Comparative evaluation of the efficacy and safety of PE-TLIF and MIS-TLIF in single segment spinal degenerative disease: a meta-analysis of cohort studies.

BACKGROUND

Percutaneous endoscopic transforaminal luminal interbody fusion (PE-TLIF) and minimally invasive transforaminal luminal interbody fusion (MIS-TLIF) are commonly employed minimally invasive surgical approaches for lumbar degenerative disease. The aim of this study is to compare the efficacy and safety of the two surgical methods.

OBJECTIVES

To compare the clinical and perioperative outcomes of PE-TLIF versus MIS-TLIF.

METHODS

We searched the Cochrane Library using (MIS-TLIF) AND ((PE-TLIF) OR (P-TLIF)) OR (Endo TLIF) as the search term, Embase, PubMed, and China National Knowledge Infrastructure databases from database establishment to February 15, 2025, and select literature with single segment surgery as the surgical approach. We conducted a meta-analysis and systematic review of Visual Analog Scale (VAS), Oswestry Disability Index (ODI), surgical duration, hospital stay, evidence of complications, and intra-operative blood loss for the back and legs.

RESULTS

Fourteen studies involving 1102 patients were included. Compared with MIS-TLIF, PE-TLIF showed lower VAS scores for back pain at 3 months postoperatively [SMD = -0.45, 95 %CI(-0.56, -0.34), P < 0.00001] and 12 months postoperatively [SMD = -0.16, 95 %CI (-0.30, -0.02), P = 0.02]. In the VAS (L) comparison, the two groups showed a statistically significant difference at 6 months post-surgery [SMD = -0.19, 95 %CI(-0.37, -0.01), P = 0.03]. Similarly, PE-TLIF had a lower ODI compared to MIS-TLIF only in 6 months after surgery [SMD = -1.75, 95 %CI(-2.94, -0.56), P = 0.004]. The two surgical approaches demonstrated statistically significant differences in operative time [WMD = 18.37, 95 % CI: 3.89 to 32.84, P = 0.01], intraoperative blood loss[WMD = -42.51, 95 % CI: 57.25 to -27.77, P < 0.00001], and hospital stays[WMD = -1.08, 95 % CI: 1.65 to -0.50, P = 0.0002], while showing no significant differences in complication rates[WMD = 1.12, 95 % CI: 0.67 to 1.84, P = 0.67,] and fusion rates[WMD = 0.79, 95 % CI: 0.48 to 1.31, P = 0.37].

CONCLUSIONS

hospital stay This meta-analysis indicates that PE-TLIF and MIS-TLIF each have their respective advantages. Given the limited number of high-quality studies and heterogeneity in results, further multicenter randomized controlled trials are required to confirm these findings.