Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis

Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis

Jun Hao Tan, Gabriel Liu, Ruimin Ng, Nishant Kumar, Hee-Kit Wong, Gabriel Liu

August 2018, Volume 27, Issue 8, pp 1877 - 1886
First Online: 01 June 2018


Obesity is a global health problem. It increases the risk of surgical complications and re-operations. While both MIS-TLIF and O-TLIF are reported to have comparably good long-term outcomes for non-obese patients, no consensus has been reached for obese patients.


A comprehensive search of the published literature was performed: PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials database in accordance to the PRISMA 2009 checklist. Data were collected with attention to baseline demographics, intra-operative blood loss, duration of surgery, surgical complications, hospitalization stay, VAS and Oswestry disability index (ODI) pre- and postoperatively.


A total of 863 abstracts were identified from the databases, of which 4 articles were included in the meta-analysis. A total of 430 patients were identified, of which 217(50.5%) underwent the O-TLIF, while 213(49.5%) underwent MIS-TLIF. One hundred and ninety-four (45.1%) patients were males, while 236(54.9%) were females. The average age was 54.8 ± 12.0 years. The pooled BMI was 33.4 ± 4.7 for the open-TLIF group, and 32.7 ± 3.9 for MIS-TLIF group (p = 0.22). When comparing O-TLIF to MIS-TLIF: Patients who underwent O-TLIF had 383 mls more blood loss (95% CI: 329.5–437.4, p 


MIS-TLIF is safe and may be a better option for lumbar fusion in obese patients.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material [Figure not available: see fulltext.]