Surgical Outcomes After Single-Level Endoscopic Transforaminal Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis

Courtney E Stone; Brandon L Myers; Sunny Gupta; Tyler X Giles; Neal A Patel; Julian L Gendreau; Mickey E Abraham; Antonios Mammis

doi:10.7759/cureus.11052

Surgical Outcomes After Single-Level Endoscopic Transforaminal Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis

Cureus. 2020 Oct 20;12(10):e11052. doi: 10.7759/cureus.11052.

Authors

Courtney E Stone¹, Brandon L Myers², Sunny Gupta³, Tyler X Giles⁴, Neal A Patel¹, Julian L Gendreau⁵, Mickey E Abraham⁶, Antonios Mammis⁷

Affiliations

¹ Neurological Surgery, Mercer University School of Medicine, Savannah, USA.
² Anesthesia, Eisenhower Army Medical Center, Fort Gordon, USA.
³ Public Health, Emory University School of Medicine - Rollins School of Public Health, Atlanta, USA.
⁴ Neurological Surgery, Mercer University School of Medicine, Macon, USA.
⁵ Medicine, Eisenhower Army Medical Center, Fort Gordon, USA.
⁶ Neurological Surgery, University of California, San Diego, USA.
⁷ Neurological Surgery, Rutgers New Jersey Medical School, Newark, USA.

Abstract

Background and objective Novel surgical advancements have introduced endoscopic operative techniques for low back surgery, including transforaminal lumbar interbody fusion (TLIF), which theoretically allows for improved decompression with minimal invasiveness. In addition, endoscopically performed TLIF has allowed for the use of local anesthesia as an alternative method to general anesthesia for patients. We aimed to evaluate the clinical outcomes in patients undergoing endoscopic TLIF and also compare the outcomes in patients undergoing general versus local anesthesia. Methods The databases of PubMed, Medline, Embase, and the Cochrane Library were queried for all studies involving patients undergoing endoscopic TLIF. After the extraction of the data and assessment of study quality via the Newcastle-Ottawa Scale, statistical analysis was performed with the R software (The R Foundation, Vienna, Austria) metafor package. The random-effects model was used as the data was largely heterogeneous (I²>50%). Results In total, 15 studies involving a total of 441 patients were selected for the final quantitative meta-analysis. The overall mean difference between the postoperative visual analog scale (VAS) leg scores and preoperative VAS scores was 3.45 (95% CI: 4.93-1.97, p: <0.01). Postoperative VAS low back scores revealed a mean difference of 3.36 (95% CI: 5.09-1.63, p: <0.01). The overall mean difference of ODI scores was 4.58 (95% CI: 6.76-2.40, p: <0.01). Mean blood loss was 136.32 mL and the mean operative time was 149.15 minutes. The mean length of stay postoperatively was lower in the local anesthesia group compared to the general anesthesia group (1.40 vs 5.99 days respectively). There were no outcome variables of patients undergoing general anesthesia versus local anesthesia that showed statistically significant differences in this analysis due to the small amount of data published on patients undergoing endoscopic TLIF with local anesthesia. In addition, the failure of studies in reporting standard deviations as data parameters further limited the quantitative analysis. Conclusion Endoscopic TLIF appears to be a viable option for patients undergoing lumbar interbody fusion. Initial data reveal that endoscopic TLIF with local anesthesia may offer patients outcomes similar to those in patients undergoing endoscopic TLIF with general anesthesia, with lower operative times and length of stay.

Keywords: endoscopic; eras protocols; fusion; general anesthesia; interbody; local anesthesia; lumbar; minimally-invasive spine; tlif; transforaminal.