Unilateral Laminotomy for Interbody Fusion versus Minimally Invasive TLIF for Lumbar Degenerative Diseases: A Quantitative Analysis of 14 Cohort Studies Involving 1,158 Patients

Unilateral Laminotomy for Interbody Fusion versus Minimally Invasive TLIF for Lumbar Degenerative Diseases: A Quantitative Analysis of 14 Cohort Studies Involving 1,158 Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unilateral Laminotomy for Interbody Fusion versus Minimally Invasive TLIF for Lumbar Degenerative Diseases: A Quantitative Analysis of 14 Cohort Studies Involving 1,158 Patients Mingjiang Luo, Wei Lin, Ziliang Zhao, Jinkai He, Yan Chen, Weijian Li, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8966841/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Objective This study aimed to systematically review and compare the efficacy and safety of unilateral laminotomy for interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative diseases (LDD). Methods A systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify clinical cohort studies published up to April 15, 2025, that compared ULIF with MIS-TLIF for LDD. Standard meta-analytic methods were applied to evaluate outcomes, including pain scores, fusion rates, operative time, length of hospital stay, and intraoperative blood loss. Continuous variables were pooled using standardized mean differences (SMDs), whereas dichotomous variables were assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity across studies was examined using the I² statistic, and sensitivity analyses were performed to explore potential sources of heterogeneity and assess the robustness of the results. Publication bias was evaluated using Begg’s test and funnel plots. Results Fourteen cohort studies involving 1,158 patients were included. Compared with MIS-TLIF, ULIF was associated with a significantly shorter hospital stay (SMD = − 1.02, 95% CI: −1.59 to − 0.45) and reduced intraoperative blood loss (SMD = − 2.88, 95% CI: −3.78 to − 1.79). However, ULIF required a longer operative time (SMD = 1.87, 95% CI: 1.15 to 2.59). ULIF demonstrated superior short-term pain improvement, whereas long-term pain outcomes were comparable between the two techniques. Both procedures achieved high fusion rates (ULIF: 93.4%, MIS-TLIF: 93.7%) with no significant differences. Conclusion This meta-analysis indicates that both ULIF and MIS-TLIF are effective surgical options for LDD. ULIF offers advantages in reducing hospital stay, intraoperative blood loss, and short-term postoperative pain, although it requires longer operative time. Both techniques yield similarly high fusion rates and comparable long-term pain relief. Unilateral Laminotomy for Interbody Fusion TLIF Lumbar Degenerative Diseases Quantitative Analysis Cohort Studies Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Lumbar degenerative disease (LDD) is a common spinal disorder characterized by low back pain, radiating leg pain, lower-limb numbness or weakness, and restricted mobility, all of which significantly impair patients’ daily functioning and overall health status[ 1 ]. Many patients respond poorly to conservative management and eventually require surgical intervention due to markedly reduced quality of life[ 2 ]. With changes in lifestyle and a rapidly aging population, the prevalence of LDD continues to rise, imposing a substantial burden on both patient well-being and socioeconomic resources[ 3 ]. For patients with LDD complicated by spondylolisthesis or severe degeneration, lumbar interbody fusion (LIF) is often indicated. The most widely used minimally invasive LIF techniques include unilateral laminotomy for interbody fusion (ULIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) [ 1 , 4 ]. ULIF utilizes a lateral or oblique approach that avoids major neurovascular structures and allows interbody preparation and grafting outside the spinal canal, typically combined with pedicle screw or lateral screw fixation[ 5 ]. The technique offers several advantages, such as smaller incisions, improved endoscopic visualization, reduced inflammatory response, and faster postoperative pain relief and functional recovery[ 5 , 6 ]. However, ULIF is associated with a higher risk of complications—including dural tears, nerve root injury, and newly developed radicular pain—and requires advanced surgical expertise with a relatively long learning curve[ 7 ] [ 5 ]. MIS-TLIF is performed through a transforaminal approach using a minimally invasive tubular retractor system to achieve decompression, interbody preparation, and fusion, supplemented by pedicle screw fixation[ 5 ]. Its advantages include reduced surgical trauma, less intraoperative blood loss, faster recovery, and shorter hospital stays[ 8 – 10 ]. Nonetheless, MIS-TLIF may be limited by restricted working space and visualization, as well as tissue damage or muscle compression caused by tubular dilators[ 9 ]. Existing studies have reported inconsistent findings regarding the relative efficacy and safety of ULIF and MIS-TLIF. Some evidence suggests that ULIF minimizes muscle retraction, reduces intraoperative blood loss, shortens muscle ischemia and denervation time, and leads to superior early postoperative pain improvement compared with MIS-TLIF[ 11 – 15 ]. Conversely, other studies report comparable intraoperative bleeding, postoperative drainage volume, length of hospital stay, and postoperative pain improvement between the two techniques[ 3 , 4 , 9 , 16 , 17 ]. Given these conflicting results, we conducted a systematic review and meta-analysis to comprehensively evaluate the efficacy and safety of ULIF versus MIS-TLIF in the treatment of LDD. Methods Protocol Approval, Registration, and Patient Consent This study was conducted in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines[ 18 ]. The review protocol has been prospectively registered in PROSPERO. Search Strategy Two independent investigators systematically searched PubMed, Embase, and the Cochrane Library for studies related to ULIF, MIS-TLIF, and LDD. The search included articles published up to April 15, 2025, with no restrictions on publication date. A predefined search strategy and specific combinations of terms were used, including (“Spine/surgery” OR “Endoscopy” OR “Spinal Stenosis”) AND (“Spinal Fusion” OR “Minimally Invasive Surgical Procedures” OR “Endoscopes” OR “Full-endoscopic surgery”) AND (“Low back pain” OR “Intervertebral Disc Degeneration/surgery” OR “Intervertebral Disc Displacement”) (eTable 1). To minimize the risk of missing potentially relevant studies, the investigators also performed a manual search using Google Scholar to identify additional eligible articles. Any disagreements during study selection were resolved through consultation with a third independent reviewer. Eligibility Criteria Keywords were developed based on the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) framework, which guided the formulation of the search strategy. Two reviewers independently assessed the eligibility of identified studies according to predefined criteria. Studies were included if they investigated patients with LDD undergoing ULIF or MIS-TLIF. Population : Patients diagnosed with LDD Intervention : ULIF. Comparison : MIS-TLIF. Outcomes : Fusion rate, Oswestry Disability Index (ODI), visual analogue scale (VAS), infection, dural tear, epidural hematoma, operative time (minutes), intraoperative blood loss (mL), length of hospital stay (days), and recurrence rate. Effect sizes were reported as standardized mean differences (SMDs) or odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Study Design : Prospective or retrospective cohort studies. The following were excluded: meta-analyses, non-English publications, studies involving duplicate populations, case reports, and studies lacking sufficient data for analysis. Data Extraction Data extraction will be performed independently by two reviewers using a predefined extraction form (Excel, Office 2016). The extracted information will include the first author, year of publication, study design, country, study period, sample size, mean age, proportion of female participants, follow-up duration, surgical level, disease type, outcome measures, and complications. When feasible, the corresponding authors of the original studies will be contacted to obtain missing data. To ensure accuracy and consistency, all extracted data will undergo cross-verification, and any discrepancies will be resolved through consultation with a third independent reviewer. Quality Assessment To ensure the reliability and validity of the synthesized evidence, all included studies were rigorously assessed for risk of bias. Two reviewers independently evaluated each eligible study using the Newcastle–Ottawa Scale (NOS), which considers three domains: selection of participants, comparability of study groups, and outcome assessment. Each study could receive a maximum score of 9, with scores of 6–7 indicating low-quality studies and scores of 8–9 indicating high-quality studies. Lower scores represent a higher risk of bias, whereas higher scores indicate a lower risk of bias [ 19 ]. Statistical Analysis All data in this study were analyzed using Stata software (version 17.0; StataCorp, College Station, TX, USA). The I² statistic (ranging from 0 to 100%) was used to quantify heterogeneity among studies. An I² value ≥ 50% was considered indicative of significant heterogeneity, in which case a random-effects model was applied; otherwise, a fixed-effects model was used. Pooled ORs with 95% CIs were calculated to evaluate differences in postoperative outcomes between ULIF and MIS-TLIF for LDD. Continuous outcomes, including operative time, blood loss, length of hospital stay, fusion rate, VAS scores, and ODI scores, were assessed using SMDs with 95% CIs. Publication bias was evaluated visually using funnel plots and quantitatively using Begg’s and Egger’s tests. Sensitivity analyses, performed by sequentially excluding individual studies, were used to assess the stability of the results and explore sources of heterogeneity. A p-value < 0.05 was considered statistically significant. Results Literature Search An initial literature search identified 19,430 records, of which 16,396 remained after removing duplicates. Following screening of titles, abstracts, and full texts, 40 studies were initially considered for inclusion. Full texts were retrieved for 32 studies, while 8 studies were excluded due to unavailability. After full-text review, 4 meta-analyses, 9 non-English articles, 3 studies with insufficient outcome data, and 2 irrelevant studies were further excluded. Ultimately, 14 studies [ 3 , 7 , 8 , 17 , 20 – 29 ], including 1,158 participants (mean sample size = 83), met the inclusion criteria for the present meta-analysis (Fig. 1 and eTable 2). Study Characteristics The baseline characteristics of the included studies are summarized in Table 1 . Seven studies [ 7 , 22 , 23 , 25 , 27 – 29 ] were published after 2021, while seven studies [ 3 , 8 , 17 , 20 , 21 , 24 , 26 ] were published before 2021. Thirteen studies [ 3 , 7 , 8 , 17 , 20 – 24 , 26 – 29 ] were retrospective cohort studies, and one study [ 25 ] was a prospective cohort study. Among the 14 included studies, 78.6% (11/14) achieved a NOS score ≥ 8, indicating high methodological quality (Table 2 ). Sample sizes ranged from 49 to 145 participants, with a mean of 83 participants per study. The mean age of participants ranged from 52.3 to 70.5 years. The minimum follow-up duration was 12 months, and the maximum was 30.7 months, with a mean follow-up of 15.89 months. Nine studies [ 3 , 8 , 20 , 21 , 24 – 27 , 29 ] were conducted in China, three studies [ 22 , 23 , 28 ] in South Korea, one study [ 17 ] in Thailand, and one study [ 7 ] in Indonesia. Ten studies [ 7 , 8 , 20 – 23 , 25 , 26 , 28 , 29 ] included patients with spondylolisthesis with stenosis or instability, one study [ 27 ] included patients with lumbar spinal stenosis, and three studies [ 3 , 17 , 24 ] involved other specific conditions. Table 1 Characteristics of studies included in meta-analysis. First author Year Study Design Region Observation Period Sample size Average age Female Heo, Dong Hwa 2019 Retrospective Korea 2016.02-2017.10 ULIF:23 MIS-TLIF:46 ULIF:61.4 MIS-TLIF:63.5 ULIF:69.6 MIS-TLIF:58.7 Ge, M. 2022 Retrospective China 2017.10-2019.10 ULIF:41 MIS-TLIF:43 ULIF:59.6 MIS-TLIF:62.7 ULIF:48.8 MIS-TLIF:55.8 Kim, J. E. 2021 Retrospective Korea 2015–2018 ULIF:32 MIS-TLIF:55 ULIF:70.5 MIS-TLIF:67.3 ULIF:46.8 MIS-TLIF:54.5 Chen, H. 2023 Retrospective China 2019.01-2021.07 ULIF:48 MIS-TLIF:51 ULIF:57.65 MIS-TLIF:57.32 ULIF:45.8 MIS-TLIF:41.2 Xu, H. 2024 Retrospective China 2019.01-2021.12 ULIF:55 MIS-TLIF:55 ULIF:60.23 MIS-TLIF:60.96 ULIF:43.64 MIS-TLIF:47.27 Ao, S. 2020 Prospective China 2018.04-2018.08 ULIF:35 MIS-TLIF:40 ULIF:52.8 MIS-TLIF:53.68 ULIF:54.29 MIS-TLIF:45 Huang, X. 2023 Retrospective China 2022.08-2021.03 ULIF:38 MIS-TLIF:44 ULIF:60.13 MIS-TLIF:59.68 ULIF:42.1 MIS-TLIF:40.9 Zhao, X. B. 2021 Retrospective China 2017.06-2018.05 ULIF:40 MIS-TLIF:38 ULIF:56.93 MIS-TLIF:57.01 ULIF:42.5 MIS-TLIF:47.4 Kang, M. S. 2021 Retrospective Korea 2018.03-2019.07 ULIF:47 MIS-TLIF:32 ULIF:66.87 MIS-TLIF:66.38 ULIF:63.8 MIS-TLIF:46.9 Zhang, H. 2021 Retrospective China 2019.05-2019.08 ULIF:32 MIS-TLIF:30 ULIF:53.1 MIS-TLIF:55.7 ULIF:62.5 MIS-TLIF:53.3 Arunakul, R. 2024 Retrospective Thailand 2012.01-2023.01 ULIF:34 MIS-TLIF:56 ULIF:61.26 MIS-TLIF:62.84 ULIF:73.53 MIS-TLIF:76.79 Gatam, Asrafi