Table 1.
Characteristics of the include trials
| Characteristics | Wong et al.[25] | Sulaiman and Singh[30] | Tian et al.[31] | Singh et al.[18] | Zheng et al.[32] | Chu et al.[36] |
|---|---|---|---|---|---|---|
| Year of publication | 2014 | 2014 | 2014 | 2014 | 2014 | 2014 |
| Study design | Prospective cohort | Retrospective cohort | Retrospective cohort | Retrospective cohort | Retrospective cohort | Retrospective cohort |
| Class of evidence* | III | III | III | III | III | III |
| Number of enrolled patient (MIS:open) | 198 (144:54) | 68 (57:11) | 61 (30:31) | 66 (33:33) | 48 (22:26) | 51 (15:36) |
| Mean follow-up time (months; MIS:open) | 45.0:46.0 | 24:24 | 25.63:25.63 | 6.0:6.0 | 12:12 | 13.6:13.6 |
| Follow-up rate (%, months) (MIS:open) | 100:100 (33) NR (>33) | 100:100 (12) NR (>12) | 100:100 (24) NR (>24) | 100:100 (6) | 100:100 (6) NR (>6) | 100:100 (6) NR (>6) |
| Mean age (years, MIS:open) | 61.0:58.0 | 61.1:56.4 | 48.21:48.90 | 51.7:49.9 | 49.4:50.7 | 53:53 |
| Gender (% male; MIS:open) | 42.4:46.3 | 30:36 | 53:74 | 69.7:63.6 | 31.8:42.3 | 66.7:66.7 |
| Diagnosis (MIS:open) | ||||||
| DDD | 27:10 | 27:25 | 19:9 | 22:21 | 15:36 | |
| Spondylolisthesis | 66:25 | 57:11 | 3:6 | 6:9 | 0:5 | |
| Others | 51:24 | 8:5 | ||||
| Inclusion/exclusion criteria | NR | Inclusion Evidence on magnetic resonance imaging of Grades I or II degenerative lumbar spondylolisthesis; Mechanical low back pain and radicular leg symptoms Lack of response to at least 6 weeks of conservative therapy Age 18–80 years Exclusion Patient had an active medical or worker’s compensation lawsuit or any pre-existing spinal pathology |
Inclusion Symptomatic degenerative disease of the lumbosacral spine (L2 to S1) No response to nonoperative treatments for 6 months Single-level involvement Exclusion Age <18 years or >65 years Previous lumbar surgery Osteoporosis spinal trauma or infections |
Inclusion Diagnosis of either lumbar DDD, degenerative spondylolisthesis, or spinal stenosis; Patients had failed conservative management, including medications, a minimum of 6 weeks of physical therapy, and epidural injections when indicated Exclusion Patients requiring 2 or more levels of fusion Who were undergoing revision surgeries |
Inclusion Symptomatic and refractory to prior conservative treatment for low back pain with or without unilateral leg pain Single-level DDD or degenerative I grade spondylolisthesis; Lack of response to at least 12 weeks of conservative therapy Exclusion Patients associated with previous spinal surgery, lumbar fracture, active infection, tumor, malformation Patients who have severe adjacent segment degeneration |
Inclusion Patients need to have evidence on magnetic resonance imaging of lumbar DDD, degenerative Have mechanical low back pain and radicular symptoms Unresponsive to at least 12 weeks of conservative therapy At least 6 months of follow-up Exclusion NR |
| Clinical outcome | OPT, MBL, LOS, complications, VAS, ODI, fusion rate | OPT, MBL, LOS, complications, VAS, ODI | OPT, MBL, LOS, complications, VAS, ODI, fusion rate, ambulation time | ORT, MBL, LOS, VAS | OPT, MBL, complications, VAS, ODI, JOA, fusion rate | OPT, MBL, LOS, complications, VAS, ODI, fusion rate |
| Definition fusion/evaluation measure | NR/dynamic flexion- extension lumbar radiographs in conjunction with a CT scan within the 16–24 months | NR | Grades I or II (Bridwell interbody fusion grading system)/radiographs (antero-posterior and lateral images) were employed to affirm the fusion rates and CT scans at 24 months | NR | Trabecular bony bridges between contiguous vertebral bodies at the instrumented levels, and <4° segmental movement/dynamic flexion-extension lumbar radiographs in conjunction with a CT scan within the 24 months | Trabecular bony bridges between contiguous vertebral bodies at the instrumented levels, and <4° segmental movement/dynamic flexion-extension lumbar radiographs |
