Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

Table 1 Studies evaluating minimally invasive laminectomy

Ref.	Year	Surgery	Population	MIS patients	Open patients
RCTs/IRCTs
Cho et al[14]	2007	Split process laminectomy: Marmot operation	LSS	40	30
Usman et al[15]	2013	Unilateral laminectomy	LSS, no spondylolisthesis	30	30
Mobbs et al[17]	2014	Laminectomy: Unilateral laminectomy for bilateral decompression	LSS, max 2 levels, no spondylolisthesis	27	27
Watanabe et al[16]	2011	Lumbar spinous process-splitting laminectomy	Neurogenic claudication	22	19
Clinical case series
Rahman et al[18]	2008	Laminectomy	LSS, no discectomy	38	88
Nomura et al[19]	2014	Laminectomy: Spinous process-splitting laminectomy	Spondylolisthesis, LSS due to herniation	124	-
Parikh et al[20]	2008	Laminectomy	Degenerative disease	75	-
Komp et al[21]	2011	Laminectomy: Unilateral laminectomy for bilateral decompression	LSS, no spondylolisthesis > 1	74	-
Nomura et al[22]	2012	Laminectomy: Unilateral laminectomy for bilateral decompression: Paramedian approach	LSS, no discectomy	70	-
Tomasino et al[23]	2009	Laminectomy: Unilateral laminectomy for bilateral decompression	LSS, herniation in obese	28	-
Wada et al[24]	2010	Laminectomy	LSS, elderly patients	15	-

RCT: Randomized controlled trial; IRCT: Incomplete randomized controlled trial; LSS: Lumbar spinal stenosis; MIS: Minimally invasive.

Table 2 Studies comparing perioperative outcomes of minimally invasive laminectomy vs open laminectomy

	Length of surgery (min) ± SD		Estimated blood loss (cc) ± SD		Neurologic complications		Length of stay (d) ± SD
	MIS	Open	MIS	Open	MIS	Open	MIS	Open
RCTs/IRCTs
Cho et al[14]	259 ± 122	193 ± 68	154 ± 135	132 ± 128	-	-	4.0 ± 2.9	7.2 ± 1.6
Usman et al[15]	69 ± 0.1	65 ± 0.1	-	-	-	-	4.7 ± 0.5	3.5 ± 0.5
Mobbs et al[17]	-	-	40	110	4%	7%	2.3	4.2
Watanabe et al[16]	69 ± 29	82 ± 36	44 ± 75	55 ± 48	0%	0%	-	-
Clinical case series
Rahman et al[18]	110 ± 10	157 ± 7	52 ± 14	246 ± 32	5%	8%	2.1 ± 0.7	4.1 ± 0.4
Nomura et al[19]	187 ± 68	-	90 ± 94	-	2%	-	-	-
Parikh et al[20]	118 ± 40	-	41 ± 90	-	11%	-	1.2	1.3
Komp et al[21]	44	-	01	-	14%	-	-	-
Nomura et al[22]	772	-	15.02	-	0%	-	-	-
Tomasino et al[23]	102 ± 44	-	35 ± 76	-	11%	-	2.1	2.2
Wada et al[24]	144	-	60	-	7%	-	-	-

¹No measurable blood loss;

²Per level. SD: Standard deviation; RCT: Randomized controlled trial; IRCT: Incomplete randomized controlled trial; MIS: Minimally invasive.

