Gutierrez Yolanda V, Martin Blake, Nwose Joshua, Sepulveda Alyssa L, Shaju Ronald A, Ahmad Aamir, Ablove Robert
Orthopedics, University of Texas Rio Grande Valley, Edinburg, USA.
Medicine, University of Texas Rio Grande Valley, Edinburg, USA.
Cureus. 2025 Jul 25;17(7):e88723. doi: 10.7759/cureus.88723. eCollection 2025 Jul.
Degenerative spondylolisthesis is a common etiology of low back pain characterized by the anterior displacement of one vertebral body relative to the one below it. A key contributing factor is intervertebral disc degeneration, which compromises spinal stability. In patients with a lack of neurological issues, conservative treatment is recommended. If conservative treatment is ineffective, surgery is deemed the next step, involving decompression and fusion of the vertebrae. Over the past several decades, minimally invasive surgical (MIS) techniques have been developed and refined. This systematic review aims to compare different types of MIS techniques for the treatment of degenerative spondylolisthesis to determine the advantages and disadvantages of each. We searched PubMed and manually screened The Global Spine Journal and The Journal of Orthopaedic Surgery and Research using Boolean operators to identify studies published from 2015 to 2025. Inclusion criteria encompassed retrospective cohorts, randomized controlled trials, and comparative studies of patients with degenerative spondylolisthesis. Risk of bias was qualitatively assessed based on study design and reporting. Due to heterogeneity, data were synthesized descriptively. A total of 302 studies were initially identified; only 13 met the inclusion criteria. A total of 714 patients were included in the review. The most common technique was MIS transforaminal lumbar interbody fusion (TLIF), followed by MIS OLIF. All the studies demonstrated improvement in the Oswestry Disability Index (ODI) post-operatively. Secondary outcomes such as operation time, blood loss, radiographic fusion rates, and hospital stay varied across the studies. Both MIS TLIF and MIS OLIF have demonstrated effectiveness in the surgical management of degenerative spondylolisthesis, with MIS TLIF showing favorable outcomes for single-level decompression and MIS OLIF for multilevel fusion and deformity correction. However, variability in follow-up duration, outcome reporting, and patient selection limits direct comparison. While MIS approaches may reduce perioperative morbidity compared to traditional open fusion and can be effective after failed conservative treatment, current evidence does not definitively favor one technique over the other. Further high-quality, comparative studies are needed to establish superiority in terms of long-term outcomes and complication rates.
退行性腰椎滑脱是下腰痛的常见病因，其特征是一个椎体相对于其下方椎体向前移位。一个关键的促成因素是椎间盘退变，这会损害脊柱稳定性。对于没有神经问题的患者，建议采用保守治疗。如果保守治疗无效，则认为下一步应进行手术，包括椎体减压和融合。在过去几十年中，微创外科（MIS）技术得到了发展和完善。本系统评价旨在比较不同类型的MIS技术治疗退行性腰椎滑脱的效果，以确定每种技术的优缺点。我们检索了PubMed，并使用布尔运算符手动筛选了《全球脊柱杂志》和《骨科手术与研究杂志》，以识别2015年至2025年发表的研究。纳入标准包括回顾性队列研究、随机对照试验以及对退行性腰椎滑脱患者的比较研究。基于研究设计和报告对偏倚风险进行定性评估。由于存在异质性，数据采用描述性合成。最初共识别出302项研究；只有13项符合纳入标准。本评价共纳入714例患者。最常用的技术是MIS经椎间孔腰椎椎体间融合术（TLIF），其次是MIS斜外侧腰椎椎间融合术（OLIF）。所有研究均显示术后奥斯威斯利功能障碍指数（ODI）有所改善。手术时间、失血量、影像学融合率和住院时间等次要结果在不同研究中有所不同。MIS TLIF和MIS OLIF在退行性腰椎滑脱的手术治疗中均显示出有效性，MIS TLIF在单节段减压方面显示出良好效果，MIS OLIF在多节段融合和畸形矫正方面显示出良好效果。然而，随访时间、结果报告和患者选择的差异限制了直接比较。虽然与传统开放融合相比，MIS方法可能会降低围手术期发病率，并且在保守治疗失败后可能有效，但目前的证据并没有明确表明一种技术优于另一种技术。需要进一步开展高质量的比较研究，以确定在长期结果和并发症发生率方面的优势。
