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Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis

PURPOSE: To evaluate the efficacy of minimally invasive spinal fusion in comparison to open fusion for adult lumbar spondylolisthesis or spondylosis. MATERIALS AND METHODS: The present study was conducted as a meta-analysis of all estimates from studies that were selected after comprehensive literat...

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Autores principales: Park, Yung, Seok, Sang-Ok, Lee, Soo-Bin, Ha, Joong-Won
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Yonsei University College of Medicine 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949295/
https://www.ncbi.nlm.nih.gov/pubmed/29749136
http://dx.doi.org/10.3349/ymj.2018.59.4.524
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author Park, Yung
Seok, Sang-Ok
Lee, Soo-Bin
Ha, Joong-Won
author_facet Park, Yung
Seok, Sang-Ok
Lee, Soo-Bin
Ha, Joong-Won
author_sort Park, Yung
collection PubMed
description PURPOSE: To evaluate the efficacy of minimally invasive spinal fusion in comparison to open fusion for adult lumbar spondylolisthesis or spondylosis. MATERIALS AND METHODS: The present study was conducted as a meta-analysis of all estimates from studies that were selected after comprehensive literature search by two independent reviewers. RESULTS: Of 745 articles, nine prospective cohort studies were identifed. The quality of evidence was downgraded because of study design, inconsistency, imprecision, and publication bias. Greater Oswestry Disability Index score improvement [weighted mean difference (WMD), 3.2; 95% confdence 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 less blood 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 significant differences in pain improvement, fusion rate, complications, or subsequent surgeries between the two treatment groups (low-quality evidence). CONCLUSION: Although present findings are limited by insufficient evidence and there is a lack of adequately powered high-quality randomized controlled trials to address this gap in evidence, our results support that minimally invasive lumbar fusion is more effective than open fusion for adult spondylolisthesis and other spondylosis in terms of functional improvement, reducing infection rate, and decreasing blood loss and hospital stay.
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spelling pubmed-59492952018-06-01 Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis Park, Yung Seok, Sang-Ok Lee, Soo-Bin Ha, Joong-Won Yonsei Med J Original Article PURPOSE: To evaluate the efficacy of minimally invasive spinal fusion in comparison to open fusion for adult lumbar spondylolisthesis or spondylosis. MATERIALS AND METHODS: The present study was conducted as a meta-analysis of all estimates from studies that were selected after comprehensive literature search by two independent reviewers. RESULTS: Of 745 articles, nine prospective cohort studies were identifed. The quality of evidence was downgraded because of study design, inconsistency, imprecision, and publication bias. Greater Oswestry Disability Index score improvement [weighted mean difference (WMD), 3.2; 95% confdence 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 less blood 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 significant differences in pain improvement, fusion rate, complications, or subsequent surgeries between the two treatment groups (low-quality evidence). CONCLUSION: Although present findings are limited by insufficient evidence and there is a lack of adequately powered high-quality randomized controlled trials to address this gap in evidence, our results support that minimally invasive lumbar fusion is more effective than open fusion for adult spondylolisthesis and other spondylosis in terms of functional improvement, reducing infection rate, and decreasing blood loss and hospital stay. Yonsei University College of Medicine 2018-06-01 2018-05-03 /pmc/articles/PMC5949295/ /pubmed/29749136 http://dx.doi.org/10.3349/ymj.2018.59.4.524 Text en © Copyright: Yonsei University College of Medicine 2018 http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Yung
Seok, Sang-Ok
Lee, Soo-Bin
Ha, Joong-Won
Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis
title Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis
title_full Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis
title_fullStr Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis
title_full_unstemmed Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis
title_short Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis
title_sort minimally invasive lumbar spinal fusion is more effective than open fusion: a meta-analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949295/
https://www.ncbi.nlm.nih.gov/pubmed/29749136
http://dx.doi.org/10.3349/ymj.2018.59.4.524
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