Comparison of Oblique Lateral Interbody Fusion and Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Disease: A Meta-Analysis

Abstract Aim: Both oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) are frequently used to treat degenerative lumbar disease. The purpose of this meta-analysis is to compare the radiologic and clinical outcomes between these two methods.Methods: Electronic databases, including PubMed, Web of Science and MEDLINE, were searched to identify relevant studies that compared OLIF and TLIF up to May 2020. The radiographic outcomes comprised of the disc height (DH), lumbar lordotic angle (LLA), disc angle (DA), fusion rate (FR), and foraminal height (FH). The secondary outcomes were length of hospital stay, operation time, estimated blood loss, visual analog scale (VAS), and Oswestry Disability Index (ODI). Data pooling and a meta-analysis with the random effects model were performed to evaluate the major results and conclusions. Results: A total of nine studies that involved 593 patients (271 patients in the OLIF group and 322 in the TLIF group) were included in the meta-analysis. Similar changes, in terms of disc height and fusion rate of >80%, were observed between the two groups. In comparing OLIF to TLIF, the OLIF group had less estimated blood loss, and a shorter operative time and hospital stay, with statistical difference. However, there was no significant difference in VAS and ODI between OLIF and TLIF.The meta-analysis suggested that TLIF is associated with better postoperative LLA, FH and DA, when compared to OLIF. However, these were not statistically significant (P>005).Conclusion: These results demonstrate that both OLIF and TLIF are similar in terms of the restoration of disc height and intervertebral fusion rate in the treatment of degenerative lumbar diseases. OLIF was superior to TLIF in terms of operation time, hospital stay and estimated blood loss. However, there was no advantage in restoring the sagittal balance and correcting the lordosis.

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Minimally invasive transforaminal lumbar interbody fusion versus oblique lateral interbody fusion for lumbar degenerative disease: a meta-analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04687-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Qing-Yi Zhang ◽

Jie Tan ◽

Kai Huang ◽

Hui-Qi Xie

Keyword(s):

Back Pain ◽

Blood Loss ◽

Lumbar Lordosis ◽

Interbody Fusion ◽

Meta Analysis ◽

Operation Time ◽

Fusion Rate ◽

Disc Height ◽

Leg Pain ◽

Intraoperative Blood Loss

Abstract Background Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases. In the present study, a meta-analysis was conducted to compare the clinical and radiographic efficacy of these two procedures. Methods A systematic literature review was performed, and the quality of retrieved studies was evaluated with the Newcastle-Ottawa Scale (NOS). Clinical outcomes, including operation time, intraoperative blood loss, improvement in Visual Analogue Scale (VAS), improvement in Oswestry Disability Index (ODI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate and complications, in addition to radiographic outcomes, including restoration of disc height, disc angle, overall lumbar lordosis, fusion rate and subsidence, were extracted and input into a fixed or random effect model to compare the efficacy of MIS-TLIF and OLIF. Results Seven qualified studies were included. Clinically, OLIF resulted in less intraoperative blood loss and shorter operation time than MIS-TLIF. Improvement of VAS for leg pain was more obvious in the OLIF group (P < 0.0001), whereas improvement of VAS for back pain (P = 0.08) and ODI (P = 0.98) as well as JOABPEQ effectiveness rate (P = 0.18) were similar in the two groups. Radiographically, OLIF was more effective in restoring disc height (P = 0.01) and equivalent in improving the disc angle (P = 0.18) and lumbar lordosis (P = 0.48) compared with MIS-TLIF. The fusion rate (P = 0.11) was similar in both groups, while the subsidence was more severe in the MIS-TLIF group (P < 0.00001). Conclusions The above evidence suggests that OLIF is associated with a shorter operation time (with supplementary fixation in the prone position) and less intraoperative blood loss than MIS-TLIF and can lead to better leg pain alleviation, disc height restoration and subsidence resistance. No differences regarding back pain relief, functional recovery, complications, disc angle restoration, lumbar lordosis restoration and fusion rate were found. However, due to the limited number of studies, our results should be confirmed with high-level studies to fully compare the therapeutic efficacy of MIS-TLIF and OLIF. Trial registration PROSPERO ID: CRD42020201903.

