Effects of three common lumbar interbody fusion procedures for degenerative disc disease: A network meta-analysis of prospective studies

Objectives: Lumbar interbody fusion (LIF) is a treatment option for patients with degenerative disc disease (DDD). However, the effects of the most common LIF procedures-posterior LIF, transforaminal LIF, and anterior LIF-for the treatment of patients with DDD remain controversial. This study evaluated the pain and function caused by the LIF procedures for the treatment of patients with DDD. Methods: Cochrane library, EMBASE, Ovid Medline, and PubMed were searched from inception to July 17, 2018. We only included prospective studies comparing the LIF procedures for treating patients with DDD. Pain score, Oswestry disability index (ODI) score, and operative time were analyzed in a contrast-based consistency model. Results are reported in weighted mean difference (WMD) and 95% confidence interval (CI). Results: This study included eight prospective studies that recruited 503 patients for the LIF procedures. Minimally invasive posterior LIF resulted in lower pain scores than open transforaminal LIF (WMD: -1.45, 95% CI: -2.27 to -0.63) and open posterior LIF (WMD: -0.61, 95% CI: -1.10 to -0.12). It also resulted in a lower ODI score than open transforaminal LIF (WMD: -15.34, 95% CI: -21.76 to -8.91), anterior LIF (WMD: -15.64, 95% CI: -26.37 to -4.91), minimally invasive transforaminal LIF (WMD: -11.63, 95% CI: -16.86 to -6.40), and open posterior LIF (WMD: -10.93, 95% CI: -16.07 to -5.79). Small study effects were not detected in any consistency models. Conclusions: Although minimally invasive posterior LIF has longer operative time than anterior LIF, it is associated with lower pain and ODI scores. Therefore, minimally invasive posterior LIF may be a superior LIF procedure for patients with DDD.