Munazzam Shahzad Waqas, Rai Vikramaditya, Asfandyar Qazi Adam, Khan Shandana, Mohammed Cara
Orthopaedic and Spine Unit, Hayatabad, Medical Complex, Hayatabad, Peshawar, Pakistan.
Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.
J Orthop Case Rep. 2025 Jan;15(1):224-234. doi: 10.13107/jocr.2025.v15.i01.5184.
In recent years, there has been a growing utilization of minimally invasive (MI) techniques, which provide the potential advantages of minimizing surgical stress, post-operative pain, and hospitalization duration. Nevertheless, the existing body of literature primarily comprises of studies conducted at a single medical site, which are of low quality and lack a comprehensive analysis of treatment techniques exclusively focused on spondylolisthesis. We conducted this systematic review and meta-analysis to compare minimally invasive surgery (MIS) and open surgery (OS) spinal fusion outcomes for the treatment of spondylolisthesis. OS spinal fusion is an interventional option for patients with spinal illness who have not had success with non-surgical treatments.
This systematic review of the literature regarding MI and OS spinal fusion for spondylolisthesis treatment was performed using the preferred reporting items for systematic reviews and meta-analysis guidelines for article identification, screening, eligibility, and inclusion. Electronic literature search of Medline/PubMed, Cochrane Library, and Google Scholar databases yielded 1078 articles. These articles were screened against established criteria for inclusion into this study.
A total of eight retrospective and four prospective articles with a total of 3354 patients were found. Reported spondylolisthesis grades were I and II only. Overall, MI was associated with lower operative time (mean difference [MD], -6.44 min; 95% confidence interval [CI], -45.57-32.71; P = 0.0001) and shorter length of hospital stay (MD, -0.49 days; 95% CI, -0.58 to -0.40; P = 0.000). There was no significant difference overall between MIS and OS in terms of functional or pain outcomes. Rates of complications were not significantly different between the MI group and the OS group, though overall 75 and 153 complications were observed in MI group and OS group.
Available data indicate that MI spinal fusion is a secure and efficient method for managing Grade I and Grade II spondylolisthesis. Furthermore, whereas prospective trials establish a connection between MI and improved functional outcomes, it is necessary to conduct longer-term and randomized trials to confirm any correlation identified in this study.
近年来，微创（MI）技术的应用越来越广泛，该技术具有将手术应激、术后疼痛和住院时间降至最低的潜在优势。然而，现有文献主要由在单一医疗地点进行的研究组成，这些研究质量较低，且缺乏对专门针对腰椎滑脱治疗技术的全面分析。我们进行了这项系统评价和荟萃分析，以比较微创脊柱手术（MIS）和开放手术（OS）治疗腰椎滑脱的融合效果。OS脊柱融合术是脊柱疾病患者非手术治疗失败后的一种干预选择。
本系统评价使用系统评价的首选报告项目和荟萃分析指南对关于MIS和OS脊柱融合治疗腰椎滑脱的文献进行识别、筛选、合格性评估和纳入。对Medline/PubMed、Cochrane图书馆和谷歌学术数据库进行电子文献检索，共获得1078篇文章。根据既定标准对这些文章进行筛选，以纳入本研究。
共找到8篇回顾性文章和4篇前瞻性文章，涉及3354例患者。报告的腰椎滑脱分级仅为I级和II级。总体而言，MIS与较短的手术时间相关（平均差值[MD]，-6.44分钟；95%置信区间[CI]，-45.57至-32.71；P = 0.0001）和较短的住院时间（MD，-0.49天；95% CI=-0.58至-0.40；P = 0.000）。在功能或疼痛结局方面，MIS和OS总体上没有显著差异。MI组和OS组的并发症发生率没有显著差异，尽管MI组和OS组分别观察到75例和153例并发症。
现有数据表明，MIS脊柱融合术是治疗I级和II级腰椎滑脱的一种安全有效的方法。此外，虽然前瞻性试验证实了MIS与改善功能结局之间的联系，但有必要进行长期随机试验，以确认本研究中发现的任何相关性。