Rizki 2021 Retrospective Indonesia 2016.01-2020.04 ULIF:72 MIS-TLIF:73 ULIF:55.1 MIS-TLIF:52.3 ULIF:36.8 MIS-TLIF:63.2 Song, Xin 2023 Retrospective China 2019.05-2021.10 ULIF:25 MIS-TLIF:24 ULIF:52.36 MIS-TLIF:56.38 ULIF:64 MIS-TLIF:66.67 Guo, Wenlong 2023 Retrospective China 2019.09-2021.03 ULIF:26 MIS-TLIF:23 ULIF:64.15 MIS-TLIF:66.09 ULIF:53.8 MIS-TLIF:56.5 Table 1 Characteristics of studies included in meta-analysis (Continued). First author Follow-up period Surgery site Outcomes Complications Disease type Heo, Dong Hwa 12 months L3–4, L4–5, L5–S1 ODI, VAS, mean operative time, EBL, fusion rate, and Complications Hematoma, Dural tear, Infection Grade 1 degenerative/isthmic spondylolisthesis, central stenosis with/without foraminal stenosis and instability Ge, M. 24 months L3–4, L4–5, L5–S1 VAS, ODI, JOA, Fusion and Complication, TBL Hematoma Stenosis, grade I–II spondylolisthesis, herniation with instability or recurrence Kim, J. E. 12 months L2–L3, L3–4, L4–5, L5–S1 VAS, ODI, LOS, Fusion rate, Macnab, operative time, and Complications Hematoma Degenerative/lytic spondylolisthesis, central and foraminal stenosis Chen, H. 16.3 months L3-4, L4-5, L5-S1, L3–L5, L4–S1, L2–L5 ODI, VAS, operative time, blood loss, LOS, Complications, and Macnab Dural tears, Infection Persistent symptoms post-conservative treatment, herniation with instability Xu, H. 12 months L3–4, L4–5, L5–S1 Operation time, Blood loss, LOS, VAS, ODI, Fusion rate lordosis, and Complications Infection Single-segment lumbar degenerative disease Ao, S. 14 months L3–4, L4–5, L5–S1 VAS, ODI, Operation time, LOS, Blood loss, Complications Macnab, Fusion rate Spondylolisthesis/instability with herniation or stenosis, single-level imaging-confirmed Huang, X. 12 months L3–4, L4–5, L5–S1 VAS, ODI, Operation time, LOS, Complications, Fusion rate, Macnab, Blood loss Dural tears Grade I–II spondylolisthesis, stenosis with spondylolisthesis/instability/herniation Zhao, X. B. 30.7 months L3–4, L4–5, L5–S1 VAS, JOA, Operation time, Blood Loss, LOS, Macnab, Fusion rate NR Lumbar spinal stenosis, with or without disc herniation Kang, M. S. 15.01 months L2–L3 ,L3–4, L4–5, L5–S1 VAS, ODI, and SF-36 scores Hematoma, Dural tear, Infection Single/dual-segment stenosis with/without low-grade spondylolisthesis Zhang, H. 12 months L3–4, L4–5, L5–S1 VAS, ODI, JOA, Operative time, Blood loss, Fusion rate, NR Grade I/II spondylolisthesis with/without stenosis, single-segment instability Arunakul, R. 12 months NR VAS, ODI, Complication, Operation time, Blood loss, LOS Hematoma, Dural tear, Infection Single or two-segment-level transforaminal lumbar interbody fusion Gatam, Asrafi Rizki 12 months L3–4, L4–5, L5–S1 VAS, ODI, SF-36, and Fusion rate. Dural tear, Infection Lumbar spondylolisthesis Song, Xin 14.42 months L3–4, L4–5, L5–S1 VAS, ODI, Macnab, and Complications Lower limb numbness, muscle strength decline Spinal stenosis, spondylolisthesis, instability, and disc herniation Guo, Wenlong 24 months L3–4, L4–5, L5–S1 VAS, ODI, Operation time, Blood loss, Complication Infection, Dural tear, Hematoma Degenerative Lumbar Spondylolisthesis with Lumbar Spinal Stenosis Abbreviations: EBL: Estimated Blood Loss, HBL: Hidden blood loss, JOA: Japanese Orthopedic Association, LOS: Length of Stay, MIS-TLIF: Minimally Invasive Transforaminal Lumbar Interbody Fusion, ODI: Oswestry Disability Index, SF-36: The Medical Outcomes Study 36-item Short-Form Health Survey, TBL: Total blood loss, ULIF: Unilateral Lumbar Interbody Fusion, VBL: Visible blood loss, VAS: Visual Analog Scale Table 2 Methodological quality score of the included studies based on the Newcastle–Ottawa Scale (NOS) tool. Author Year Study Design Selection Comparability Exposure/Outcome Total Score Risk of Bias Representativeness of cohort * Selection of control cohort * Ascertainment of exposure * Outcome not present at start * Comparability of cohorts ** Assessment of outcome * Length of follow-up * Adequacy of follow-up * Total score 9* Heo, Dong Hwa 2019 Retrospective * * * ** * * * 8 Low Ge, M. 2022 Retrospective * * * * * * * 7 High Kim, J. E. 2021 Retrospective * * ** ** * * * 9 Low Chen, H. 2023 Retrospective * * * ** * * * 8 Low Xu, H. 2024 Retrospective * * ** * * * * 8 Low Ao, S. 2020 Prospective * * * * ** * * * 9 Low Huang, X. 2023 Retrospective * * * ** * * * 8 Low Zhao, X. B. 2021 Retrospective * * * * * * 6 High Kang, M. S. 2021 Retrospective * * ** ** * * * 9 Low Zhang, H. 2021 Retrospective * * * ** * * * 8 Low Arunakul, R. 2024 Retrospective * * ** ** * * * 9 Low Gatam, Asrafi Rizki 2021 Retrospective * * ** * * * * 8 Low Song, Xin 2023 Retrospective * * * * * * * 7 High Guo, Wenlong 2023 Retrospective * * ** * * * * 8 Low Clinical Outcomes Fusion Rate Eleven studies [ 3 , 7 , 8 , 22 – 29 ] reported fusion outcomes in a total of 997 patients, with 480 patients in the ULIF group (445 achieved fusion) and 517 patients in the MIS-TLIF group (479 achieved fusion). The pooled fusion rate was 0.934 in the ULIF group (95% CI: 0.903–0.960, P = 0.176, I² = 28.2%) and 0.937 in the MIS-TLIF group (95% CI: 0.899–0.967, P = 0.012, I² = 55.7%) (Fig. 2 ). Subgroup analyses in the ULIF group revealed the following patterns: studies published more recently reported higher fusion rates (≤ 2021: 0.91, 95% CI: 0.87–0.95; >2021: 0.96, 95% CI: 0.93–0.99); older patient age was associated with lower fusion rates (≤ 60 years: 0.95, 95% CI: 0.91–0.98; >60 years: 0.91, 95% CI: 0.86–0.95); fusion rates were higher in China compared to Korea (China: 0.95, 95% CI: 0.92–0.98; Korea: 0.88, 95% CI: 0.80–0.94); and longer follow-up was associated with higher fusion rates (≤ 12 months: 0.93, 95% CI: 0.89–0.96; >12 months: 0.94, 95% CI: 0.88–0.98) (Table 3 ). Table 3 Subgroup analyses for the rate of fusion after ULIF. Variables No. studies Rate of Fusion 95% CI I² (%) P for heterogeneity P for interaction Study year 0.044 ≤ 2021 7 0.91 0.87 to 0.95 28.21 0.21 > 2021 4 0.96 0.93 to 0.99 0.00 0.80 Age 0.179 ≤ 60 6 0.95 0.91 to 0.98 18.13 0.30 > 60 5 0.91 0.86 to 0.95 27.19 0.24 Sample size 0.778 < 45 7 0.93 0.88 to 0.97 37.25 0.14 ≥ 45 4 0.93 0.89 to 0.97 30.80 0.23 Region 0.038 China 7 0.95 0.92 to 0.98 0.00 0.44 Korea 3 0.88 0.80 to 0.94 25.17 0.26 Follow-up period 0.691 ≤ 12 months 6 0.93 0.89 to 0.96 0.00 0.45 > 12 months 5 0.94 0.88 to 0.98 55.77 0.06 NOS score 0.075 < 8 2 0.98 0.92 to 1.00 0.00 ≥ 8 9 0.92 0.89 to 0.95 25.08 0.22 Abbreviations : CI: Confidence interval; CT: Computed tomograph; ULIF: Unilateral Laminotomy for Interbody Fusion; NOS: Newcastle-Ottawa Scale In the MIS-TLIF group, subgroup analyses based on publication year, patient age, region, follow-up duration, and NOS score revealed a significant reduction in heterogeneity, suggesting these factors may be potential sources of variability. Specifically, more recent studies reported higher fusion rates (≤ 2021: 0.92, 95% CI: 0.86–0.97; >2021: 0.96, 95% CI: 0.93–0.99); older age was associated with lower fusion rates (≤ 60 years: 0.96, 95% CI: 0.93–0.98; >60 years: 0.91, 95% CI: 0.82–0.96); fusion rates were higher in China than in Korea (China: 0.96, 95% CI: 0.94–0.98; Korea: 0.86, 95% CI: 0.74–0.95); and longer follow-up was associated with higher fusion rates (≤ 12 months: 0.93, 95% CI: 0.87–0.98; >12 months: 0.94, 95% CI: 0.91–0.97) (Table 4 ). Table 4 Subgroup analyses for the rate of fusion after MIS-TLIF. Variables No. studies Rate of fusion 95% CI I² (%) P for heterogeneity P for interaction Study year 0.116 ≤ 2021 7 0.92 0.86 to 0.97 65.28 0.01 > 2021 4 0.96 0.93 to 0.99 0.00 0.89 Age 0.141 ≤ 60 6 0.96 0.93 to 0.98 0.00 0.46 > 60 5 0.91 0.82 to 0.96 70.14 0.01 Sample size 0.936 < 45 6 0.93 0.89 to 0.97 28.74 0.22 ≥ 45 5 0.93 0.88 to 0.97 41.38 0.15 Region 0.029 China 7 0.96 0.94 to 0.98 0.00 0.69 Korea 3 0.86 0.74 to 0.95 70.52 0.03 Follow-up period 0.795 ≤ 12 months 6 0.93 0.87 to 0.98 72.98 0.00 > 12 months 5 0.94 0.91 to 0.97 0.00 0.43 NOS score 0.658 < 8 2 0.97 0.92 to 1 0.00 ≥ 8 9 0.93 0.89 to 0.97 64.10 0.00 Abbreviations : CI: Confidence interval; CT: Computed tomograph; MIS-TLIF: Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion; NOS: Newcastle-Ottawa Scale VAS Scores A total of 10 studies [ 3 , 8 , 17 , 21 – 26 , 29 ] reported postoperative VAS scores. Meta-analysis demonstrated that the ULIF group had significantly lower VAS scores compared to the MIS-TLIF group at 1 month and 3 months postoperatively (1 month: SMD = -0.99, 95% CI: -1.32 to -0.66, P < 0.001, I² = 78.9%; 3 months: SMD = -0.45, 95% CI: -0.68 to -0.21, P = 0.03, I² = 53.8%) (Fig. 3 ). However, no significant differences were observed at 6 months (SMD = -0.23, 95% CI: -0.50 to 0.03, P = 0.83, I² = 0.0%), 12 months (SMD = -0.24, 95% CI: -0.40 to -0.08, P = 0.98, I² = 0.0%), or at the final follow-up (SMD = -0.15, 95% CI: -0.37 to 0.07, P = 0.86, I² = 0.0%) (Fig. 3 ). The funnel plot for 1-month postoperative VAS scores initially suggested a slight rightward asymmetry (eFigure 1). Begg's test indicated potential publication bias (P = 0.0042). After adjustment using the nonparametric trim-and-fill method, the funnel plot suggested one potentially missing study (eFigure 2), but the SMD remained largely unchanged (SMD = -1.09, 95% CI: -1.45 to -0.73). The funnel plot for 3-month postoperative VAS scores appeared approximately symmetrical, and Begg's test confirmed no significant publication bias (P = 0.0635) (eTable 3). ODI Scores Nine studies [ 3 , 8 , 17 , 21 , 23 – 26 , 29 ] reported postoperative ODI scores to evaluate the efficacy of ULIF versus MIS-TLIF. The results showed that at 1 month postoperatively, the ODI score in the ULIF group was significantly lower than that in the MIS-TLIF group (SMD: -0.61, 95% CI: -1.07 to -0.16, P = 0.00, I² = 87.37%). However, no significant differences were observed at 3 months (SMD: -0.25, 95% CI: -0.49 to -0.00, P = 0.02, I² = 57.29%), 6 months (SMD: -0.16, 95% CI: -0.57 to 0.24, P = 0.20, I² = 55.98%), 12 months (SMD: -0.06, 95% CI: -0.25 to 0.13, P = 0.24, I² = 24.64%), or at the final follow-up (SMD: -0.06, 95% CI: -0.28 to 0.15, P = 0.42, I² = 0.00%) (Fig. 4 ). Visual inspection of the funnel plot suggested potential publication bias for the 1-month postoperative ODI (eFigure 3). This was further confirmed by Begg’s test (P = 0.0354). To adjust for this bias, the trim-and-fill method was applied, incorporating two imputed missing studies (eFigure 4). After adjustment, the corrected result was SMD: -0.86, 95% CI: -1.36 to -0.35, which was consistent with the initial analysis, thereby confirming the robustness of the findings (eTable 3). Surgical Outcomes Operative Time Thirteen studies [ 3 , 8 , 17 , 20 – 29 ] including a total of 1,013 patients (476 in the ULIF group and 537 in the MIS-TLIF group) reported operative time. Pooled analysis demonstrated that the ULIF group had significantly longer operative time compared with the MIS-TLIF group (SMD = 1.87, 95% CI: 1.15–2.59, P < 0.001, I² = 95.64%) (Fig. 5 ). Sensitivity analysis using the leave-one-out method confirmed the robustness of the results, as exclusion of any single study did not substantially alter the pooled SMD (range: 1.52–2.04, 95% CI: 0.89–2.76) (eFigure 5). Funnel plot inspection suggested a slight rightward asymmetry (eFigure 6), and Begg’s test indicated potential publication bias (P = 0.0327). To further assess the impact of publication bias, the Trim-and-Fill (T-F) method was applied, adding three hypothetical missing studies (eFigure 7). The adjusted pooled effect size remained consistent with the original results (SMD = 2.39, 95% CI: 1.51–3.26) (eTable 3). Intraoperative Blood Loss A total of 12 studies [ 3 , 8 , 17 , 20 – 22 , 24 – 29 ] involving 926 patients reported intraoperative blood loss. The pooled analysis demonstrated that blood loss in the ULIF group was significantly lower than in the MIS-TLIF group (SMD = -2.88, 95% CI: -3.78 to -1.97, P < 0.001, I² = 96.55%) (Fig. 6 ). To assess the robustness of the results, a leave-one-out sensitivity analysis was performed. Excluding any single study did not substantially alter the pooled SMD (range: -3.14, 95% CI: -4.09 to -2.20 to -2.03, 95% CI: -4.29 to -0.96) (eFigure 8). Visual inspection of the funnel plot indicated asymmetry, suggesting potential publication bias (eFigure 9), which was confirmed by Begg’s test (P = 0.0003). The trim-and-fill method was subsequently applied to adjust for potential bias, revealing three potentially missing studies (eFigure 10). After adjustment, the pooled effect remained consistent with the primary analysis (SMD = -3.82, 95% CI: -5.22 to -2.43) (eTable 3). Length of Hospital Stay Nine studies [ 3 , 17 , 20 , 23 – 28 ] reported data on the length of hospital stay. The results indicated that the ULIF group had a significantly shorter hospital stay compared with the MIS-TLIF group (SMD = -1.02, 95% CI: -1.59 to -0.45, P = 0.00, I²=92.29%) (Fig. 7 ). To assess the robustness of the results, a leave-one-out sensitivity analysis was performed. The pooled SMD remained largely unchanged after excluding any single study (lowest SMD: -1.20, 95% CI: -1.72 to -0.69; highest SMD: -0.80, 95% CI: -2.72 to -1.18) (eFigure 11). Visual inspection of the funnel plot suggested symmetry, indicating no significant publication bias (eFigure 12). Discussion Principal findings This meta-analysis included 14 studies with a total of 1,158 patients, systematically comparing the efficacy and safety of ULIF versus MIS-TLIF in the treatment of LDD. The results demonstrated that ULIF was associated with significantly lower