| Surgical information | ||||||
| Number of segments treated | One (79:35) Two (55:21) | One (45:2) Two (12:9) | One (30:30) | One (33:33) | One (22:26) | One (15:36) |
| Level of fusion | ||||||
| L4–L5 | 62:14 | 37:8 | 14:17 | NR | 11:15 | NR |
| L5 to S1 | 65:21 | 12:9 | 14:13 | 11:10 | ||
| Others | 17:9 | 2:4 | 2:1 | 0:1 | ||
| Interbody device | PEEK cage | PEEK cage | PEEK/titanium cage | Cage | PEEK cage | Cage |
| Graft use | Autologous | Autologous | Autologous | Autologous | Autologous | Autologous |
| Screw use | Bilateral | Bilateral | Bilateral | Bilateral (O) | Bilateral | Bilateral |
| Unilateral (MI) | ||||||
| Characteristics | Parker et al.[17] | Saetia et al.[29] | Gu et al.[28] | Brodano et al.[27] | Zairi et al.[26] | Lau et al.[14] |
| Year of publication | 2013 | 2013 | 2013 | 2013 | 2013 | 2013 |
| Study design | Prospective cohort | Retrospective cohort | Prospective cohort | Retrospective cohort | Retrospective cohort | Retrospective cohort |
| Class of evidence* | II | III | III | III | III | III |
| Number of enrolled patient (MIS:open) | 100 (50:50) | 24 (12:12) | 82 (44:38) | 64 (30:34) | 100 (40:60) | 127 (78:49) |
| Mean follow-up time (months; MIS:open) | 24:24 | 28:28 | 20.6:20.0 | 23:25 | 27.0:30.0 | NR |
| Follow-up rate (%, months) (MIS:open) | 100:100 (24) | 100:100 (24) NR (>24) | 100:100 (16) NR (>16) | 100:100 (12) NR (>12) | 100:100 (24) NR (>24) | NR |
| Mean age (years, MIS:open) | 53.5:52.6 | 63.10:67.40 | 66.4:64.1 | 46:51 | 49:48 | 54.1:52.5 |
| Gender (% male; MIS:open) | 32.0:36.0 | 10:50 | 43.1:39.5 | 60:58.8 | 50:47 | 52.2:50.0 |
| Diagnosis (MIS:open) | ||||||
| DDD | 15:11 | 30:34 | 18:25 | 12:14 | ||
| Spondylolisthesis | 50:50 | 12:12 | 22:35 | 11:24 | ||
| Others | 29:27 | |||||
| Inclusion/exclusion criteria | Inclusion Patients need to have evidence on magnetic resonance imaging of Grade I degenerative lumbar spondylolisthesis; Have mechanical low back pain and radicular symptoms Unresponsive to at least 6 weeks of conservative therapy Age 18–70 years Exclusion Undergone a previous back operation An extraspinal cause of back pain or sciatica An active medical or workman’s compensation lawsuit Any pre-existing spinal pathology Unwilling or unable to participate with follow-up procedures |
Inclusion Patients were Grades I or II spondylolisthesis presenting with mechanical low back pain, radiculopathy, and/or neurogenic claudication Preoperative evaluation with static (antero-posterior and lateral) and dynamic (flexion- extension) plain L-S spine radiography and MRI Patients had failed conservative management (minimum 6 months) before surgery Exclusion NR |
Inclusion: Two-level fusions were needed between L3 and S1 Persistent or recurrent low back pain or leg pain lasting at least 6 months and resulting in a significant reduction of quality of life, despite conservative therapy, including physical therapy and pain management Segmental instability was >4 mm of translation or 10 of angular motion on preoperative flexion-extension radiographs Exclusion Patients associated with previous spinal surgery, lumbar fracture, active infection, severe osteoporosis, and severe obesity Combination of coronal and/or sagittal deformities that needed a surgical correction Degenerative spondylolisthesis with major instability or isthmic spondylolisthesis Any major psychological problem |
Inclusion Symptomatic and refractory to prior conservative treatment low back pain with or without unilateral leg pain Single-level DDD or degenerative I grade spondylolisthesis documented with both X-Ray and MRI of the lumbar spine Minimum follow-up period after operation 6 months Exclusion: Patients with DDD or degenerative spondylolisthesis at more than one level Patients with spinal stenosis with neurogenic claudication or bilateral leg pain Patients with isthmic spondylolisthesis Patients with <12 months follow-up Patients who had previously undergone spinal surgery |