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Transforaminal and Posterior Lumbar Interbody Fusion for Llumbar Degenerative Diseases, which one is better: A meta-analysis Through a Ggrade Analysis of Evidence

10.21203/rs.3.rs-910433/v1 ◽

2021 ◽

Author(s):

aixian tian ◽

xinlong ma ◽

jianxiong Ma

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Meta Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Length Of Hospital Stay ◽

Operation Time ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Significant Difference

Abstract BackgroundTo explore the efficacy and safety between posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.MethodsWe searched the literature in Pubmed, Embase, Cochrane Library and Web of Science. The index words were posterior lumbar interbody fusion, PLIF, transforaminal lumbar interbody fusion, TLIF, lumbar interbody fusion, spinal fusion, degenerative disc disease and lumbar degenerative diseases. Primary outcomes were fusion rate and complications. Secondary outcomes were visual analog scale (ΔVAS), Oswestry Disability Index (ΔODI), total blood loss, operation time and length of hospital stay. Review Manager 5.3 and Stata13.1 was used for the analysis of forest plots, heterogeneity, sensitivity and publication bias.Results17 studies were included (N=1562; PLIF, n=835; TLIF, n=727). The pooled data showed PLIF had a higher complications (P= 0.000), especially in nerve injury (p = 0.003) and dural tear (p = 0.005). PLIF required longer operation time (p = 0.004), more blood loss (p = 0.000) and hospital stays (p = 0.006). Surprisingly subgroup analysis showed there was significant difference in complications in patients under 55 (p = 0.000) and Asian countries (p = 0.000). No statistical difference was found between the two groups with regard to fusion rate (p = 0.593),ΔVAS (p = 0.364) andΔODI (p = 0.237).ConclusionsThis meta-analysis showed there were no significant difference in fusion rate, ΔVAS and ΔODI. However TLIF could reduce complications, especially nerve injury and dural tear. Besides, TLIF was associated with statistically significant less blood loss, shorter operation time and shorter length of hospital stay.

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Comparison of Clinical Outcomes and Complications Between Percutaneous Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Disease: A Systematic Review and Meta-Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.441 ◽

2021 ◽

Vol 24 (6) ◽

pp. 441-452

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Clinical Outcomes ◽

Interbody Fusion ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Degenerative Lumbar Disease

BACKGROUND: Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has been increasingly used to treat degenerative lumbar disease in recent years. However, there are still controversies about whether PE-TLIF is superior to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). OBJECTIVES: To compare clinical outcomes and complications of PE-TLIF and MIS-TLIF in treating degenerative lumbar disease. STUDY DESIGN: A systematic review and meta-analysis. METHODS: A comprehensive search of online databases including PubMed, Embase, and the Cochrane Library was performed to identify related studies reporting the outcomes and complications of PE-TLIF and MIS-TLIF for degenerative lumbar disease. The clinical outcomes were assessed by the Visual Analog Scale and Oswestry Disability Index. In addition, the operative time, intraoperative blood loss, time to ambulation, length of hospital stay, fusion rate, and surgery-related complications were summarized. Forest plots were constructed to investigate the results. RESULTS: A total of 28 studies involving 1,475 patients were included in this meta-analysis. PE-TLIF significantly reduced operative time, intraoperative blood loss, time to ambulation, and length of hospital stay compared to MIS-TLIF. Moreover, PE-TLIF was superior to MIS-TLIF in the early postoperative relief of back pain. However, there were no significant differences in medium to long-term clinical outcomes, fusion rate, and incidence of complications between PE-TLIF and MIS-TLIF. LIMITATIONS: The current evidence is heterogeneous and most studies included in this meta-analysis are nonrandomized controlled trials. CONCLUSIONS: The present meta-analysis indicates that medium to long-term clinical outcomes and complication rates of PE-TLIF were similar to MIS-TLIF for the treatment of degenerative lumbar disease. However, PE-TLIF shows advantages in less surgical trauma, faster recovery, and early postoperative relief of back pain. KEY WORDS: Percutaneous endoscopic transforaminal lumbar interbody fusion, minimally invasive transforaminal lumbar interbody fusion, degenerative lumbar disease, chronic pain, systematic review, meta-analysis

