Long-Term Outcomes of Minimally Invasive vs. Traditional Open Spinal Fusion: A Comparative Analysis

Spinal fusion is a widely performed surgical intervention for managing degenerative spinal conditions, instability, and deformities. Traditionally, open spinal fusion has been the standard approach, offering direct visualization and access to spinal structures. However, advancements in surgical techniques have led to the development of minimally invasive spinal fusion (MISF) as an alternative, aiming to achieve comparable clinical outcomes while reducing surgical trauma, postoperative pain, and recovery time. Despite these advantages, concerns remain regarding the long-term effectiveness of MISF, particularly in terms of fusion rates, complication risks, and adjacent segment disease (ASD). This review critically examines the long-term outcomes of MISF compared to traditional open fusion, focusing on key factors such as perioperative outcomes, pain relief, functional recovery, fusion success rates, and cost-effectiveness. Perioperative data indicate that MISF is associated with reduced blood loss, shorter hospital stays, and lower infection rates but may involve longer surgical times and a steeper learning curve. Long-term clinical outcomes appear comparable between MISF and open fusion, with both techniques achieving high fusion rates and significant improvements in pain and function. However, the impact of MISF on adjacent segment disease remains inconclusive, with conflicting evidence regarding its potential biomechanical advantages. Cost-effectiveness analyses suggest that MISF may offer financial advantages in the long term by reducing hospitalization and rehabilitation expenses, despite higher initial surgical costs. Nonetheless, limitations in current research, including variability in study methodologies, patient selection, and surgeon expertise, necessitate further high-quality, long-term randomized controlled trials. This review synthesizes the current literature on MISF and traditional open fusion, identifies existing research gaps, and outlines future directions for optimizing surgical decision-making and improving patient outcomes.