Inclusion Patients who underwent single-level TLIF for DDD or degenerative low-grade (1 or 2) spondylolisthesis Exclusion Patients who underwent a multi-level TLIF and the patients with a history of lumbar arthrodesis |
Inclusion NR Exclusion Age <18 years BMI <30.0 kg/m2 TLIF of >1 level Patients who have undergone additional spinal instrumentation Patients who have undergone posterior fusion beyond 1 vertebra above and below the site of TLIF |
| Clinical outcome | OPT, MBL, LOS, complications, VAS, ODI, SF-12, QALY, EQ-5D | OPT, MBL, LOS, complications, VAS, ODI, fusion rate | OPT, MBL, LOS, complications, VAS, ODI, fusion rate | OPT, MBL, LOS, complications, VAS, ODI, fusion rate | OPT, MBL, LOS, complications, VAS, ODI, fusion rate | MBL, LOS, complications |
| Definition fusion/evaluation measure | NR | Grades I or II (Bridwell interbody fusion grading System)/plain film and CT of the L-S spine at 24 months | Grades I or II (Bridwell interbody fusion grading system)/radiographs (AP and lateral images) at 12 months | NR/posterior-anterior and lateral view as well as dynamic X-rays of the lumbar spine (max flexion - max extension) at 12 months | Bony bridging anterior to the cage and bony continuity between the two endplates through the cage/CT scan at 12 months | NR |
| Surgical information | ||||||
| Number of segments treated | One (50:50) | One (12:12) | Two (44:38) | One (30:34) | One (40:60) | One (23:38) |
| Level of fusion | ||||||
| L4–L5 | 32:30 | 11:7 | 23:24 7:10 | NR | 9:17 8:17 6:4 | |
| L5 to S1 | 14:17 | 1:3 | ||||
| Others | 4:3 | 0:2 | 44:38 | |||
| Interbody device | Cage | Cage | PEEK cage | PEEK cage | PEEK cage | PEEK cage |
| Graft use | Autologous | Autologous | Autologous | Autologous | Autologous (30) BCP (30 + 40) | Autologous |
| Screw use | Bilateral | Bilateral | Bilateral | Unilateral | Bilateral | Bilateral |
| Characteristics | Rodríguez-Vela et al.[19] | Yang et al.[33] | Lee et al.[16] | Lau et al.[15] | Wang et al[34] | Liang et al.[35] |
| Year of publication | 2013 | 2013 | 2012 | 2011 | 2011 | 2011 |
| Study design | Prospective cohort | Retrospective cohort | Prospective cohort | Retrospective cohort | Randomized controlled trial | Retrospective cohort |
| Class of evidence* | III | III | II | III | I | III |
| Number of enrolled patient (MIS:open) | 41 (21:20) | 147 (43:104) | 144 (72:72) | 22 (10:12) | 79 (41:38) | 87 (42:45) |
| Mean follow-up time (months; MIS:open) | 45.0:45.0 | 21:23 | 24.0:24.0 | 15.2:12.6 | 32.7:32.7 | 33.6:34.8 |
| Follow-up rate (%, months) (MIS:open) | 100:100 (36) NR (>36) | 100:100 (18) NR (>18) | 95.8:100 (6) 95.8:91.7 (24) | 100:100 (12) NR (>12) | 100:100 (24) NR (>24) | 100:100 (26) NR (>26) |
| Mean age (years, MIS:open) | 41.81:43.15 | 55:52 | 52.2:56.6 | 46.9:56.9 | 51.4:57.3 | 49.8:51.3 |
| Gender (% male; MIS:open) | 66.7:65.0 | 34.9:35.6 | 27.8:30.6 | 40.0:42.0 | 65.9:60.5 | 54.8:57.8 |
| Diagnosis (MIS:open) | ||||||
| DDD | 21:20 | 23:52 | NR | 5:6 | 30:24 11:14 | 42:45 |
| Spondylolisthesis | 20:52 | 4:6 | ||||
| Others | 1:0 | |||||
| Inclusion/exclusion criteria | Inclusion Patients without previous medical conditions, who underwent a one-level TLIF 6 months of failed nonoperative treatment or neurologic deficit progression DDD Exclusion: Patients with lumbar stenosis or isthmic spondylolisthesis |
Inclusion Diagnosis of either lumbar DDD, degenerative spondylolisthesis, or spinal stenosis No response to nonoperative treatments for 3 months Patients had clinic dates with at least 18 months of follow-up |
Inclusion Single-level TLIF (open or MIS) MIS cases utilizing sextant ITM (Medtronic, MN) pedicle screw-rod instrumentation and capstone (Medtronic MN) interbody cage Exclusion Previous spinal instrumentation |
