Related Experiment Video
Updated: Mar 16, 2026
Novel Mini-open Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal
Lei Xie1, Wen-Jian Wu1, Yu Liang1
1Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025; Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Background:
The previous studies agree that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures.
Methods:
Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database (the literature search comprised Medical Subject Heading terms and key words or Emtree term). The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios (RR s) and weighted mean differences (WMDs) with 95% confidence intervals were calculated for the clinical outcomes and perioperative data.
Results:
Twenty-four studies (n = 1967 patients) were included in this review (n = 951, open-TLIF, n = 1016, MIS-TLIF). MIS-TLIF was associated with a significant decrease in the visual analog score (VAS)-back pain score (WMD = -0.44; P = 0.001), Oswestry Disabilities Index (WMD = -1.57; P = 0.005), early ambulation (WMD = -1.77; P = 0.0001), less blood loss (WMD = -265.59; P < 0.00001), and a shorter hospital stay (WMD = -1.89; P < 0.0001). However, there were no significant differences in the fusion rate (RR = 0.99; P = 0.34), VAS-leg pain (WMD = -0.10; P = 0.26), complication rate (RR = 0.84; P = 0.35), operation time (WMD = -5.23; P = 0.82), or reoperation rate (RR = 0.73; P = 0.32).
Conclusions:
MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.
Insights
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) offers better functional outcomes, reduced blood loss, and shorter hospital stays compared to open-TLIF. This approach does not increase complication or reoperation rates, making it a favorable surgical option.
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is increasingly compared to open-TLIF.
- Previous studies suggest MIS-TLIF may offer advantages in functional outcomes, blood loss, and hospital stay.
- Limited high-quality evidence necessitates further meta-analysis to definitively compare these procedures.
Purpose of the Study:
- To conduct a meta-analysis comparing clinical outcomes and perioperative data between open-TLIF and MIS-TLIF.
- To evaluate functional outcomes, blood loss, operative time, complication rates, and reoperation rates.
- To provide higher-grade evidence for surgical decision-making in lumbar interbody fusion.
Main Methods:
- Systematic literature search of Medline, Embase, Web of Science, CNKI, Wanfang, and VIP databases.
- Inclusion of prospective and retrospective studies comparing open-TLIF and MIS-TLIF published up to January 2015.
- Calculation of pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals for various outcomes.
Main Results:
- MIS-TLIF demonstrated significant improvements in VAS-back pain, Oswestry Disabilities Index, early ambulation, blood loss, and hospital stay.
- No significant differences were found in fusion rate, VAS-leg pain, complication rate, operation time, or reoperation rate.
- Analysis included 24 studies with a total of 1967 patients (951 open-TLIF, 1016 MIS-TLIF).
Conclusions:
- MIS-TLIF provides comparable fusion rates to open-TLIF.
- MIS-TLIF is associated with superior functional outcomes, reduced blood loss, and shorter hospital stays.
- The evidence suggests MIS-TLIF does not elevate complication or reoperation rates compared to open-TLIF.