intraoperative blood loss and shorter hospital stay compared with MIS-TLIF, indicating reduced surgical trauma and faster postoperative recovery. However, ULIF required a significantly longer operative time, suggesting a higher technical complexity or a steeper learning curve. In terms of short-term postoperative pain relief, ULIF showed greater improvement in VAS and ODI scores, whereas no significant differences were observed between the two groups in long-term follow-up. Fusion rates were comparable between the groups, indicating that both procedures provide similar spinal stability. Comparison with Other Studies and Potential Mechanisms This study demonstrated that ULIF exhibited significant advantages in reducing intraoperative blood loss and shortening hospital stay. The shorter hospitalization observed with ULIF may be attributed to its truly minimally invasive nature and the dual-channel endoscopic technique [ 4 , 5 , 30 ]. Compared with MIS-TLIF, ULIF utilizes two small incisions to establish separate observation and working channels, minimizing paraspinal muscle and soft tissue dissection and retraction, thereby reducing postoperative pain and facilitating early mobilization and functional recovery [ 31 – 33 ]. These findings are consistent with those of Heo et al., who reported accelerated postoperative recovery in ULIF patients under the ERAS protocol [ 22 , 34 , 35 ]. Regarding intraoperative blood loss, our study further highlights the superiority of ULIF, which may be attributed to its continuous irrigation system. Saline irrigation not only provides a clear surgical field but also exerts hydrostatic pressure to assist hemostasis, effectively controlling bleeding from bone surfaces and the epidural venous plexus [ 32 , 36 – 38 ]. Furthermore, unlike MIS-TLIF, which requires sequential muscle dilation to establish the working channel, ULIF avoids muscle fiber tearing and sustained compression-induced ischemia, thereby reducing overall surgical trauma and blood loss from the outset [ 4 , 26 , 37 , 39 , 40 ]. This is supported by Yang et al., who found significantly lower intraoperative blood loss in ULIF patients compared to conventional minimally invasive fusion, particularly in multi-level or obese patients [ 4 , 5 , 31 , 41 ]. Although ULIF demonstrated superior short-term improvement in VAS and ODI scores (1–3 months postoperatively), long-term outcomes (≥ 6 months) in terms of functional recovery and pain relief did not differ significantly between the two procedures [ 5 , 30 , 42 ]. This may be related to the conventional advantages of MIS-TLIF in achieving adequate nerve root decompression and interbody fusion stability [ 43 – 45 ]. With tubular retractor systems and microscopic assistance, MIS-TLIF provides three-dimensional visualization and direct instrument handling, facilitating extensive scar removal, neural decompression, and large-volume bone grafting, which is particularly advantageous in cases with severe adhesions or complex deformities [ 46 ]. Although ULIF offers a broad endoscopic view and flexible instrument manipulation, it relies on two-dimensional imaging and is limited by incision positioning, posing technical challenges in extremely narrow spaces or cases requiring bilateral decompression; inadequate decompression may theoretically increase the risk of residual symptoms or recurrence [ 47 , 48 ]. Therefore, despite the early rehabilitation benefits of ULIF, MIS-TLIF may ensure more reliable long-term stability in certain complex degenerative cases [ 49 , 50 ]. Regarding complications, our study found no significant differences between ULIF and MIS-TLIF in terms of fusion rates, recurrence, or overall complication incidence. Notably, some studies have reported a relatively higher risk of dural tears during the early learning curve of ULIF, which is closely associated with the surgeon’s proficiency in anatomical recognition and instrument handling under endoscopy [ 51 , 52 ]. However, with the dissemination of techniques and the development of dedicated instruments (e.g., burrs, protective sleeves), this risk can be mitigated through training. Moreover, the smaller and more dispersed incisions in ULIF theoretically reduce incision-related complications [ 53 , 54 ]. While MIS-TLIF is technically mature, sustained muscular compression through the working channel may cause transient postoperative muscle weakness or back pain, which remains a concern [ 55 – 57 ]. Significance This study provides clinical reference evidence, indicating that ULIF offers significant advantages in reducing intraoperative blood loss and shortening hospital stay, making it particularly suitable for patients who are sensitive to surgical trauma and seek rapid recovery, such as elderly individuals, those with multiple comorbidities, or patients with urgent demands for returning to social activities. Although ULIF and MIS-TLIF demonstrate comparable long-term functional outcomes and overall safety, ULIF shows superior short- to mid-term pain relief and functional recovery due to better muscle preservation and milder postoperative acute responses. On the other hand, MIS-TLIF, with its wider operative field and well-established technical framework, remains reliable and stable for managing severe spondylolisthesis, complex revision cases, or multi-level fusion procedures. Therefore, clinical decision-making should comprehensively consider patient-specific pathology, surgeon expertise, and institutional resources to balance minimally invasiveness with surgical thoroughness, thereby formulating individualized procedures that best serve patient interests. Future studies should focus on conducting high-quality, multicenter randomized controlled trials, performing subgroup analyses for varying disease severity and age groups, and extending follow-up periods to further assess the long-term fusion stability and late complication risks of ULIF. Integration of health economic evaluations would further provide comprehensive evidence supporting the standardized application of minimally invasive spinal techniques. Strengths This meta-analysis has several notable strengths. First, to the best of our knowledge, it represents one of the largest meta-analyses to date comparing ULIF with MIS-TLIF for LDD. A total of 14 studies including 1,158 patients were included, comprehensively evaluating multiple outcomes such as operative time, blood loss, length of hospital stay, pain scores, functional disability indices, and fusion rates, thereby providing robust clinical evidence. Second, we employed a systematic literature search strategy without restrictions on language or publication date, querying major databases including PubMed, Embase, and the Cochrane Library, which maximized the inclusion of relevant cohort studies worldwide, reducing potential publication bias and enhancing the generalizability of our findings. Third, this study strictly adhered to the PRISMA guidelines, with the protocol prospectively registered on the PROSPERO platform. The quality of included studies was rigorously assessed using the NOS, ensuring transparency and methodological rigor. Fourth, for outcomes with substantial heterogeneity, we performed sensitivity analyses and publication bias adjustments (e.g., trim-and-fill method), and the pooled effect estimates remained stable, indicating the robustness of our conclusions. Limitations Nevertheless, several limitations should be acknowledged. First, substantial heterogeneity was observed for multiple outcomes, including operative time and blood loss (I² > 90%), which may be attributed to variations in surgical techniques, surgeon experience, patient inclusion criteria, follow-up duration, and rehabilitation protocols across studies. Although sensitivity analyses suggested overall robustness, the lack of individual patient data precluded further subgroup analyses on potential confounders such as surgeon experience, affected spinal levels, or prior surgeries, which should be addressed in future research. Second, all included studies were observational in design, with only one prospective cohort study, limiting the ability to fully control for confounding and precluding causal inference regarding differences in efficacy between ULIF and MIS-TLIF. Future large-scale, multicenter, well-designed randomized controlled trials with long-term follow-up, particularly focusing on different patient subgroups, are warranted to further validate our findings. Conclusion This meta-analysis indicates that both ULIF and MIS-TLIF are effective surgical options for LDD. ULIF offers advantages in reducing hospital stay, intraoperative blood loss, and short-term postoperative pain, although it requires longer operative time. Both techniques yield similarly high fusion rates and comparable long-term pain relief. Declarations Informed consent This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required. Competing interests: The authors declare no potential conflicts of interest. Data availability: The data that support the findings of this study are available on request from the corresponding author. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Consent for publication: Not applicable Consent to participate: Not applicable Ethical approval: Not applicable Clinical trial number: Not applicable Disclosure statement The authors declare no potential conflicts of interest. Funding: This work was supported by the Health and Family Planning Commission Program of Hunan Province (no. 202204074707), and the Health and Family Planning Commission Program of Wuhan City (no. WX18C29). Author contributions: Study concept and design (ML, WL); Acquisition of data (WL, ZZ, JH, YC, WL, YT, YX, YL, XS, WW, PL); Analysis and interpretation of data (ML, CW); Drafting of the manuscript (ML, WL, ZZ, JH); Critical revision of the manuscript for important intellectual content (all authors); Study supervision (ML, WL, SL, XZ). References Bydon, M., M.A. Alvi, and A. Goyal, Degenerative Lumbar Spondylolisthesis: Definition, Natural History, Conservative Management, and Surgical Treatment. Neurosurg Clin N Am, 2019. 30 (3): p. 299-304. Liu, F., et al., Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases. Indian J Orthop, 2014. 48 (4): p. 374-9. Xu, H., et al., Comparison of Outcomes Between Endoscopic Transforaminal Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Degenerative Disease: A Retrospective Study. World Neurosurgery, 2024. 183 : p. e98-e108. He, Y., Q. Cheng, and J. She, Unilateral biportal endoscopic lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for single-segment lumbar degenerative disease: a meta-analysis. BMC Musculoskeletal Disorders, 2024. 25 (1). Akeda, K., et al., Comparison of mid-term outcomes between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level lumbar degenerative disease. PLOS One, 2025. 20 (4). Cao, S., et al., Oblique lateral interbody fusion (OLIF) compared with unilateral biportal endoscopic lumbar interbody fusion (ULIF) for degenerative lumbar spondylolisthesis: a 2-year follow-up study. Journal of Orthopaedic Surgery and Research, 2023. 18 (1). Gatam, A.R., et al., Unilateral Biportal Endoscopic Lumbar Interbody Fusion: A Technical Note and an Outcome Comparison with the Conventional Minimally Invasive Fusion. Orthopedic Research and Reviews, 2021. Volume 13 : p. 229-239. Ge, M., et al., Comparison of hidden blood loss and clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion. International Orthopaedics, 2022. 46 (9): p. 2063-2070. . Lener, S., et al., Defining the MIS-TLIF: A Systematic Review of Techniques and Technologies Used by Surgeons Worldwide. Global Spine Journal, 2020. 10 (2_suppl): p. 151S-167S. Yang, H., et al., Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis. Front Neurol, 2022. 13 : p. 1089981. Zhang, X., et al., Comparison of mid-term outcomes between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level lumbar degenerative disease. PLoS One, 2025. 20 (4): p. e0321569. Li, Y., et al., Comparison of efficacy between unilateral biportal endoscopic lumbar fusion versus minimally invasive transforaminal lumbar fusion in the treatment of lumbar degenerative diseases: A systematic review and meta-analysis. Medicine (Baltimore), 2023. 102 (34): p. e34705. He, Y., Q. Cheng, and J. She, Unilateral biportal endoscopic lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for single-segment lumbar degenerative disease: a meta-analysis. BMC Musculoskelet Disord, 2024. 25 (1): p. 938. Zhu, Z., et al., Unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of degenerative lumbar spondylolisthesis: a retrospective analysis. BMC Musculoskelet Disord, 2025. 26 (1): p. 526. Gatam, A.R., et al., Unilateral Biportal Endoscopic Lumbar Interbody Fusion: A Technical Note and an Outcome Comparison with the Conventional Minimally Invasive Fusion. Orthop Res Rev, 2021. 13 : p. 229-239. Arunakul, R., et al., Unilateral biportal endoscopic versus microscopic transforaminal lumbar interbody fusion for lumbar degenerative disease: a retrospective study. Journal of Orthopaedic Surgery and Research, 2024. 19 (1). Page, M.J., et al., The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. International Journal of Surgery, 2021. 88 . Stang, A., Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology, 2010. 25 (9): p. 603-605. Guo, W., et al., Clinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up. Journal of Orthopaedic Surgery and Research, 2023. 