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Minimally invasive procedure reduces adjacent segment degeneration and disease: New benefit-based global
Xiao-Chuan Li1, Chun-Ming Huang1, Cheng-Fan Zhong1
1Department of Orthopedic Surgery, Gaozhou People's Hospital, Guangdong, China.
Objective:
Adjacent segment pathology (ASP) is a common complication presenting in patients with axial pain and dysfunction, requiring treatment or follow-up surgery. However, whether minimally invasive surgery (MIS), including MIS transforaminal / posterior lumbar interbody fusion (MIS-TLIF/PLIF) decreases the incidence rate of ASP remains unknown. The aim of this meta-analysis was to compare the incidence rate of ASP in patients undergoing MIS versus open procedures.
Methods:
This systematic review was undertaken by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We searched electronic databases, including PubMed, EMBASE, SinoMed, and the Cochrane Library, without language restrictions, to identify clinical trials comparing MIS to open procedures. The results retrieved were last updated on June 15, 2016.
Results:
Overall, 9 trials comprising 770 patients were included in the study; the quality of the studies included 4 moderate and 5 low-quality studies. The pooled data analysis demonstrated low heterogeneity between the trials and a significantly lower ASP incidence rate in patients who underwent MIS procedure, compared with those who underwent open procedure (p = 0.0001). Single-level lumbar interbody fusion was performed in 6 trials of 408 patients and we found a lower ASP incidence rate in MIS group, compared with those who underwent open surgery (p = 0.002). Moreover, the pooled data analysis showed a significant reduction in the incidence rate of adjacent segment disease (ASDis) (p = 0.0003) and adjacent segment degeneration (ASDeg) (p = 0.0002) for both procedures, favoring MIS procedure. Subgroup analyses showed no difference in follow-up durations between the procedures (p = 0.93).
Conclusion:
Therefore, we conclude that MIS-TLIF/PLIF can reduce the incidence rate of ASDis and ASDeg, compared with open surgery. Although the subgroup analysis did not indicate a difference in follow-up duration between the two procedures, larger-scale, well-designed clinical trials with extensive follow-up are needed to confirm and update the findings of this analysis.
Insights
Minimally invasive surgery (MIS), including MIS transforaminal/posterior lumbar interbody fusion (MIS-TLIF/PLIF), significantly reduces the incidence of adjacent segment pathology (ASP) compared to open procedures. This meta-analysis found lower rates of adjacent segment disease and degeneration with MIS. Further large-scale trials are recommended.
Area of Science:
- Spine surgery
- Minimally Invasive Surgery (MIS)
- Adjacent Segment Pathology (ASP)
Background:
- Adjacent segment pathology (ASP) is a frequent complication following spinal fusion, often necessitating further intervention.
- The comparative efficacy of minimally invasive surgery (MIS) versus open procedures in preventing ASP remains unclear.
Purpose of the Study:
- To conduct a meta-analysis comparing the incidence rate of adjacent segment pathology (ASP) in patients undergoing MIS versus open spinal fusion procedures.
- To evaluate the impact of MIS transforaminal/posterior lumbar interbody fusion (MIS-TLIF/PLIF) on ASP rates.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Comprehensive search of major electronic databases (PubMed, EMBASE, SinoMed, Cochrane Library) without language restrictions.
- Inclusion of 9 clinical trials with 770 patients comparing MIS and open surgical techniques.
Main Results:
- Pooled analysis of 9 trials (4 moderate, 5 low quality) revealed a significantly lower incidence of ASP in the MIS group compared to the open surgery group (p = 0.0001).
- Analysis of single-level lumbar interbody fusion (408 patients) also showed a reduced ASP incidence with MIS (p = 0.002).
- Significant reductions in adjacent segment disease (ASDis) (p = 0.0003) and adjacent segment degeneration (ASDeg) (p = 0.0002) were observed, favoring MIS procedures.
Conclusions:
- Minimally invasive surgery (MIS-TLIF/PLIF) is associated with a reduced incidence of adjacent segment disease (ASDis) and adjacent segment degeneration (ASDeg) compared to open surgery.
- While follow-up durations did not differ significantly between groups, larger, well-designed trials with extended follow-up are warranted to validate these findings.
