<0.0001) than the open group (low-quality evidence). There were no significantdifferences in pain improvement, fusion rate, complications, or subsequent surgeries between the two treatment groups (lowqualityevidence). Conclusion: Although present findings are limited by insufficient evidence and there is a lack of adequately powered high-qualityrandomized controlled trials to address this gap in evidence, our results support that minimally invasive lumbar fusion is moreeffective than open fusion for adult spondylolisthesis and other spondylosis in terms of functional improvement, reducing infectionrate, and decreasing blood loss and hospital stay.
Abstract
Purpose: To evaluate the efficacy of minimally invasive spinal fusion in comparison to open fusion for adult lumbar spondylolisthesisor spondylosis. Materials and Methods: The present study was conducted as a meta-analysis of all estimates from studies that were selected aftercomprehensive literature search by two independent reviewers. Results: Of 745 articles, nine prospective cohort studies were identified. The quality of evidence was downgraded because ofstudy design, inconsistency, imprecision, and publication bias. Greater Oswestry Disability Index score improvement [weightedmean difference (WMD), 3.2; 95% confidence interval (CI), 1.5 to 5.0; p=0.0003] and a lower infection rate (odds ratio, 0.3; 95% CI,0.1 to 0.9; p=0.02) were observed in the minimally invasive group (low-quality evidence). The minimally invasive group had lessblood loss (WMD, 269.5 mL; 95% CI, 246.2 to 292.9 mL; p<0.0001), a shorter hospital stay (WMD, 1.3 days; 95% CI, 1.1 to 1.5 days,p<0.0001), and longer operation time (WMD, 21.0 minutes; 95% CI, 15.9 to 26.2 minutes; p<0.0001) and radiation exposure time(WMD, 25.4 seconds; 95% CI, 22.0 to 28.8 seconds, p<0.0001) than the open group (low-quality evidence). There were no significantdifferences in pain improvement, fusion rate, complications, or subsequent surgeries between the two treatment groups (lowqualityevidence). Conclusion: Although present findings are limited by insufficient evidence and there is a lack of adequately powered high-qualityrandomized controlled trials to address this gap in evidence, our results support that minimally invasive lumbar fusion is moreeffective than open fusion for adult spondylolisthesis and other spondylosis in terms of functional improvement, reducing infectionrate, and decreasing blood loss and hospital stay.
참고문헌 (29)
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