18 (1). Song, X., et al., Clinical Efficacy of Bilateral Decompression Using Biportal Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases. World Neurosurgery, 2023. 173 : p. e371-e377. Heo, D.H. and C.K. Park, Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery. Neurosurgical Focus, 2019. 46 (4). Kim, J.-E., Comparison of Minimal Invasive Versus Biportal Endoscopic Transforaminal Lumbar Interbody Fusion for Single-level Lumbar Disease.pdf. 2021. Chen, H., et al., Comparison of minimally invasive transforaminal lumbar interbody fusion and endoscopic lumbar interbody fusion for lumbar degenerative diseases: a retrospective observational study. Journal of Orthopaedic Surgery and Research, 2023. 18 (1). Ao, S., et al., Comparison of Preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: Is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study. International Journal of Surgery, 2020. 76 : p. 136-143. Huang, X., et al., Comparison of surgical invasiveness, hidden blood loss, and clinical outcome between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a retrospective cohort study. BMC Musculoskeletal Disorders, 2023. 24 (1). Zhao, X.b., et al., Early Clinical Evaluation of Percutaneous Full‐endoscopic Transforaminal Lumbar Interbody Fusion with Pedicle Screw Insertion for Treating Degenerative Lumbar Spinal Stenosis. Orthopaedic Surgery, 2021. 13 (1): p. 328-337. Kang, M.-S., et al., Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. The Spine Journal, 2021. 21 (12): p. 2066-2077. Zhang, H., et al., Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: Technique Note and Comparison of Early Outcomes with Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis. International Journal of General Medicine, 2021. Volume 14 : p. 549-558. Han, H., et al., Short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 2023. 18 (1). Yang, H., et al., Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis. Frontiers in Neurology, 2023. 13 . Kim, J.-E., et al., Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis. Asian Spine Journal, 2019. 13 (2): p. 334-342. Pao, J.-L., Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Double Cages: Surgical Techniques and Treatment Outcomes. Neurospine, 2023. 20 (1): p. 80-91. Heo, D.H., J.W. Jang, and C.K. Park, Enhanced recovery after surgery pathway with modified biportal endoscopic transforaminal lumbar interbody fusion using a large cage. Comparative study with minimally invasive microscopic transforaminal lumbar interbody fusion. European Spine Journal, 2023. 32 (8): p. 2853-2862. Dai, M., et al., Enhanced recovery after unilateral biportal endoscopic lumbar interbody fusion combined with unilateral biportal endoscopy for the treatment of severe lumbar spinal stenosis. Asian Journal of Surgery, 2024. 47 (5): p. 2435-2437. Ju, C.I. and S.M. Lee, Complications and Management of Endoscopic Spinal Surgery. Neurospine, 2023. 20 (1): p. 56-77. Kim, D.-G., et al., Comparison of Hidden Blood Loss in Biportal Endoscopic Spine Surgery and Open Surgery in the Lumbar Spine: A Retrospective Multicenter Study. Journal of Clinical Medicine, 2025. 14 (11). Zhu, Z., et al., Unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of degenerative lumbar spondylolisthesis: a retrospective analysis. BMC Musculoskeletal Disorders, 2025. 26 (1). Tabaraee, E., et al., Quantification of Multifidus Atrophy and Fatty Infiltration Following a Minimally Invasive Microdiscectomy. International Journal of Spine Surgery, 2015. 9 . Ahn, J.-S., et al., Multifidus Muscle Changes After Biportal Endoscopic Spinal Surgery: Magnetic Resonance Imaging Evaluation. World Neurosurgery, 2019. 130 : p. e525-e534. Ma, T., et al., Unilateral biportal endoscopic vs. open surgery in the treatment of young obese patients’ lumbar degenerative diseases: a retrospective study. Frontiers in Surgery, 2024. 11 . Yang, L., et al., A Novel Unilateral Bi/Multi‐Portal Endoscopic Transforaminal Interbody Fusion Utilizing Uniaxial Spinal Endoscope Instead of Arthroscope: Technical Note and Preliminary Clinical Results. Orthopaedic Surgery, 2024. 17 (1): p. 192-201. Wang, Y., et al., Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis. Bmj, 2020. Zhai, W.-J., et al., Comparison between minimally invasive and open transforaminal lumbar interbody fusion for the treatment of multi‑segmental lumbar degenerative disease: A systematic evaluation and meta‑analysis. Experimental and Therapeutic Medicine, 2024. 27 (4). Zhang, X., et al., Comparison of midline lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion for treatment of lumbar degeneration disease. Scientific Reports, 2024. 14 (1). Zhang, J., et al., Comparative study on the technique and efficacy of microscope-assisted MI-TLIF and naked-eye MI-TLIF in lumbar revision surgery. Journal of Orthopaedic Surgery and Research, 2024. 19 (1). Park, M.-K., et al., Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up. Neurosurgical Review, 2019. 42 (3): p. 753-761. Heo, D.H., et al., Technique of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion. Neurospine, 2020. 17 (Suppl 1): p. S129-S137. Zhuo, C., et al., Comparison of the short-term efficacy of MIS-TLIF and Endo-LIF for the treatment of two-segment lumbar degenerative disease. BMC Musculoskeletal Disorders, 2024. 25 (1). Ahn, Y., et al., Learning curve for minimally invasive transforaminal lumbar interbody fusion: a systematic review. European Spine Journal, 2022. 31 (12): p. 3551-3559. Wu, K., et al., Evolving Paradigms in Spinal Surgery: A Systematic Review of the Learning Curves in Minimally Invasive Spine Techniques. Neurospine, 2024. 21 (4): p. 1251-1275. Guo, W., et al., Evaluation of the learning curve and complications in unilateral biportal endoscopic transforaminal lumbar interbody fusion: cumulative sum analysis and risk-adjusted cumulative sum analysis. Journal of Orthopaedic Surgery and Research, 2024. 19 (1). Liu, S.-X., et al., Unilateral biportal endoscopic spine surgery: a meta-analysis unveiling the learning curve and clinical benefits. Frontiers in Surgery, 2024. 11 . Demirtaş, O.K. and M.İ. Özer, Unilateral biportal endoscopic discectomy for lumbar disc herniation: Learning curve analysis with CUSUM analysis and clinical outcomes. Clinical Neurology and Neurosurgery, 2025. 249 . Hu, W., et al., The Degeneration of Paraspinal Muscles and Its Correlation with the Postoperative Clinical Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF). Journal of Pain Research, 2025. Volume 18 : p. 1827-1836. Cummock, M.D., et al., An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion. Journal of Neurosurgery: Spine, 2011. 15 (1): p. 11-18. Fessler, R., et al., Bilateral neurological deficits following unilateral minimally invasive TLIF: A review of four patients. Surgical Neurology International, 2014. 5 (8). Additional Declarations No competing interests reported. Supplementary Files 6.SupplementaryMaterials.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 18 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviews received at journal 13 Mar, 2026 Reviewers agreed at journal 13 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviewers invited by journal 09 Mar, 2026 Editor assigned by journal 04 Mar, 2026 Submission checks completed at journal 27 Feb, 2026 First submitted to journal 25 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8966841","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":604502714,"identity":"a94a4549-ded6-4a15-8f13-d538fdf6701a","order_by":0,"name":"Mingjiang 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhihong","middleName":"","lastName":"Xiao","suffix":""}],"badges":[],"createdAt":"2026-02-25 10:55:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8966841/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8966841/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104583690,"identity":"d670f4ec-f5a6-4aa4-96fe-25e361301fd9","added_by":"auto","created_at":"2026-03-13 15:22:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1216558,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram of the study selection process.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8966841/v1/568c589b1a83d4ab5f26009b.png"},{"id":104583694,"identity":"81600d62-aa08-4d0b-8cc1-f1da12d294b4","added_by":"auto","created_at":"2026-03-13 15:22:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26367733,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of the pooled analysis for fusion rate.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8966841/v1/22a0b02f494e9817648dd136.png"},{"id":104583696,"identity":"a8a2df13-eda2-4924-9024-b52585d3e26c","added_by":"auto","created_at":"2026-03-13 15:22:32","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":65182421,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of the pooled analysis for VAS-back scores.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8966841/v1/041d298676cc8d1ef2eb263d.png"},{"id":104781613,"identity":"de5cd730-4167-4cd7-84fa-b7711c28185a","added_by":"auto","created_at":"2026-03-17 07:56:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":78050714,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of the pooled analysis for ODI scores.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-8966841/v1/94a2d4b525abcdeaaf2926ef.png"},{"id":104583693,"identity":"e519263b-3030-482d-879e-cf5224a95cab","added_by":"auto","created_at":"2026-03-13 15:22:31","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1521753,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of the pooled analysis for operative time.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-8966841/v1/6e084cf13d82771307be8f1e.png"},{"id":104583691,"identity":"3fcf7d6a-2246-4273-bed1-07a3d98d628b","added_by":"auto","created_at":"2026-03-13 15:22:31","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1610830,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of the pooled analysis for blood loss.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-8966841/v1/47571f28510e7829d0cb6a24.png"},{"id":104781278,"identity":"1841ca68-38d0-4073-a12e-efa6895e42d7","added_by":"auto","created_at":"2026-03-17 07:55:17","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":1415343,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of the pooled analysis for length of hospital stay\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-8966841/v1/3ecbe1d3a39fceb9dc9f7a7a.png"},{"id":104583698,"identity":"500447df-1338-403a-acd1-dbc9a1e8ad26","added_by":"auto","created_at":"2026-03-13 15:22:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":42989149,"visible":true,"origin":"","legend":"","description":"","filename":"6.SupplementaryMaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-8966841/v1/48456f67d36e818935f9d713.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unilateral Laminotomy for Interbody Fusion versus Minimally Invasive TLIF for Lumbar Degenerative Diseases: A Quantitative Analysis of 14 Cohort Studies Involving 1,158 Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLumbar degenerative disease (LDD) is a common spinal disorder characterized by low back pain, radiating leg pain, lower-limb numbness or weakness, and restricted mobility, all of which significantly impair patients\u0026rsquo; daily functioning and overall health status[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Many patients respond poorly to conservative management and eventually require surgical intervention due to markedly reduced quality of life[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. With changes in lifestyle and a rapidly aging population, the prevalence of LDD continues to rise, imposing a substantial burden on both patient well-being and socioeconomic resources[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For patients with LDD complicated by spondylolisthesis or severe degeneration, lumbar interbody fusion (LIF) is often indicated. The most widely used minimally invasive LIF techniques include unilateral laminotomy for interbody fusion (ULIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eULIF utilizes a lateral or oblique approach that avoids major neurovascular structures and allows interbody preparation and grafting outside the spinal canal, typically combined with pedicle screw or lateral screw fixation[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The technique offers several advantages, such as smaller incisions, improved endoscopic visualization, reduced inflammatory response, and faster postoperative pain relief and functional recovery[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, ULIF is associated with a higher risk of complications\u0026mdash;including dural tears, nerve root injury, and newly developed radicular pain\u0026mdash;and requires advanced surgical expertise with a relatively long learning curve[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMIS-TLIF is performed through a transforaminal approach using a minimally invasive tubular retractor system to achieve decompression, interbody preparation, and fusion, supplemented by pedicle screw fixation[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Its advantages include reduced surgical trauma, less intraoperative blood loss, faster recovery, and shorter hospital stays[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Nonetheless, MIS-TLIF may be limited by restricted working space and visualization, as well as tissue damage or muscle compression caused by tubular dilators[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExisting studies have reported inconsistent findings regarding the relative efficacy and safety of ULIF and MIS-TLIF. Some evidence suggests that ULIF minimizes muscle retraction, reduces intraoperative blood loss, shortens muscle ischemia and denervation time, and leads to superior early postoperative pain improvement compared with MIS-TLIF[\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Conversely, other studies report comparable intraoperative bleeding, postoperative drainage volume, length of hospital stay, and postoperative pain improvement between the two techniques[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Given these conflicting results, we conducted a systematic review and meta-analysis to comprehensively evaluate the efficacy and safety of ULIF versus MIS-TLIF in the treatment of LDD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eProtocol Approval, Registration, and Patient Consent\u003c/h2\u003e \u003cp\u003eThis study was conducted in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The review protocol has been prospectively registered in PROSPERO.