Endoscopic Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis

OBJECTIVE: To compare clinical efficacy and safety of endoscopic lumbar interbody fusion (Endo-LIF) and mini-mally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in treatment of lumbar degenerative diseases. METHODS: A literature search was performed using PubMed, Embase, Web of Science, and Cochrane Library databases. Studies published up to November 15, 2020, that compared Endo-LIF with MIS-TLIF for treating lumbar degenerative diseases were retrieved. Data were extrac-ted according to predefined clinical outcome measures. Primary outcomes were preoperative and postoperative visual analog scale for leg and back pain and Oswestry Disability Index scores. Secondary outcomes were operative time and intraoperative blood loss; length of hospitalization; and complication, reoperation, and fusion rates. Data analysis was conducted with statistical software. RESULTS: The meta-analysis included 6 studies comprising 480 patients. Results of the merged analysis revealed similar complication, reoperation, and fusion rates and preoperative and postoperative visual analog scale for leg and back pain and Oswestry Disability Index scores (P > 0.05) for Endo-LIF and MIS-TLIF. Nevertheless, with the exception of longer operative time (P < 0.05), Endo-LIF compared favorably with MIS-TLIF, with less intraoperative blood loss, shorter hospital stay (P < 0.05), and better long-term functional outcome. CONCLUSIONS: Based on the evidence provided by this study, there is no significant difference in clinical efficacy and safety between Endo-LIF and MIS-TLIF in the treatment of lumbar degenerative diseases. Although Endo-LIF has a longer operative time, it has the advantages of less tissue trauma and rapid recovery after operation.

Automated summary

A comparison between Endo-LIF and MIS-TLIF in treating lumbar degenerative diseases showed no significant differences in complication, reoperation, and fusion rates, as well as preoperative and postoperative pain scores and disability index. Endo-LIF had the advantage of less intraoperative blood loss, shorter hospital stay, and better long-term functional outcome compared to MIS-TLIF, despite a longer operative time.