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Minimally Invasive Surgery Versus Open Surgery Spinal Fusion for Spondylolisthesis: A Systematic Review and Meta-analysis

Lu, Victor M. MD; Kerezoudis, Panagiotis MD; Gilder, Hannah E. BS; McCutcheon, Brandon A. MD, MPP; Phan, Kevin BS; Bydon, Mohamad MD

doi: 10.1097/BRS.0000000000001731
Literature Review

Study Design. Systematic review and meta-analysis.

Objective. Compare minimally invasive surgery (MIS) and open surgery (OS) spinal fusion outcomes for the treatment of spondylolisthesis.

Summary of Background Data. OS spinal fusion is an interventional option for patients with spinal disease who have failed conservative therapy. During the past decade, MIS approaches have increasingly been used, with potential benefits of reduced surgical trauma, postoperative pain, and length of hospital stay. However, current literature consists of single-center, low-quality studies with no review of approaches specific to spondylolisthesis only.

Methods. This first systematic review of the literature regarding MIS and OS spinal fusion for spondylolisthesis treatment was performed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for article identification, screening, eligibility, and inclusion. Electronic literature search of Medline/PubMed, Cochrane, EMBASE, and Scopus databases yielded 2489 articles. These articles were screened against established criteria for inclusion into this study.

Results. A total of five retrospective and five prospective articles with a total of 602 patients were found. Reported spondylolisthesis grades were I and II only. Overall, MIS was associated with less intraoperative blood loss (mean difference [MD], −331.04 mL; 95% confidence interval [CI], −490.48 to −171.59; P < 0.0001) and shorter length of hospital stay (MD, −1.74 days; 95% CI, −3.04 to −0.45; P = 0.008). There was no significant difference overall between MIS and OS in terms of functional or pain outcomes. Subgroup analysis of prospective studies revealed MIS had greater operative time (MD, 19.00 minutes; 95% CI, 0.90 to 37.10; P = 0.04) and lower final functional scores (weighted MD, −1.84; 95% CI, −3.61 to −0.07; P = 0.04) compared with OS.

Conclusion. Current data suggests spinal fusion by MIS is a safe and effective approach to treat grade I and grade II spondylolisthesis. Moreover, although prospective trials associate MIS with better functional outcomes, longer-term and randomized trials are warranted to validate any association found in this study.

Level of Evidence: 2

*Department of Neurologic Surgery, Mayo Clinic, Rochester, MN

Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN

Sydney Medical School, University of Sydney, Australia.

Address correspondence and reprint requests to Mohamad Bydon, MD, Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; E-mail:

Received 5 March, 2016

Revised 13 May, 2016

Accepted 23 May, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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