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eTwo independent investigators systematically searched PubMed, Embase, and the Cochrane Library for studies related to ULIF, MIS-TLIF, and LDD. The search included articles published up to April 15, 2025, with no restrictions on publication date. A predefined search strategy and specific combinations of terms were used, including (\u0026ldquo;Spine/surgery\u0026rdquo; OR \u0026ldquo;Endoscopy\u0026rdquo; OR \u0026ldquo;Spinal Stenosis\u0026rdquo;) AND (\u0026ldquo;Spinal Fusion\u0026rdquo; OR \u0026ldquo;Minimally Invasive Surgical Procedures\u0026rdquo; OR \u0026ldquo;Endoscopes\u0026rdquo; OR \u0026ldquo;Full-endoscopic surgery\u0026rdquo;) AND (\u0026ldquo;Low back pain\u0026rdquo; OR \u0026ldquo;Intervertebral Disc Degeneration/surgery\u0026rdquo; OR \u0026ldquo;Intervertebral Disc Displacement\u0026rdquo;) (eTable 1).\u003c/p\u003e \u003cp\u003eTo minimize the risk of missing potentially relevant studies, the investigators also performed a manual search using Google Scholar to identify additional eligible articles. Any disagreements during study selection were resolved through consultation with a third independent reviewer.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003eKeywords were developed based on the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) framework, which guided the formulation of the search strategy. Two reviewers independently assessed the eligibility of identified studies according to predefined criteria. Studies were included if they investigated patients with LDD undergoing ULIF or MIS-TLIF.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePopulation\u003c/b\u003e: Patients diagnosed with LDD\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eIntervention\u003c/b\u003e: ULIF.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eComparison\u003c/b\u003e: MIS-TLIF.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eOutcomes\u003c/b\u003e: Fusion rate, Oswestry Disability Index (ODI), visual analogue scale (VAS), infection, dural tear, epidural hematoma, operative time (minutes), intraoperative blood loss (mL), length of hospital stay (days), and recurrence rate. Effect sizes were reported as standardized mean differences (SMDs) or odds ratios (ORs) with corresponding 95% confidence intervals (CIs).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eStudy Design\u003c/b\u003e: Prospective or retrospective cohort studies.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe following were excluded: meta-analyses, non-English publications, studies involving duplicate populations, case reports, and studies lacking sufficient data for analysis.\u003c/p\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eData extraction will be performed independently by two reviewers using a predefined extraction form (Excel, Office 2016). The extracted information will include the first author, year of publication, study design, country, study period, sample size, mean age, proportion of female participants, follow-up duration, surgical level, disease type, outcome measures, and complications. When feasible, the corresponding authors of the original studies will be contacted to obtain missing data. To ensure accuracy and consistency, all extracted data will undergo cross-verification, and any discrepancies will be resolved through consultation with a third independent reviewer.\u003c/p\u003e\n\u003ch3\u003eQuality Assessment\u003c/h3\u003e\n\u003cp\u003eTo ensure the reliability and validity of the synthesized evidence, all included studies were rigorously assessed for risk of bias. Two reviewers independently evaluated each eligible study using the Newcastle\u0026ndash;Ottawa Scale (NOS), which considers three domains: selection of participants, comparability of study groups, and outcome assessment. Each study could receive a maximum score of 9, with scores of 6\u0026ndash;7 indicating low-quality studies and scores of 8\u0026ndash;9 indicating high-quality studies. Lower scores represent a higher risk of bias, whereas higher scores indicate a lower risk of bias [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll data in this study were analyzed using Stata software (version 17.0; StataCorp, College Station, TX, USA). The I\u0026sup2; statistic (ranging from 0 to 100%) was used to quantify heterogeneity among studies. An I\u0026sup2; value\u0026thinsp;\u0026ge;\u0026thinsp;50% was considered indicative of significant heterogeneity, in which case a random-effects model was applied; otherwise, a fixed-effects model was used. Pooled ORs with 95% CIs were calculated to evaluate differences in postoperative outcomes between ULIF and MIS-TLIF for LDD. Continuous outcomes, including operative time, blood loss, length of hospital stay, fusion rate, VAS scores, and ODI scores, were assessed using SMDs with 95% CIs. Publication bias was evaluated visually using funnel plots and quantitatively using Begg\u0026rsquo;s and Egger\u0026rsquo;s tests. Sensitivity analyses, performed by sequentially excluding individual studies, were used to assess the stability of the results and explore sources of heterogeneity. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eLiterature Search\u003c/h2\u003e \u003cp\u003eAn initial literature search identified 19,430 records, of which 16,396 remained after removing duplicates. Following screening of titles, abstracts, and full texts, 40 studies were initially considered for inclusion. Full texts were retrieved for 32 studies, while 8 studies were excluded due to unavailability. After full-text review, 4 meta-analyses, 9 non-English articles, 3 studies with insufficient outcome data, and 2 irrelevant studies were further excluded. Ultimately, 14 studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], including 1,158 participants (mean sample size\u0026thinsp;=\u0026thinsp;83), met the inclusion criteria for the present meta-analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and eTable 2).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy Characteristics\u003c/h2\u003e \u003cp\u003eThe baseline characteristics of the included studies are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Seven studies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] were published after 2021, while seven studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] were published before 2021. Thirteen studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] were retrospective cohort studies, and one study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] was a prospective cohort study. Among the 14 included studies, 78.6% (11/14) achieved a NOS score\u0026thinsp;\u0026ge;\u0026thinsp;8, indicating high methodological quality (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Sample sizes ranged from 49 to 145 participants, with a mean of 83 participants per study. The mean age of participants ranged from 52.3 to 70.5 years. The minimum follow-up duration was 12 months, and the maximum was 30.7 months, with a mean follow-up of 15.89 months. Nine studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] were conducted in China, three studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] in South Korea, one study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] in Thailand, and one study [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] in Indonesia. Ten studies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] included patients with spondylolisthesis with stenosis or instability, one study [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] included patients with lumbar spinal stenosis, and three studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] involved other specific conditions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of studies included in meta-analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst author\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObservation Period\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAverage age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeo, Dong Hwa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2016.02-2017.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:23\u003c/p\u003e \u003cp\u003eMIS-TLIF:46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:61.4\u003c/p\u003e \u003cp\u003eMIS-TLIF:63.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:69.6\u003c/p\u003e \u003cp\u003eMIS-TLIF:58.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGe, M.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2017.10-2019.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:41\u003c/p\u003e \u003cp\u003eMIS-TLIF:43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:59.6\u003c/p\u003e \u003cp\u003eMIS-TLIF:62.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:48.8\u003c/p\u003e \u003cp\u003eMIS-TLIF:55.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim, J. E.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2015\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:32\u003c/p\u003e \u003cp\u003eMIS-TLIF:55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:70.5\u003c/p\u003e \u003cp\u003eMIS-TLIF:67.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:46.8\u003c/p\u003e \u003cp\u003eMIS-TLIF:54.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2019.01-2021.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:48\u003c/p\u003e \u003cp\u003eMIS-TLIF:51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:57.65\u003c/p\u003e \u003cp\u003eMIS-TLIF:57.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:45.8\u003c/p\u003e \u003cp\u003eMIS-TLIF:41.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXu, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2019.01-2021.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:55\u003c/p\u003e \u003cp\u003eMIS-TLIF:55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:60.23\u003c/p\u003e \u003cp\u003eMIS-TLIF:60.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:43.64\u003c/p\u003e \u003cp\u003eMIS-TLIF:47.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAo, S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProspective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2018.04-2018.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:35\u003c/p\u003e \u003cp\u003eMIS-TLIF:40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:52.8\u003c/p\u003e \u003cp\u003eMIS-TLIF:53.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:54.29\u003c/p\u003e \u003cp\u003eMIS-TLIF:45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuang, X.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2022.08-2021.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:38\u003c/p\u003e \u003cp\u003eMIS-TLIF:44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:60.13\u003c/p\u003e \u003cp\u003eMIS-TLIF:59.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:42.1\u003c/p\u003e \u003cp\u003eMIS-TLIF:40.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhao, X. B.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2017.06-2018.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:40\u003c/p\u003e \u003cp\u003eMIS-TLIF:38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:56.93\u003c/p\u003e \u003cp\u003eMIS-TLIF:57.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:42.5\u003c/p\u003e \u003cp\u003eMIS-TLIF:47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKang, M. S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2018.03-2019.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:47\u003c/p\u003e \u003cp\u003eMIS-TLIF:32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:66.87\u003c/p\u003e \u003cp\u003eMIS-TLIF:66.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:63.8\u003c/p\u003e \u003cp\u003eMIS-TLIF:46.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhang, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2019.05-2019.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:32\u003c/p\u003e \u003cp\u003eMIS-TLIF:30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:53.1\u003c/p\u003e \u003cp\u003eMIS-TLIF:55.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:62.5\u003c/p\u003e \u003cp\u003eMIS-TLIF:53.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArunakul, R.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThailand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2012.01-2023.