NR | Inclusion Unilateral or bilateral lower limb pain, numbness, or symptoms of intermittent claudication, with or without significant low back pain Imaging studies showing single-level lumbar disc herniation, spinal stenosis, or spondylolisthesis 6 months of regular conservative treatment without relief of symptoms Informed consent |
Inclusion Diagnosis of either lumbar DDD, degenerative spondylolisthesis, or spinal stenosis Imaging studies showing single-level lumbar disc herniation, spinal stenosis or spondylolisthesis |
| Previous lumbar spine surgery (except single discectomy) Presence of MRI degenerative changes in other lumbar levels | Exclusion Undergone a previous back operation Any pre-existing spinal pathology Any major psychological problem |
Tumor spinal pathologies Spinal infections Acute spinal trauma | Exclusion Multisegment lumbar disc herniation, spinal stenosis or, abnormal vertebral alignment Severe osteoporosis or other metabolic bone disease Fractured vertebra, cracked pedicle, or a congenital, isthmic or other abnormal bone structure Infection in the intervertebral space or other areas Previous surgical treatment of segmental defects Severe systemic disease which contraindicated surgery Consent not given |
Exclusion Undergone a previous back operation Any pre-existing spinal pathology Any major psychological problem |
||
| Clinical outcome | Complications, VAS, ODI, SF-36, NASS | OPT, MBL, LOS, complications, VAS, ODI, fusion rate | OPT, MBL, LOS, complications, VAS, ODI, fusion rate, SF-36, NASS, ambulation time | ORT, MBL, complications, ambulation time, postoperative drainage, pain outcome scores | OPT, MBL, LOS, complications, VAS, ODI | ORT, MBL, complications, VAS, ODI, fusion rate |
| Definition fusion/evaluation measure | NR | Fusion was defined as Brantigan–Steffee classification D or E, translation movement <2 mm and SA <5°/dynamic flexion-extension lumbar radiographs in conjunction with a CT scan within the 12 months | The fusion was defined as Grades I or II. (Bridwell interbody fusion grading system)/static and dynamic plain at 6 months and 24 months | NR | NR | NR |
| Surgical information | ||||||
| Number of segments treated | One (21:20) | One (43:104) | One (72:72) | One (9:7) Two (1:5) | One (41:38) | One (42:45) |
| Level of fusion | ||||||
| L4–L5 | NR | 24:63 | 54:49 | 5:6 | 11:15 | 21:21 |
| L5 to S1 | 17:39 | 14:17 | 4:1 | 11:10 | 16:11 | |
| Others | 2:2 | 4:6 | 1:5 | 0:1 | 5:7 | |
| Interbody device | CIO®/CAPASTONE® | Cage | PEEK/titanium cage | Cage | PEEK cage | PEEK cage |
| Graft use | Autologous | Autologous and DBM | Autologous | Autologous | Autologous | PMMA |
| Screw use | Bilateral | Bilateral | Bilateral | Bilateral | Bilateral | Bilateral |
| Characteristics | Shunwu et al.[22] | Wang et al.[24] | Villavicencio et al.[23] | Schizas et al.[21] | Dhall et al.[13] | Scheufler et al.[20] |
| Year of publication | 2010 | 2010 | 2010 | 2009 | 2008 | 2007 |
| Study design | Prospective cohort | Prospective cohort | Retrospective cohort | Prospective cohort | Retrospective cohort | Retrospective cohort |
| Class of evidence* | II | III | III | III | III | III |
| Number of enrolled patient (MIS:open) | 62 (32:30) | 85 (42:43) | 139 (76:63) | 36 (18:18) | 42 (21:21) | 94 (43:51) |
| Mean follow-up time (months; MIS:open) | 24.0:24.0 | 26.3:26.3 | 37.5:37.5 | 22.0:24.0 | 24.0:34.0 | 16.0:16.0 |
| Follow-up rate (%, months) (MIS:open) | 96:93 (24) NR (>24) |
100:100 (13) NR (>13) |
100:100 (24) NR (>24) |
100:100 (12) NR (>12) |
100:100 (>12) 38:62 (>24) 19:38 (>36) |
100:100 (16) |
| Mean age (years, MIS:open) | 51.4:52.0 | 47.9:53.2 | 50.5:58.9 | 45.5:48.1 | 53.0:53.0 | 52.6:53.4 |
| Gender (% male; MIS:open) | 56.3:46.7 | 30.1:37.2 | 38.0:45.0 | NR | NR | 45.2:47.8 |
| Diagnosis (MIS:open) | ||||||
| DDD | 14:8 | NR | 2:6 | 14:10 | 18:25 | |
| Spondylolisthesis | 5:8 | 24:22 | 15:12 | 7:11 | 33:37 | |
| Others | 3:4 | 18:21 | 1:0 | |||