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Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06248-8 ◽

2021 ◽

Author(s):

J. Kampers ◽

E. Gerhardt ◽

P. Sibbertsen ◽

T. Flock ◽

H. Hertel ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Radical Hysterectomy ◽

Postoperative Morbidity ◽

Meta Analysis ◽

Operation Time ◽

Mean Difference ◽

Inclusion Criteria ◽

Estimated Blood Loss

Abstract Purpose Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.

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Anterior Lumbar Interbody Fusion (ALIF) or Transforaminal Lumbar Interbody Fusion (TLIF) for Fusion Surgery in L5/S1 – What Is the Best Way to Restore a physiological Alignment?

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1560-3106 ◽

2021 ◽

Author(s):

Uwe Platz ◽

Henry Halm ◽

Björn Thomsen ◽

Ferenc Pecsi ◽

Mark Köszegvary ◽

...

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Operation Time ◽

Transforaminal Lumbar Interbody Fusion ◽

Clinical Results ◽

Anterior Lumbar Interbody Fusion ◽

X Rays ◽

Lumbar Interbody Fusion ◽

Spine Registry ◽

Estimated Blood Loss

Abstract Study Design A retrospective single center cohort study with prospective collected data from an institutional spine registry. Objectives To determine whether restoration of lordosis L5/S1 is possible with both anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF) and to find out which technique is superior to recreate lordosis in L5/S1. Methods Seventy-seven patients with ALIF and seventy-nine with TLIF L5/S1 were included. Operation time, estimated blood loss), and complications were evaluated. Segmental lordosis L5/S1 and L4/5, overall lordosis, and proximal lordosis (L1 to L4) were measured in X-rays before and after surgery. Oswesery disability index and EQ-5D were assessed before surgery, and 3 and 12 months after surgery. Results Mean operation time was 176.9 minutes for ALIF and 195.7 minutes for TLIF (p = 0.048). Estimated blood loss was 249.2 cc for ALIF and 362.9 cc for TLIF (p = 0.005). In terms of complications, only a difference in dural tears were found (TLIF 6, ALIF none; p = 0.014). Lordosis L5/S1 increased in the ALIF group (15.8 to 24.6°; p < 0.001), whereas no difference was noted in the TLIF group (18.4 to 19.4°; p = 0.360). Clinical results showed significant improvement in the Oswesery disability index (ALIF: 43 to 21.9, TLIF: 45.2 to 23.0) and EQ-5D (ALIF: 0.494 to 0.732, TLIF: 0.393 to 0.764) after 12 months in both groups, without differences between the groups. Conclusion ALIF and TLIF are comparable methods for performing fusion at L5/S1, with good clinical outcomes and comparable rates of complications. However, there is only a limited potential for recreating lordosis at L5/S1 with a TLIF.

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Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Global Spine Journal ◽

10.1177/21925682211016426 ◽

2021 ◽

pp. 219256822110164

Author(s):

Elsayed Said ◽

Mohamed E. Abdel-Wanis ◽

Mohamed Ameen ◽

Ali A. Sayed ◽

Khaled H. Mosallam ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Interbody Fusion ◽

Revision Rate ◽

Meta Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Operation Time ◽

Controlled Trials ◽

Lumbar Interbody Fusion ◽

Randomized Controlled

Study Design: Systematic review and meta-analysis. Objectives: Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes. Methods: Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. P < 0.05 was considered significant. Results: We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss. Conclusions: This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.

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The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

Surgical Innovation ◽

10.1177/1553350619856167 ◽

2019 ◽

Vol 26 (6) ◽

pp. 744-752

Author(s):

Hailun Zhan ◽

Chunping Huang ◽

Tengcheng Li ◽

Fei Yang ◽

Jiarong Cai ◽

...

