Dados do Trabalho

Título

Systematic Revision and Meta-analysis of MIS versus OPEN surgery for degenerative lumbar surgeries

Objetivo

The aim of this work is to perform a broad systematic revision to identify the effects of minimally invasive surgery versus open surgery without restraining to a specific technique or lumbar degenerative pathology.

Metodologia

Search and Retrieval strategy
The electronic databases, including PubMed, Google Scholar, Ovid, and BVS, were systematically reviewed using the following Search strategy “(((((Minimally invasive) AND Open) AND Spine surgery) AND Degenerative)) AND Lumbar ).” Only articles in English or Portuguese were added to the review. Two authors checked all the retrieved references, and any disputes on whether to include an article were settled by mutual consensus. The step-by-step selection process is depicted as a flowchart as recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) (Figure 1). This study is registered in PROSPERO. However, it has not been evaluated due to the COVID-19 pandemic.

The results for continuous variables were presented in mean differences (MD), while dichotomous variables in odds ratios (OR). Meanwhile, inter-study heterogeneity was assessed using Cochran’s Q-statistic test, and heterogeneity between the studies included was evaluated using the chi-square test, with a < 0.05 indicating heterogeneity. In the presence of heterogeneity, the random-effects model was employed, and in the other cases, the fixed-effects model. Moreover, the publication bias was assessed using the funnel plot and the eggers regression, in which values p < 0.05 indicated publication bias. In cases of publication bias, the authors opted to use the trim-fill method of the “meta” package in R, which estimated and adjusted the meta-analysis results to account for the possible publication bias. Moreover, the authors chose to use the fixed-random model when performing the trim-fill.

Resultados

After the final screening, fifty-three articles were included, with four articles divided into two pieces and one into three pieces, totalizing fifty-nine analyzed studies

The results showed a significant reduction in the risk of complications when adopting an MIS approach (OR = 0.56, 95%CI = 0.45 – 0.69, p < 0.0001)
The results showed that the MIS procedures do not present a significant impact on the reduction of ODI (SMD = -0.14, 95%CI = -0.39 – 0.09; p = 0.23)
As for the treatment effect, MIS surgery's use promoted a significant reduction in surgical blood loss (SMD = -0.79, 95%CI = -0.88 - -0.70, p < 0.0001)
The MIS approaches did not exert any significant impact on the surgical duration
small reduction of the LoS when using MIS approaches (SMD = -0.33, 95%CI = -0.60 - -0.06, p = 0.01)

Conclusões

MIS surgeries are capable of improving several surgical parameters compared to traditional procedures. Although no difference in ODI was seen.