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:34\u003c/p\u003e \u003cp\u003eMIS-TLIF:56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:61.26\u003c/p\u003e \u003cp\u003eMIS-TLIF:62.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:73.53\u003c/p\u003e \u003cp\u003eMIS-TLIF:76.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGatam, Asrafi Rizki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndonesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2016.01-2020.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:72\u003c/p\u003e \u003cp\u003eMIS-TLIF:73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:55.1\u003c/p\u003e \u003cp\u003eMIS-TLIF:52.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:36.8\u003c/p\u003e \u003cp\u003eMIS-TLIF:63.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSong, Xin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2019.05-2021.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:25\u003c/p\u003e \u003cp\u003eMIS-TLIF:24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:52.36\u003c/p\u003e \u003cp\u003eMIS-TLIF:56.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:64\u003c/p\u003e \u003cp\u003eMIS-TLIF:66.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuo, Wenlong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2019.09-2021.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULIF:26\u003c/p\u003e \u003cp\u003eMIS-TLIF:23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eULIF:64.15\u003c/p\u003e \u003cp\u003eMIS-TLIF:66.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULIF:53.8\u003c/p\u003e \u003cp\u003eMIS-TLIF:56.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of studies included in meta-analysis (Continued).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst author\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up period\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurgery site\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDisease type\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeo, Dong Hwa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eODI, VAS, mean operative time, EBL, fusion rate, and Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHematoma, Dural tear, Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGrade 1 degenerative/isthmic spondylolisthesis, central stenosis with/without foraminal stenosis and instability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGe, M.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, JOA, Fusion and Complication, TBL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStenosis, grade I\u0026ndash;II spondylolisthesis, herniation with instability or recurrence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim, J. E.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL2\u0026ndash;L3, L3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, LOS, Fusion rate, Macnab, operative time, and Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDegenerative/lytic spondylolisthesis, central and foraminal stenosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3-4, L4-5, L5-S1, L3\u0026ndash;L5, L4\u0026ndash;S1, L2\u0026ndash;L5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eODI, VAS, operative time, blood loss, LOS, Complications, and Macnab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDural tears, Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePersistent symptoms post-conservative treatment, herniation with instability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXu, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOperation time, Blood loss, LOS, VAS, ODI, Fusion rate lordosis, and Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSingle-segment lumbar degenerative disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAo, S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, Operation time, LOS, Blood loss, Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMacnab, Fusion rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpondylolisthesis/instability with herniation or stenosis, single-level imaging-confirmed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuang, X.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, Operation time, LOS, Complications, Fusion rate, Macnab, Blood loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDural tears\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGrade I\u0026ndash;II spondylolisthesis, stenosis with spondylolisthesis/instability/herniation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhao, X. B.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.7 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, JOA, Operation time, Blood Loss, LOS, Macnab, Fusion rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumbar spinal stenosis, with or without disc herniation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKang, M. S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.01 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL2\u0026ndash;L3 ,L3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, and SF-36 scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHematoma, Dural tear, Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSingle/dual-segment stenosis with/without low-grade spondylolisthesis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhang, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, JOA, Operative time, Blood loss, Fusion rate,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGrade I/II spondylolisthesis with/without stenosis, single-segment instability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArunakul, R.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, Complication, Operation time, Blood loss, LOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHematoma, Dural tear, Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSingle or two-segment-level transforaminal lumbar interbody fusion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGatam, Asrafi Rizki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, SF-36, and Fusion rate.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDural tear, Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumbar spondylolisthesis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSong, Xin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.42 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, Macnab, and Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower limb numbness, muscle strength decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpinal stenosis, spondylolisthesis, instability, and disc herniation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuo, Wenlong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL3\u0026ndash;4, L4\u0026ndash;5, L5\u0026ndash;S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS, ODI, Operation time, Blood loss, Complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInfection, Dural tear, Hematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDegenerative Lumbar Spondylolisthesis with Lumbar Spinal Stenosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: EBL: Estimated Blood Loss, HBL: Hidden blood loss, JOA: Japanese Orthopedic Association, LOS: Length of Stay, MIS-TLIF: Minimally Invasive Transforaminal Lumbar Interbody Fusion, ODI: Oswestry Disability Index, SF-36: The Medical Outcomes Study 36-item Short-Form Health Survey, TBL: Total blood loss, ULIF: Unilateral Lumbar Interbody Fusion, VBL: Visible blood loss, VAS: Visual Analog Scale\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMethodological quality score of the included studies based on the Newcastle\u0026ndash;Ottawa Scale (NOS) tool.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003eSelection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eComparability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eExposure/Outcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk \u003c/p\u003e \u003cp\u003eof Bias\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRepresentativeness of cohort *\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSelection of control cohort *\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eAscertainment of exposure *\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eOutcome not present at start *\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eComparability of cohorts **\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eAssessment of outcome *\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003eLength of follow-up *\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003eAdequacy of follow-up *\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTotal score 9*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeo, Dong Hwa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGe, M.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim, J. E.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXu, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAo, S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProspective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuang, X.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhao, X. B.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKang, M. S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhang, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArunakul, R.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGatam, Asrafi Rizki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSong, Xin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuo, Wenlong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical Outcomes\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eFusion Rate\u003c/h2\u003e \u003cp\u003eEleven studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23 CR24 CR25 CR26 CR27 CR28\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] reported fusion outcomes in a total of 997 patients, with 480 patients in the ULIF group (445 achieved fusion) and 517 patients in the MIS-TLIF group (479 achieved fusion). The pooled fusion rate was 0.934 in the ULIF group (95% CI: 0.903\u0026ndash;0.960, P\u0026thinsp;=\u0026thinsp;0.176, I\u0026sup2; = 28.2%) and 0.937 in the MIS-TLIF group (95% CI: 0.899\u0026ndash;0.967, P\u0026thinsp;=\u0026thinsp;0.012, I\u0026sup2; = 55.7%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSubgroup analyses in the ULIF group revealed the following patterns: studies published more recently reported higher fusion rates (\u0026le;\u0026thinsp;2021: 0.91, 95% CI: 0.87\u0026ndash;0.95; \u0026gt;2021: 0.96, 95% CI: 0.93\u0026ndash;0.99); older patient age was associated with lower fusion rates (\u0026le;\u0026thinsp;60 years: 0.95, 95% CI: 0.91\u0026ndash;0.98; \u0026gt;60 years: 0.91, 95% CI: 0.86\u0026ndash;0.95); fusion rates were higher in China compared to Korea (China: 0.95, 95% CI: 0.92\u0026ndash;0.98; Korea: 0.88, 95% CI: 0.80\u0026ndash;0.94); and longer follow-up was associated with higher fusion rates (\u0026le;\u0026thinsp;12 months: 0.93, 95% CI: 0.89\u0026ndash;0.96; \u0026gt;12 months: 0.94, 95% CI: 0.88\u0026ndash;0.98) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubgroup analyses for the rate of fusion after ULIF.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. studies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRate of Fusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI\u0026sup2; (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP for heterogeneity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP for interaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.87 to 0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.93 to 0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91 to 0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86 to 0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88 to 0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89 to 0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.92 to 0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.80 to 0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89 to 0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88 to 0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNOS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.92 to 1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89 to 0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: CI: Confidence interval; CT: Computed tomograph; ULIF: Unilateral Laminotomy for Interbody Fusion;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNOS: Newcastle-Ottawa Scale\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the MIS-TLIF group, subgroup analyses based on publication year, patient age, region, follow-up duration, and NOS score revealed a significant reduction in heterogeneity, suggesting these factors may be potential sources of variability. Specifically, more recent studies reported higher fusion rates (\u0026le;\u0026thinsp;2021: 0.92, 95% CI: 0.86\u0026ndash;0.97; \u0026gt;2021: 0.96, 95% CI: 0.93\u0026ndash;0.99); older age was associated with lower fusion rates (\u0026le;\u0026thinsp;60 years: 0.96, 95% CI: 0.93\u0026ndash;0.98; \u0026gt;60 years: 0.91, 95% CI: 0.82\u0026ndash;0.96); fusion rates were higher in China than in Korea (China: 0.96, 95% CI: 0.94\u0026ndash;0.98; Korea: 0.86, 95% CI: 0.74\u0026ndash;0.95); and longer follow-up was associated with higher fusion rates (\u0026le;\u0026thinsp;12 months: 0.93, 95% CI: 0.87\u0026ndash;0.98; \u0026gt;12 months: 0.94, 95% CI: 0.91\u0026ndash;0.97) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubgroup analyses for the rate of fusion after MIS-TLIF.