Keyword(s):

Renal Function ◽

Blood Loss ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

The Self ◽

Barbed Suture ◽

Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

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Clinical and radiographic comparison of mini–open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up

Journal of Neurosurgery Spine ◽

10.3171/spi.2008.9.08142 ◽

2008 ◽

Vol 9 (6) ◽

pp. 560-565 ◽

Cited By ~ 234

Author(s):

Sanjay S. Dhall ◽

Michael Y. Wang ◽

Praveen V. Mummaneni

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Open Group ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Mean ◽

Mini Open

Object As minimally invasive approaches gain popularity in spine surgery, clinical outcomes and effectiveness of mini–open transforaminal lumbar interbody fusion (TLIF) compared with traditional open TLIF have yet to be established. The authors retrospectively compared the outcomes of patients who underwent mini–open TLIF with those who underwent open TLIF. Methods Between 2003 and 2006, 42 patients underwent TLIF for degenerative disc disease or spondylolisthesis; 21 patients underwent mini–open TLIF and 21 patients underwent open TLIF. The mean age in each group was 53 years, and there was no statistically significant difference in age between the groups (p = 0.98). Data were collected perioperatively. In addition, complications, length of stay (LOS), fusion rate, and modified Prolo Scale (mPS) scores were recorded at routine intervals. Results No patient was lost to follow-up. The mean follow-up was 24 months for the mini-open group and 34 months for the open group. The mean estimated blood loss was 194 ml for the mini-open group and 505 ml for the open group (p < 0.01). The mean LOS was 3 days for the mini-open group and 5.5 days for the open group (p < 0.01). The mean mPS score improved from 11 to 19 in the mini-open group and from 10 to 18 in the open group; there was no statistically significant difference in mPS score improvement between the groups (p = 0.19). In the mini-open group there were 2 cases of transient L-5 sensory loss, 1 case of a misplaced screw that required revision, and 1 case of cage migration that required revision. In the open group there was 1 case of radiculitis as well as 1 case of a misplaced screw that required revision. One patient in the mini-open group developed a pseudarthrosis that required reoperation, and all patients in the open group exhibited fusion. Conclusions Mini–open TLIF is a viable alternative to traditional open TLIF with significantly reduced estimated blood loss and LOS. However, the authors found a higher incidence of hardware-associated complications with the mini–open TLIF.

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Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion

Neurosurgery ◽

10.1227/neu.0000000000000913 ◽

2015 ◽

Vol 77 (6) ◽

pp. 847-874 ◽

Cited By ~ 90

Author(s):

Nickalus R. Khan ◽

Aaron J. Clark ◽

Siang Liao Lee ◽

Garrett T. Venable ◽

Nicholas B. Rossi ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Radiation Exposure ◽

Interbody Fusion ◽

Operative Time ◽

Meta Analysis ◽

Transforaminal Lumbar Interbody Fusion ◽

Complication Rates ◽

Lumbar Interbody Fusion

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (TLIF)—or MI-TLIF—has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. OBJECTIVE: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. METHODS: During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type. RESULTS: Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P < .001), length of stay (P < .001), and complications (P = .001) but increased radiation exposure (P < .001). No differences were found in fusion rate (P = .61) and operative time (P = .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P < .001), but no differences were found in early VAS-back, early ODI, and late ODI. CONCLUSION: MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.

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Open versus arthroscopic ankle arthrodesis: A systemic review and meta-analysis

10.21203/rs.3.rs-17549/v1 ◽

2020 ◽

Author(s):

Tsz Ngai Mok ◽

Qiyu He ◽

SOUNDARYA PANNEERSELVAM ◽

Huajun Wang ◽

Huige Hou ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Cohort Studies ◽

Open Surgery ◽

Meta Analysis ◽

Fusion Rate ◽

Ankle Arthritis ◽

Tourniquet Time ◽

Pooled Data ◽

Estimated Blood Loss

Abstract Background: Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods: For the systematic review, a literature search was conducted in four English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Two prospective cohort studies and 8 retrospective cohort studies, enrolling a total of 548 patients with ankle arthritis, were included. Result: For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, shorter length of hospitalisation and better functional improvement at 1 year than open surgery.

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