Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases with a minimum follow-up of 2 years: A meta-analysis protocol

Introduction: Minimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) is a relatively new approach for fusion of the lumbar spine. It was developed in addition to traditional open transforaminal interbody fusion (OTLIF) to minimize iatrogenic soft tissue damage and prevent denervation and atrophy of the paraspinal trunk musculature. Potential disadvantages of MIS-TLIF are inadequate neural element decompression and higher risk of cage migration, resulting in persistent symptoms and a need for reoperation. Other disadvantages include inadequate visualization of bony landmarks for instrumentation, and less robust postero-lateral arthrodesis than open approaches, which may affect fusion rates. Several studies have reviewed the differences between both treatments for degenerative lumbar disease, but they mainly focused on the perioperative and short-term post-operative outcomes. Since the potential disadvantages of MIS may be expected after a longer follow-up, we performed a meta-analysis comparing MISTLIF with O-TLIF for long-term outcomes.