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. studies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eRate of fusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eI\u0026sup2; (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP for heterogeneity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP for interaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.86 to 0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.93 to 0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.93 to 0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.82 to 0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.936\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.89 to 0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.88 to 0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.94 to 0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.74 to 0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.795\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.87 to 0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e72.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.91 to 0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNOS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.92 to 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.89 to 0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e64.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: CI: Confidence interval; CT: Computed tomograph; MIS-TLIF: Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion; NOS: Newcastle-Ottawa Scale\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eVAS Scores\u003c/h2\u003e \u003cp\u003eA total of 10 studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] reported postoperative VAS scores. Meta-analysis demonstrated that the ULIF group had significantly lower VAS scores compared to the MIS-TLIF group at 1 month and 3 months postoperatively (1 month: SMD = -0.99, 95% CI: -1.32 to -0.66, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2; = 78.9%; 3 months: SMD = -0.45, 95% CI: -0.68 to -0.21, P\u0026thinsp;=\u0026thinsp;0.03, I\u0026sup2; = 53.8%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, no significant differences were observed at 6 months (SMD = -0.23, 95% CI: -0.50 to 0.03, P\u0026thinsp;=\u0026thinsp;0.83, I\u0026sup2; = 0.0%), 12 months (SMD = -0.24, 95% CI: -0.40 to -0.08, P\u0026thinsp;=\u0026thinsp;0.98, I\u0026sup2; = 0.0%), or at the final follow-up (SMD = -0.15, 95% CI: -0.37 to 0.07, P\u0026thinsp;=\u0026thinsp;0.86, I\u0026sup2; = 0.0%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe funnel plot for 1-month postoperative VAS scores initially suggested a slight rightward asymmetry (eFigure 1). Begg's test indicated potential publication bias (P\u0026thinsp;=\u0026thinsp;0.0042). After adjustment using the nonparametric trim-and-fill method, the funnel plot suggested one potentially missing study (eFigure 2), but the SMD remained largely unchanged (SMD = -1.09, 95% CI: -1.45 to -0.73). The funnel plot for 3-month postoperative VAS scores appeared approximately symmetrical, and Begg's test confirmed no significant publication bias (P\u0026thinsp;=\u0026thinsp;0.0635) (eTable 3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eODI Scores\u003c/h2\u003e \u003cp\u003eNine studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] reported postoperative ODI scores to evaluate the efficacy of ULIF versus MIS-TLIF. The results showed that at 1 month postoperatively, the ODI score in the ULIF group was significantly lower than that in the MIS-TLIF group (SMD: -0.61, 95% CI: -1.07 to -0.16, P\u0026thinsp;=\u0026thinsp;0.00, I\u0026sup2; = 87.37%). However, no significant differences were observed at 3 months (SMD: -0.25, 95% CI: -0.49 to -0.00, P\u0026thinsp;=\u0026thinsp;0.02, I\u0026sup2; = 57.29%), 6 months (SMD: -0.16, 95% CI: -0.57 to 0.24, P\u0026thinsp;=\u0026thinsp;0.20, I\u0026sup2; = 55.98%), 12 months (SMD: -0.06, 95% CI: -0.25 to 0.13, P\u0026thinsp;=\u0026thinsp;0.24, I\u0026sup2; = 24.64%), or at the final follow-up (SMD: -0.06, 95% CI: -0.28 to 0.15, P\u0026thinsp;=\u0026thinsp;0.42, I\u0026sup2; = 0.00%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eVisual inspection of the funnel plot suggested potential publication bias for the 1-month postoperative ODI (eFigure 3). This was further confirmed by Begg\u0026rsquo;s test (P\u0026thinsp;=\u0026thinsp;0.0354). To adjust for this bias, the trim-and-fill method was applied, incorporating two imputed missing studies (eFigure 4). After adjustment, the corrected result was SMD: -0.86, 95% CI: -1.36 to -0.35, which was consistent with the initial analysis, thereby confirming the robustness of the findings (eTable 3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Outcomes\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003eOperative Time\u003c/h2\u003e \u003cp\u003eThirteen studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] including a total of 1,013 patients (476 in the ULIF group and 537 in the MIS-TLIF group) reported operative time. Pooled analysis demonstrated that the ULIF group had significantly longer operative time compared with the MIS-TLIF group (SMD\u0026thinsp;=\u0026thinsp;1.87, 95% CI: 1.15\u0026ndash;2.59, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2; = 95.64%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSensitivity analysis using the leave-one-out method confirmed the robustness of the results, as exclusion of any single study did not substantially alter the pooled SMD (range: 1.52\u0026ndash;2.04, 95% CI: 0.89\u0026ndash;2.76) (eFigure 5). Funnel plot inspection suggested a slight rightward asymmetry (eFigure 6), and Begg\u0026rsquo;s test indicated potential publication bias (P\u0026thinsp;=\u0026thinsp;0.0327). To further assess the impact of publication bias, the Trim-and-Fill (T-F) method was applied, adding three hypothetical missing studies (eFigure 7). The adjusted pooled effect size remained consistent with the original results (SMD\u0026thinsp;=\u0026thinsp;2.39, 95% CI: 1.51\u0026ndash;3.26) (eTable 3).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eIntraoperative Blood Loss\u003c/h2\u003e \u003cp\u003eA total of 12 studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] involving 926 patients reported intraoperative blood loss. The pooled analysis demonstrated that blood loss in the ULIF group was significantly lower than in the MIS-TLIF group (SMD = -2.88, 95% CI: -3.78 to -1.97, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2; = 96.55%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo assess the robustness of the results, a leave-one-out sensitivity analysis was performed. Excluding any single study did not substantially alter the pooled SMD (range: -3.14, 95% CI: -4.09 to -2.20 to -2.03, 95% CI: -4.29 to -0.96) (eFigure 8).\u003c/p\u003e \u003cp\u003eVisual inspection of the funnel plot indicated asymmetry, suggesting potential publication bias (eFigure 9), which was confirmed by Begg\u0026rsquo;s test (P\u0026thinsp;=\u0026thinsp;0.0003). The trim-and-fill method was subsequently applied to adjust for potential bias, revealing three potentially missing studies (eFigure 10). After adjustment, the pooled effect remained consistent with the primary analysis (SMD = -3.82, 95% CI: -5.22 to -2.43) (eTable 3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLength of Hospital Stay\u003c/h2\u003e \u003cp\u003eNine studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] reported data on the length of hospital stay. The results indicated that the ULIF group had a significantly shorter hospital stay compared with the MIS-TLIF group (SMD = -1.02, 95% CI: -1.59 to -0.45, P\u0026thinsp;=\u0026thinsp;0.00, I\u0026sup2;=92.29%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo assess the robustness of the results, a leave-one-out sensitivity analysis was performed. The pooled SMD remained largely unchanged after excluding any single study (lowest SMD: -1.20, 95% CI: -1.72 to -0.69; highest SMD: -0.80, 95% CI: -2.72 to -1.18) (eFigure 11). Visual inspection of the funnel plot suggested symmetry, indicating no significant publication bias (eFigure 12).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ePrincipal findings\u003c/h2\u003e \u003cp\u003eThis meta-analysis included 14 studies with a total of 1,158 patients, systematically comparing the efficacy and safety of ULIF versus MIS-TLIF in the treatment of LDD. The results demonstrated that ULIF was associated with significantly lower intraoperative blood loss and shorter hospital stay compared with MIS-TLIF, indicating reduced surgical trauma and faster postoperative recovery. However, ULIF required a significantly longer operative time, suggesting a higher technical complexity or a steeper learning curve. In terms of short-term postoperative pain relief, ULIF showed greater improvement in VAS and ODI scores, whereas no significant differences were observed between the two groups in long-term follow-up. Fusion rates were comparable between the groups, indicating that both procedures provide similar spinal stability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eComparison with Other Studies and Potential Mechanisms\u003c/h2\u003e \u003cp\u003eThis study demonstrated that ULIF exhibited significant advantages in reducing intraoperative blood loss and shortening hospital stay. The shorter hospitalization observed with ULIF may be attributed to its truly minimally invasive nature and the dual-channel endoscopic technique [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Compared with MIS-TLIF, ULIF utilizes two small incisions to establish separate observation and working channels, minimizing paraspinal muscle and soft tissue dissection and retraction, thereby reducing postoperative pain and facilitating early mobilization and functional recovery [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. These findings are consistent with those of Heo et al., who reported accelerated postoperative recovery in ULIF patients under the ERAS protocol [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding intraoperative blood loss, our study further highlights the superiority of ULIF, which may be attributed to its continuous irrigation system. Saline irrigation not only provides a clear surgical field but also exerts hydrostatic pressure to assist hemostasis, effectively controlling bleeding from bone surfaces and the epidural venous plexus [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Furthermore, unlike MIS-TLIF, which requires sequential muscle dilation to establish the working channel, ULIF avoids muscle fiber tearing and sustained compression-induced ischemia, thereby reducing overall surgical trauma and blood loss from the outset [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This is supported by Yang et al., who found significantly lower intraoperative blood loss in ULIF patients compared to conventional minimally invasive fusion, particularly in multi-level or obese patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough ULIF demonstrated superior short-term improvement in VAS and ODI scores (1\u0026ndash;3 months postoperatively), long-term outcomes (\u0026ge;\u0026thinsp;6 months) in terms of functional recovery and pain relief did not differ significantly between the two procedures [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This may be related to the conventional advantages of MIS-TLIF in achieving adequate nerve root decompression and interbody fusion stability [\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. With tubular retractor systems and microscopic assistance, MIS-TLIF provides three-dimensional visualization and direct instrument handling, facilitating extensive scar removal, neural decompression, and large-volume bone grafting, which is particularly advantageous in cases with severe adhesions or complex deformities [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Although ULIF offers a broad endoscopic view and flexible instrument manipulation, it relies on two-dimensional imaging and is limited by incision positioning, posing technical challenges in extremely narrow spaces or cases requiring bilateral decompression; inadequate decompression may theoretically increase the risk of residual symptoms or recurrence [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Therefore, despite the early rehabilitation benefits of ULIF, MIS-TLIF may ensure more reliable long-term stability in certain complex degenerative cases [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding complications, our study found no significant differences between ULIF and MIS-TLIF in terms of fusion rates, recurrence, or overall complication incidence. Notably, some studies have reported a relatively higher risk of dural tears during the early learning curve of ULIF, which is closely associated with the surgeon\u0026rsquo;s proficiency in anatomical recognition and instrument handling under endoscopy [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. However, with the dissemination of techniques and the development of dedicated instruments (e.g., burrs, protective sleeves), this risk can be mitigated through training. Moreover, the smaller and more dispersed incisions in ULIF theoretically reduce incision-related complications [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. While MIS-TLIF is technically mature, sustained muscular compression through the working channel may cause transient postoperative muscle weakness or back pain, which remains a concern [\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eSignificance\u003c/h2\u003e \u003cp\u003eThis study provides clinical reference evidence, indicating that ULIF offers significant advantages in reducing intraoperative blood loss and shortening hospital stay, making it particularly suitable for patients who are sensitive to surgical trauma and seek rapid recovery, such as elderly individuals, those with multiple comorbidities, or patients with urgent demands for returning to social activities. Although ULIF and MIS-TLIF demonstrate comparable long-term functional outcomes and overall safety, ULIF shows superior short- to mid-term pain relief and functional recovery due to better muscle preservation and milder postoperative acute responses. On the other hand, MIS-TLIF, with its wider operative field and well-established technical framework, remains reliable and stable for managing severe spondylolisthesis, complex revision cases, or multi-level fusion procedures. Therefore, clinical decision-making should comprehensively consider patient-specific pathology, surgeon expertise, and institutional resources to balance minimally invasiveness with surgical thoroughness, thereby formulating individualized procedures that best serve patient interests. Future studies should focus on conducting high-quality, multicenter randomized controlled trials, performing subgroup analyses for varying disease severity and age groups, and extending follow-up periods to further assess the long-term fusion stability and late complication risks of ULIF. Integration of health economic evaluations would further provide comprehensive evidence supporting the standardized application of minimally invasive spinal techniques.