127 - Lateral versus posterior approaches to degenerative pathologies: Systematic Review and Meta-analysis of recent literature

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, therefore the aim of the article was to perform a literature revision from articles published in the last 10 years to compare the LLIF approaches to the posterior approaches.

Methods. Systematic Review and Meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. Were 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, where the standard deviation or mean could not be calculated, were also excluded. The analysis was performed in the R software, 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 < 0.05) heterogeneity in the sample.

Results. 29 articles were included in the quantitative review. As for the intra/perioperative variables, the lateral approaches showed significant reduction in blood loss (SMD -0.71, p = 0.03) and similar operative time (SMD = 0.04, p > 0.05). Moreover, the use of the lateral approaches showed a tendency to lead to reduced hospitalization days (SMD = -0.34, p = 0.059), with significantly reduced Odds ratios of complications (0.49, p = 0.01). As for the clinical outcomes, both approaches showed similar improvement in ODI, but with patients in lateral groups showing reduced ODI values at Last FUP, for the VAS back the results were inverse, with similar values in Last FUP and significantly higher improvement for lateral techniques (SMD = 0.27). Finally, when analyzing the changes in segmental lordosis and lumbar lordosis, the lateral technique promoted significantly higher correction in both outcomes (SMD = 0.68 and SMD =0.47, respectively, p < 0.05).

Conclusions. Lateral approaches are capable of promoting significantly radiological correction and clinical improvement while reducing surgical blood loss and postoperative complications.