Table 3 Studies on minimally invasive lateral approaches to the lumbar spine

Ref.	Year	Surgery	Type of study	Population	MIS patients	Open patients
Cohort studies
Hrabalek et al[27]	2014	XLIF	Retrospective cohort, XLIF vs ALIF	DDD, FBSS, spondylolisthesis	88	120
Smith et al[28]	2012	XLIF	Retrospective cohort, XLIF vs ALIF	DDD, LSS, FBSS, spondylolisthesis, herniation	115	87
1Rodgers et al[12]	2010	XLIF	Retrospective cohort, XLIF vs PLIF	> 80 yr, LSS, FBSS spondylolisthesis, scoliosis, fracture	40	20
Huang et al[29]	2010	MIS-ALIF2	Prospective cohort, MIS-ALIF vs ALIF	Not defined	10	13
Case series
3Rodgers et al[13]	2011	XLIF	PCS	LSS, DDD, FBSS, spondylolisthesis, scoliosis	600	-
Ruetten et al[30]	2005	XLIF	RCS	Lumbar disc prolapse	463	-
Lykissas et al[31]	2014	XLIF	RCS	Degenerative spinal conditions	144	-
Grimm et al[32]	2014	XLIF	RCS	DDD, LSS, FBSS, scoliosis, spondylolisthesis, herniation	108	-
Tohmeh et al[33]	2011	XLIF	PCS	LSS, DDD, spondylolisthesis, spondylosis, scoliosis, recurrent herniation, ASD	102	-
Berjano et al[34]	2012	XLIF	RCS	DDD, LSS, spondylolisthesis	97	-
Lee et al[26]	2014	DLIF	RCS	LSS, spondylolisthesis, scoliosis, post-infectious	90	-
Marchi et al[35]	2012	XLIF	PCS	Spondylolisthesis	52	-
Sharma et al[36]	2011	XLIF	RCS	Spondylosis ± listhesis, scoliosis	43	-
Pimenta et al[25]	2011	XLIF	PCS	DDD	36	-
Ahmadian et al[37]	2013	XLIF	RCS	L4/L5 spondylolisthesis	31	-
Caputo et al[38]	2012	XLIF	PCS	Scoliosis	30	-
Malham et al[39]	2012	XLIF	PCS	DDD, spondylolisthesis, scoliosis	30	-
4Pimenta et al[40]	2013	XLIF	RCT	L4/L5 DDD	30	-
Elowitz et al[41]	2011	XLIF	PCS	LSS	25	-
Oliveira et al[42]	2010	XLIF	PCS	Degenerative spinal conditions	21	-

¹Author financial conflict, different time period for cohort;

²Minimally invasive flank incision;

³Reported data likely includes data separately reported in Rodgers et al[13];

⁴This randomized control trial did not have an open surgery arm. DDD: Degenerative disc disease; FBSS: Failed back surgery syndrome; LSS: Lumbar spinal stenosis; ASD: Adjacent segment disease; MIS: Minimally invasive; RCT: Randomized controlled trial; XLIF: Extreme lateral interbody fusion; ALIF: Axial lumbar interbody fusion; PCS: Prospective cohort study; RCS: Retrospective cohort study; PLIF: Posterior lumbar interbody fusion; DLIF: Direct lateral interbody fusion.

Table 4 Studies comparing perioperative outcomes of minimally invasive lateral vs open anterior approaches to the lumbar spine

Ref.	Length of surgery (min) ± SD		Estimated blood loss (cc) ± SD		Neurologic complications		Length of stay (d) ± SD
	MIS	Open	MIS	Open	MIS	Open	MIS	Open
Cohort studies
Hrabalek et al[27]	-	-	-	-	28%	24%	-	-
Smith et al[28]	112 ± 31	173 ± 31	90 ± 74	311 ± 370	3%	6%	1.7 ± 1.3	3.6 ± 0.9
Rodgers et al[12]	-	-	1.4 g Hb	2.7 g Hb	-	-	1.3	5.3
Huang et al[29]	176 ± 8	202 ± 15	572 ± 93	970 ± 209	-	-	11.6 ± 1.3	12.5 ± 1.3
Case series
Rodgers et al[13]	-	-	1.38 g Hb	-	1%	-	1.2	-
Ruetten et al[30]	27	-	01	-	0%	-	-	-
Lykissas et al[31]	295 ± 180	-	-	-	135%	-	-	-
Grimm et al[32]	122	-	181	-	20%	-	3.0	-
Tohmeh et al[33]	-	-	-	-	48%	-	-	-
Berjano et al[34]	-	-	-	-	16%	-	-	-
Lee et al[26]	52 ± 19	-	01	-	19%	-	-	-
Marchi et al[35]	73 ± 31	-	< 50	-	29%	-	-	-
Sharma et al[36]	-	-	-	-	70%	-	-	-
Pimenta et al[25]	130	-	-	-	28%	-	1.4	-
Ahmadian et al[37]	-	-	94	-	-	-	3.5	-
Caputo et al[38]	-	-	-	-	2	-	-	-
Malham et al[39]	84	-	70	-	20%	-	-	-
Pimenta et al[40]	69 ± 11	-	< 50	-	13%	-	-	-
Elowitz et al[41]	-	-	-	-	20%3	-	-	-
Oliveira et al[42]	86	-	44	-	14%	-	1.2	-

