Objective:

The purpose of this study is to compare fusion rate, clinical outcomes, complications among transforaminal lumbar interbody fusion (TLIF), and other techniques for lumbar spine diseases.

Design:

This is a systematic review and meta-analysis.

Data sources:

PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases were searched from January 2013 through December 2019.

Eligibility criteria for selecting studies:

Randomized controlled trials (RCTs) that compare lumbar interbody fusion with posterolateral fusion (PLF) and/or other lumbar interbody fusion were included for the review.

Data extraction and synthesis:

Two independent reviewers extracted relevant data and assessed the risk of bias. Meta-analysis was performed using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complications in TLIF and other techniques for lumbar spinal diseases.

Results:

Of 3,682 potential studies, 15 RCTs (915 patients) were included in the meta-analysis. Compared to other surgical techniques, TLIF had slightly lower fusion rate [RR = 0.84 (95% CI = 0.72-0.97), p = 0.02, I ² = 0.0%] at 1-year follow-up whereas there was no difference on fusion rate at 2-year follow-up [RR = 1.06 (95% CI = 0.96-1.18), p = 0.27, I ² = 69.0%]. The estimated RR of total adverse events [RR = 0.90 (95% CI = 0.59-1.38), p = 0.63, I ² = 0.0%] was similar to no fusion, PLF, PLIF, and XLIF groups, and revision rate [RR = 0.78 (95% CI = 0.34-1.79), p = 0.56, I ² = 39.0%] was similar to PLF and XLIF groups. TLIF had approximately half an hour more operative time than other techniques (no fusion, ALIF, PLF, PLIF, XLIF) [MD = 31.88 (95% CI = 5.33-58.44), p = 0.02, I ² = 92.0%]. There was no significant difference between TLIF and other techniques in terms of blood loss (no fusion, PLIF, PLF) and clinical outcomes (PLF).

Conclusions:

Besides fusion rate at 1-year follow-up and operative time, TLIF has a similar fusion rate, clinical outcomes, parameters concerning operation and complications to no fusion, PLF, and other interbody fusion (PLIF, ALIF, XLIF).

Systematic review registration:

https://www.crd.york.ac.uk/prospero/, identifier: CRD42020186858.