Complications in Minimally Invasive Spine Surgery (2013-2024): Lumbar Spine-Tubular Minimally Invasive Techniques: A Proportional Meta-Analysis.

Overview

abstract

STUDY DESIGN: Systematic review and proportional meta-analysis. OBJECTIVE: To quantify overall and specific complication rates associated with tubular minimally invasive spine surgery (MISS) for lumbar pathologies over the past decade. SUMMARY OF BACKGROUND DATA: Tubular MISS is widely used for lumbar pathologies due to its reduced tissue disruption and faster recovery compared with open surgery. However, reported complication rates vary, and pooled estimates for specific complications remain limited. MATERIALS AND METHODS: A systematic search of PubMed, Medline, Embase, and the Cochrane Library (January 2013-March 2024) was conducted following PRISMA guidelines. Studies were included if they involved 10 adult patients undergoing tubular lumbar MISS and provided extractable complication data. A random-effects model was used to pool complication rates, and study quality was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. All analyses were done using R studio. RESULTS: Seventy-five studies involving ∼12,600 patients were included in the analysis. The complication rate was 10% (95% CI: 8%-14%, I2=93%). Specific complication rates were: dural tears 4% (95% CI: 3%-5%, I2=69%) in 56 studies (6651 patients); nerve injuries 1% (95% CI: 1%-3%, I2=70%) in 41 studies (5278 patients); postoperative hematoma 1% (95% CI: 1%-2%, I2=31%) in 19 studies (2454 patients); surgical site infections 1% (95% CI: 0%-1%, I2=27%) in 46 studies (10,439 patients); revision surgeries 2% (95% CI: 2%-3%, I2=77%) in 43 studies (8948 patients); and disc reherniation 3% (95% CI: 1%-7%, I2=84%) in 14 studies (1928 patients). CONCLUSION: This meta-analysis provides a comprehensive overview of complication rates in tubular lumbar MISS, revealing generally low rates but significant heterogeneity across studies. These findings offer valuable insights for patient counseling and surgical planning, though individual patient factors and surgeon experience should be considered.