¹”Non-measurable” blood loss;

²Anterior thigh numbness in “substantial percentage” of patients which resolved in all patients at 4 wk;

³Anterior thigh numbness for more than 3 wk. Hb: Hemoglobin; SD: Standard deviation; MIS: Minimally invasive.

Table 5 Studies on minimally invasive transforaminal lumbar interbody fusion

Ref.	Year	Surgery	Population	MIS patients	Open patients
RCTs/IRCTs
Wang et al[43]	2011	TLIF	LSS, herniation, spondylolisthesis	41	38
Shunwu et al[44]	2010	TLIF	Degenerative lumbar disease	32	30
Wang et al[45]	2011	TLIF	Failed discectomy and decompression	25	27
Cohort studies
Wong et al[46]	2014	TLIF	FBSS, DDD, spondylolisthesis	144	54
Zhang et al[47]	2013	TLIF	DDD	82	76
Villavicencio et al[48]	2010	TLIF	LSS, DDD ± herniation, spondylolisthesis	76	63
Lee et al[49]	2012	TLIF	LSS, DDD, herniation, spondylolisthesis	72	72
Terman et al[50]	2014	TLIF	DDD, LSS, spondylolisthesis, herniation	53	21
Cheng et al[51]	2013	TLIF	Spondylosis/listhesis, foraminal stenosis	50	25
Liang et al[52]	2011	TLIF	Degenerative lumbar instability	45	42
Yang et al[53]	2013	TLIF	Lumbar degenerative diseases	43	104
Gu et al[54]	2014	TLIF	Degenerative conditions	43	38
Wang et al[55]	2010	TLIF	Spondylolisthesis	42	43
Zairi et al[56]	2013	Mini open TLIF	DDD, spondylolisthesis	40	60
Seng et al[57]	2013	TLIF	DDD, spondylolisthesis	40	40
Pelton et al[58]	2012	TLIF	DDD, spondylolisthesis	33	33
Singh et al[59]	2014	TLIF	DDD, spondylolisthesis	33	33
Brodano et al[60]	2013	Mini open TLIF	DDD, spondylolisthesis	30	34
Zou et al[61]	2013	TLIF	LSS, spondylolisthesis, herniation	30	30
1Peng et al[62]	2009	TLIF	DDD, spondylolisthesis	29	29
Archavlis et al[63]	2013	TLIF	SDS and severe FJO	24	25
Dhall et al[64]	2008	Mini open TLIF	DDD, spondylolisthesis	21	21
Schizas et al[65]	2009	TLIF	DDD, spondylolisthesis	18	18
Adogwa et al[66]	2011	TLIF	Grade I spondylolithesis	15	15
Niesche et al[67]	2014	TLIF	Recurrent lumbar disc herniation	14	19
Lau et al[68]	2011	TLIF	Spondylosis/listhesis/lysis	10	12

¹Differences in indications for study and control groups. LSS: Lumbar spinal stenosis; FBSS: Failed back surgery syndrome; DDD: Degenerative disc disease; SDS: Severe degenerative stenosis; FJO: Facet joint arthropathy; MIS: Minimally invasive; TLIF: Transforaminal lumbar interbody fusion; RCT: Randomized controlled trial; IRCT: Incomplete randomized controlled trial.

