Surgical Treatments for Lumbar Spine Diseases (TLIF vs. Other Surgical Techniques): A Systematic Review and Meta-Analysis

OBJECTIVE: The purpose of this study is to compare fusion rate, clinical outcomes, complications among transforaminal lumbar interbody fusion (TLIF), and other techniques for lumbar spine diseases. DESIGN: This is a systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases were searched from January 2013 through December 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomized controlled trials (RCTs) that compare lumbar interbody fusion with posterolateral fusion (PLF) and/or other lumbar interbody fusion were included for the review. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted relevant data and assessed the risk of bias. Meta-analysis was performed using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complications in TLIF and other techniques for lumbar spinal diseases. RESULTS: Of 3,682 potential studies, 15 RCTs (915 patients) were included in the meta-analysis. Compared to other surgical techniques, TLIF had slightly lower fusion rate [RR = 0.84 (95% CI = 0.72–0.97), p = 0.02, I(2) = 0.0%] at 1-year follow-up whereas there was no difference on fusion rate at 2-year follow-up [RR = 1.06 (95% CI = 0.96–1.18), p = 0.27, I(2) = 69.0%]. The estimated RR of total adverse events [RR = 0.90 (95% CI = 0.59–1.38), p = 0.63, I(2) = 0.0%] was similar to no fusion, PLF, PLIF, and XLIF groups, and revision rate [RR = 0.78 (95% CI = 0.34–1.79), p = 0.56, I(2) = 39.0%] was similar to PLF and XLIF groups. TLIF had approximately half an hour more operative time than other techniques (no fusion, ALIF, PLF, PLIF, XLIF) [MD = 31.88 (95% CI = 5.33–58.44), p = 0.02, I(2) = 92.0%]. There was no significant difference between TLIF and other techniques in terms of blood loss (no fusion, PLIF, PLF) and clinical outcomes (PLF). CONCLUSIONS: Besides fusion rate at 1-year follow-up and operative time, TLIF has a similar fusion rate, clinical outcomes, parameters concerning operation and complications to no fusion, PLF, and other interbody fusion (PLIF, ALIF, XLIF). SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020186858.