Lateral versus posterior approaches to treat degenerative lumbar pathologies-systematic review and meta-analysis of recent literature

Rodrigo Amaral, Gabriel Pokorny, Fernando Marcelino, Rafael Moriguchi, Jullyene Pokorny, Igor Barreira, Weby Mizael, Marcelo Yozo, Sebastião Fragoso, Luiz Pimenta

May 2023, Volume 32, Issue 5, pp 1655 - 1677 Review Article Read Full Article

First Online: 14 March 2023

Introduction

The lateral lumbar interbody fusion arose as a revolutionary approach to treating several spinal pathologies because the techniques were able to promote indirect decompression and lordosis restoration through a minimally invasive approach allowing for reduced blood loss and early recovery for patients. However, it is still not clear how the technique compares to other established approaches for treating spinal degenerative diseases, such as TLIF, PLIF, and PLF.

Material and methods

This is a systematic review and meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. The authors included articles that compared the LLIF technique to one or more posterior approaches, treating only degenerative pathologies, and containing at least one of the key outcomes of the study. Exclusion articles that were not original and the ones that the authors could not obtain the full text; also articles without the possibility to calculate the standard deviation or mean were excluded. For count variables, the odds ratio was used, and for continuous variables, the standard means difference (SMD) was used, and the choice between random or fixed-effects model was made depending on the presence or not of significant (p

Results

Twenty-four articles were included in the quantitative review. As for the intra-/perioperative variables, the lateral approaches showed a significant reduction in blood loss (SMD–1.56, p

Conclusion

Lateral approaches can promote significant radiological correction and similar clinical improvement while reducing surgical blood loss and postoperative complications.

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