Table 6 Studies comparing perioperative outcomes of minimally invasive vs open transforaminal lumbar interbody fusion

Ref.	Length of surgery (min) ± SD		Estimated blood loss (cc) ± SD		Neurologic complications		Length of stay (d) ± SD
	MIS	Open	MIS	Open	MIS	Open	MIS	Open
RCTs/IRCTs
Wang et al[43]	168.7 ± 36.4	145.0 ± 26.8	207.7 ± 57.6	258.9 ± 122.2	2%	0%	6.4 ± 2.5	8.7 ± 2.1
Shunwu et al[44]	159.2 ± 21.7	142.8 ± 22.5	399.8 ± 125.8	517.0 ± 147.8	0%	0%	9.3 ± 2.6	12.5 ± 1.8
Wang et al[45]	139.0 ± 27.0	143.0 ± 35.0	291.0 ± 86.0	652.0 ± 150.0	12%	19%	-	-
Cohort studies
Wong et al[46]	173	309	115	485	12%	13%	2.8	4.4
Zhang et al[47]	120 ± 35	115 ± 28	250 ± 75	650 ± 150	0%	3%	-	-
Villavicencio et al[48]	223 ± 68	215 ± 60	163 ± 131	367 ± 298	11%	13%	3.0 ± 2.3	4.2 ± 3.5
Lee et al[49]	166 ± 52	182 ± 45	161 ± 51	447 ± 519	1%	0%	3.2 ± 2.9	6.8 ± 3.4
Terman et al[50]	-	-	100	450	-	-	2.0	3.0
Cheng et al[51]	245 ± 73	279 ± 15	393 ± 284	536 ± 324	0%	12%	4.8 ± 1.8	6.1 ± 1.8
Liang et al[52]	127 ± 60	96 ± 46	194 ± 86	357 ± 116	-	-	-	-
Yang et al[53]	175 ± 35	177 ± 30	362 ± 177	720 ± 171	7%	2%	4.0 ± 1.3	7.1 ± 1.0
Gu et al[54]	196 ± 28	187 ± 23	248 ± 94	576 ± 176	5%	3%	9.3 ± 3.7	12.1 ± 3.6
Wang et al[55]	145 ± 27	156 ± 32	264 ± 89	673 ± 145	10%	7%	10.6 ± 2.5	14.6 ± 3.8
Zairi et al[56]	170	186	148	486	3%	3%	4.5	5.5
Seng et al[57]	185 ± 9	166 ± 7	127 ± 46	405 ± 80	-	-	-	-
Pelton et al[58]	112 ± 33	185 ± 34	125 ± 76	275 ± 99	-	-	2.0 ± 0.7	3.0 ± 1.1
Singh et al[59]	116 ± 28	186 ± 31	124 ± 92	380 ± 191	-	-	2.3 ± 1.2	2.9 ± 1.1
Brodano et al[60]	144	102	230	620	3%	9%	4.1	7.4
Zou et al[61]	150 ± 41	175 ± 37	131 ± 74	318 ± 177	0%	0%	7.5 ± 2.7	9.3 ± 4.2
Peng et al[62]	216	171	150	681	-	-	4.0	6.7
Archavlis et al[63]	220 ± 48	190 ± 65	185 ± 140	255 ± 468	13%	4%	7.0	11.0
Dhall et al[64]	199	237	194	505	0%	5%	3.0	5.5
Schizas et al[65]	-	-	456	961	17%	6%	6.1	8.2
Adogwa et al[66]	300	210	200	295	0%	0%	3.0	5.0
Niesche et al[67]	140	130	150	380	0%	11%	5.0	10.0
Lau et al[68]	390	365	467	566	0%	0%	5.0	6.2

RCT: Randomized controlled trial; IRCT: Incomplete randomized controlled trial; SD: Standard deviation; MIS: Minimally invasive.