Comparative outcomes of minimally invasive versus open transforaminal lumbar interbody fusion for low-grade lumbar spondylolisthesis: A systematic review and meta-analysis.

BACKGROUND

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) was developed to limit the soft-tissue disruption associated with conventional open TLIF. Evidence specific to low-grade lumbar spondylolisthesis remains limited and inconsistent. We aimed to compare perioperative and patient-reported outcomes between MIS-TLIF and open TLIF in this population.

METHODS

This review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251183867). PubMed, CENTRAL (Cochrane Library), Scopus, ScienceDirect, ProQuest, and CINAHL were searched from inception to December 2025. Randomized and comparative observational studies involving adults with Meyerding grade I-II spondylolisthesis were included. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analyses were performed using the restricted maximum-likelihood estimator, and 95% prediction intervals were calculated.

RESULTS

A total of 17 studies comprising 1850 patients met the inclusion criteria. Relative to open TLIF, MIS-TLIF yielded reduced intraoperative bleeding and a shorter postoperative hospitalization, though with prolonged surgical duration. A lower complication rate was observed but was not robust to exclusion of a single influential study, after which it became non-significant. At 2 years, ODI and VAS back pain showed small differences favoring MIS-TLIF that were statistically detectable but fell below established thresholds for clinical importance and were therefore not clinically meaningful. Substantial heterogeneity was observed, and most prediction intervals crossed the null.

CONCLUSION

MIS-TLIF appears to offer perioperative advantages over open TLIF in low-grade lumbar spondylolisthesis, while longer-term patient-reported outcomes are clinically comparable, any between-group differences remaining below MCID thresholds. Given the very low certainty of evidence across all outcomes under GRADE and the predominance of observational data at moderate-to-serious risk of bias, the choice of surgical approach should be individualized.