| Inclusion/exclusion criteria | Inclusion One-level pathological process Patients were confirmed by antero-posterior and lateral plain radiographs, (CT) scans, and (MRI) Have low back pain, with varying degrees of radiating pain and neurologic symptoms Unresponsive or inadequate to 6 months of conservative therapy Exclusion Patients with previous spinal surgery |
Inclusion Patients with degenerative or isthmic spondylolisthesis Patients presented low back pain as their predominant complaint, with varying degrees of radiating pain, neurological complaints, or a combination of these Unresponsive to at least 3 months of conservative therapy Exclusion NR |
Inclusion At least 24 months of follow-up Patients were confirmed by antero-posterior and lateral plain radiographs, (CT) scans, and (MRI) Unresponsive to at least 6 months of conservative therapy; unless their symptoms were progressive or existed in conjunction with major spinal instability confirmed in imaging studies Exclusion NR |
NR | Inclusion Single-level DDD or degenerative Grade I spondylolisthesis Exclusion NR Inclusion Single-level DDD or degenerative Grade I spondylolisthesis Exclusion NR |
Inclusion Patients presented with either axial back pain, neurogenic claudication, radiculopathy, pseudoradicular pain, or a combination of these Unresponsive to at least 3 months of conservative therapy Exclusion NR |
| Clinical outcome | OPT, MBL, LOS, complications, VAS, ODI, fusion rate, ambulation time, postoperative drainage | OPT, MBL, LOS, complications, VAS, ODI, fusion rate | OPT, MBL, LOS, complications, VAS, fusion rate, MacNab’s criteria | OPT, MBL, LOS, complications, VAS, ODI, fusion rate | OPT, MBL, LOS, complications, fusion rate, mPS scores | OPT, MBL, VAS, fusion rate, Roland-Morris low back pain, AAOS-lumbar spine questionnaire |
| Definition fusion/evaluation measure | Bony trabeculation crossed the cages or endplate interfaces/CT scans at 6 months | Trabecular bony bridges between contiguous vertebral bodies at the instrumented levels, and <4° segmental movement/static and dynamic plain X-rays at 6 months | Trabecular bone bridging on the CT scans and less than a 5° difference in angular motion between flexion and extension, and/or no radiolucency lines >2 mm in thickness covering more than 50% of the superior or inferior surface of the grafts on the plain radiographs/CT scans or plain radiographs | NR/CT scans at 12 months | NR/dynamic radiographs and with CT scans in questionable cases at 12 months | Formation of trabecular bony bridges between contiguous vertebral bodies at the instrumented levels/2-mm thin-slice CT scans at 16 months |
| Surgical information | ||||||
| Number of segments treated | One (32:30) | One (42:43) | One (47:57) Two (16:19) | NR | One (21:21) | One (43:51) |
| Level of fusion | ||||||
| L4–L5 | 20 : 16 | 21 : 23 | NR | NR | NR | |
| L5 to S1 | 11 : 12 | 18 : 17 | 12 : 11 | |||
| Others | 1 : 2 | 3 : 3 | ||||
| Interbody device | Titanium cage | PEEK cage | Structural allograft | PEEK cage | Cage | PEEK cage |
| Graft use | Autologous | Autologous | Autologous | Autologous | Autologous | Autologous |
| Screw use | Bilateral | Bilateral | Bilateral | Bilateral | Bilateral | Bilateral |
*Class of evidence was assessed by Oxford Centre for Evidence-based Medicine-Levels of Evidence (March 2009). MIS: Minimally invasive surgery; Open:open surgery; CT: Computed tomography; MRI: Magnetic resonance imaging; BCP: Biphasic calcium phosphate; PEEK: Polyether ether ketone; DBM: Demineralized bone matrix; PM: Polymethyl methacrylic; OPT: Operation time; MBL: Mean blood loss; LOS: Length of hospital stay; VAS: Visual analog score; ODI: Oswestry Disabilities Index; SF-36: Short Form 36 Health Survey; SF-12: Short Form 12 Health Survey; NASS: North American Spine Society; EQ-5D: EuroQol-5D; AAOS: American Academy of Orthopedic Surgeons; mPS: Modified Prolo Scale; NR: Not report; DDD: Degenerative disc disease; JOA: Japanese Orthopaedic Association Scores; L-S: Lumbo-sacral; TLIF: Transforaminal lumbar interbody fusion.