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eStrengths\u003c/h2\u003e \u003cp\u003eThis meta-analysis has several notable strengths. First, to the best of our knowledge, it represents one of the largest meta-analyses to date comparing ULIF with MIS-TLIF for LDD. A total of 14 studies including 1,158 patients were included, comprehensively evaluating multiple outcomes such as operative time, blood loss, length of hospital stay, pain scores, functional disability indices, and fusion rates, thereby providing robust clinical evidence. Second, we employed a systematic literature search strategy without restrictions on language or publication date, querying major databases including PubMed, Embase, and the Cochrane Library, which maximized the inclusion of relevant cohort studies worldwide, reducing potential publication bias and enhancing the generalizability of our findings. Third, this study strictly adhered to the PRISMA guidelines, with the protocol prospectively registered on the PROSPERO platform. The quality of included studies was rigorously assessed using the NOS, ensuring transparency and methodological rigor. Fourth, for outcomes with substantial heterogeneity, we performed sensitivity analyses and publication bias adjustments (e.g., trim-and-fill method), and the pooled effect estimates remained stable, indicating the robustness of our conclusions.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eNevertheless, several limitations should be acknowledged. First, substantial heterogeneity was observed for multiple outcomes, including operative time and blood loss (I\u0026sup2; \u0026gt; 90%), which may be attributed to variations in surgical techniques, surgeon experience, patient inclusion criteria, follow-up duration, and rehabilitation protocols across studies. Although sensitivity analyses suggested overall robustness, the lack of individual patient data precluded further subgroup analyses on potential confounders such as surgeon experience, affected spinal levels, or prior surgeries, which should be addressed in future research. Second, all included studies were observational in design, with only one prospective cohort study, limiting the ability to fully control for confounding and precluding causal inference regarding differences in efficacy between ULIF and MIS-TLIF. Future large-scale, multicenter, well-designed randomized controlled trials with long-term follow-up, particularly focusing on different patient subgroups, are warranted to further validate our findings.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis meta-analysis indicates that both ULIF and MIS-TLIF are effective surgical options for LDD. ULIF offers advantages in reducing hospital stay, intraoperative blood loss, and short-term postoperative pain, although it requires longer operative time. Both techniques yield similarly high fusion rates and comparable long-term pain relief.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Health and Family Planning Commission Program of Hunan Province (no. 202204074707), and the Health and Family Planning Commission Program of Wuhan City (no. WX18C29).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept and design (ML, WL); Acquisition of data (WL, ZZ, JH, YC, WL, YT, YX, YL, XS, WW, PL); Analysis and interpretation of data (ML, CW); Drafting of the manuscript (ML, WL, ZZ, JH); Critical revision of the manuscript for important intellectual content (all authors); Study supervision (ML, WL, SL, XZ).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBydon, M., M.A. Alvi, and A. Goyal, \u003cem\u003eDegenerative Lumbar Spondylolisthesis: Definition, Natural History, Conservative Management, and Surgical Treatment.\u003c/em\u003e Neurosurg Clin N Am, 2019. \u003cstrong\u003e30\u003c/strong\u003e(3): p. 299-304.\u003c/li\u003e\n\u003cli\u003eLiu, F., et al., \u003cem\u003eTransforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases.\u003c/em\u003e Indian J Orthop, 2014. \u003cstrong\u003e48\u003c/strong\u003e(4): p. 374-9.\u003c/li\u003e\n\u003cli\u003eXu, H., et al., \u003cem\u003eComparison of Outcomes Between Endoscopic Transforaminal Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Degenerative Disease: A Retrospective Study.\u003c/em\u003e World Neurosurgery, 2024. \u003cstrong\u003e183\u003c/strong\u003e: p. e98-e108.\u003c/li\u003e\n\u003cli\u003eHe, Y., Q. Cheng, and J. She, \u003cem\u003eUnilateral biportal endoscopic lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for single-segment lumbar degenerative disease: a meta-analysis.\u003c/em\u003e BMC Musculoskeletal Disorders, 2024. \u003cstrong\u003e25\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eAkeda, K., et al., \u003cem\u003eComparison of mid-term outcomes between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level lumbar degenerative disease.\u003c/em\u003e PLOS One, 2025. \u003cstrong\u003e20\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eCao, S., et al., \u003cem\u003eOblique lateral interbody fusion (OLIF) compared with unilateral biportal endoscopic lumbar interbody fusion (ULIF) for degenerative lumbar spondylolisthesis: a 2-year follow-up study.\u003c/em\u003e Journal of Orthopaedic Surgery and Research, 2023. \u003cstrong\u003e18\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eGatam, A.R., et al., \u003cem\u003eUnilateral Biportal Endoscopic Lumbar Interbody Fusion: A Technical Note and an Outcome Comparison with the Conventional Minimally Invasive Fusion.\u003c/em\u003e Orthopedic Research and Reviews, 2021. \u003cstrong\u003eVolume 13\u003c/strong\u003e: p. 229-239.\u003c/li\u003e\n\u003cli\u003eGe, M., et al., \u003cem\u003eComparison of hidden blood loss and clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion.\u003c/em\u003e International Orthopaedics, 2022. \u003cstrong\u003e46\u003c/strong\u003e(9): p. 2063-2070.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e\u0026lt;Comparison of Minimal Invasive Versus Biportal Endoscopic Transforaminal Lumbar Interbody Fusion for Single-level Lumbar Disease.pdf\u0026gt;.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eLener, S., et al., \u003cem\u003eDefining the MIS-TLIF: A Systematic Review of Techniques and Technologies Used by Surgeons Worldwide.\u003c/em\u003e Global Spine Journal, 2020. \u003cstrong\u003e10\u003c/strong\u003e(2_suppl): p. 151S-167S.\u003c/li\u003e\n\u003cli\u003eYang, H., et al., \u003cem\u003eUnilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis.\u003c/em\u003e Front Neurol, 2022. \u003cstrong\u003e13\u003c/strong\u003e: p. 1089981.\u003c/li\u003e\n\u003cli\u003eZhang, X., et al., \u003cem\u003eComparison of mid-term outcomes between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level lumbar degenerative disease.\u003c/em\u003e PLoS One, 2025. \u003cstrong\u003e20\u003c/strong\u003e(4): p. e0321569.\u003c/li\u003e\n\u003cli\u003eLi, Y., et al., \u003cem\u003eComparison of efficacy between unilateral biportal endoscopic lumbar fusion versus minimally invasive transforaminal lumbar fusion in the treatment of lumbar degenerative diseases: A systematic review and meta-analysis.\u003c/em\u003e Medicine (Baltimore), 2023. \u003cstrong\u003e102\u003c/strong\u003e(34): p. e34705.\u003c/li\u003e\n\u003cli\u003eHe, Y., Q. Cheng, and J. She, \u003cem\u003eUnilateral biportal endoscopic lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for single-segment lumbar degenerative disease: a meta-analysis.\u003c/em\u003e BMC Musculoskelet Disord, 2024. \u003cstrong\u003e25\u003c/strong\u003e(1): p. 938.\u003c/li\u003e\n\u003cli\u003eZhu, Z., et al., \u003cem\u003eUnilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of degenerative lumbar spondylolisthesis: a retrospective analysis.\u003c/em\u003e BMC Musculoskelet Disord, 2025. \u003cstrong\u003e26\u003c/strong\u003e(1): p. 526.\u003c/li\u003e\n\u003cli\u003eGatam, A.R., et al., \u003cem\u003eUnilateral Biportal Endoscopic Lumbar Interbody Fusion: A Technical Note and an Outcome Comparison with the Conventional Minimally Invasive Fusion.\u003c/em\u003e Orthop Res Rev, 2021. \u003cstrong\u003e13\u003c/strong\u003e: p. 229-239.\u003c/li\u003e\n\u003cli\u003eArunakul, R., et al., \u003cem\u003eUnilateral biportal endoscopic versus microscopic transforaminal lumbar interbody fusion for lumbar degenerative disease: a retrospective study.\u003c/em\u003e Journal of Orthopaedic Surgery and Research, 2024. \u003cstrong\u003e19\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003ePage, M.J., et al., \u003cem\u003eThe PRISMA 2020 statement: An updated guideline for reporting systematic reviews.\u003c/em\u003e International Journal of Surgery, 2021. \u003cstrong\u003e88\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eStang, A., \u003cem\u003eCritical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.\u003c/em\u003e European Journal of Epidemiology, 2010. \u003cstrong\u003e25\u003c/strong\u003e(9): p. 603-605.\u003c/li\u003e\n\u003cli\u003eGuo, W., et al., \u003cem\u003eClinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up.\u003c/em\u003e Journal of Orthopaedic Surgery and Research, 2023. \u003cstrong\u003e18\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eSong, X., et al., \u003cem\u003eClinical Efficacy of Bilateral Decompression Using Biportal Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases.\u003c/em\u003e World Neurosurgery, 2023. \u003cstrong\u003e173\u003c/strong\u003e: p. e371-e377.\u003c/li\u003e\n\u003cli\u003eHeo, D.H. and C.K. Park, \u003cem\u003eClinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery.\u003c/em\u003e Neurosurgical Focus, 2019. \u003cstrong\u003e46\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eKim, J.-E., \u003cem\u003eComparison of Minimal Invasive Versus Biportal Endoscopic Transforaminal Lumbar Interbody Fusion for Single-level Lumbar Disease.pdf.\u003c/em\u003e 2021.\u003c/li\u003e\n\u003cli\u003eChen, H., et al., \u003cem\u003eComparison of minimally invasive transforaminal lumbar interbody fusion and endoscopic lumbar interbody fusion for lumbar degenerative diseases: a retrospective observational study.\u003c/em\u003e Journal of Orthopaedic Surgery and Research, 2023. \u003cstrong\u003e18\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eAo, S., et al., \u003cem\u003eComparison of Preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: Is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study.\u003c/em\u003e International Journal of Surgery, 2020. \u003cstrong\u003e76\u003c/strong\u003e: p. 136-143.\u003c/li\u003e\n\u003cli\u003eHuang, X., et al., \u003cem\u003eComparison of surgical invasiveness, hidden blood loss, and clinical outcome between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a retrospective cohort study.\u003c/em\u003e BMC Musculoskeletal Disorders, 2023. \u003cstrong\u003e24\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eZhao, X.b., et al., \u003cem\u003eEarly Clinical Evaluation of Percutaneous Full‐endoscopic Transforaminal Lumbar Interbody Fusion with Pedicle Screw Insertion for Treating Degenerative Lumbar Spinal Stenosis.\u003c/em\u003e Orthopaedic Surgery, 2021. \u003cstrong\u003e13\u003c/strong\u003e(1): p. 328-337.\u003c/li\u003e\n\u003cli\u003eKang, M.-S., et al., \u003cem\u003eMinimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique.\u003c/em\u003e The Spine Journal, 2021. \u003cstrong\u003e21\u003c/strong\u003e(12): p. 2066-2077.\u003c/li\u003e\n\u003cli\u003eZhang, H., et al., \u003cem\u003ePercutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: Technique Note and Comparison of Early Outcomes with Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis.\u003c/em\u003e International Journal of General Medicine, 2021. \u003cstrong\u003eVolume 14\u003c/strong\u003e: p. 549-558.\u003c/li\u003e\n\u003cli\u003eHan, H., et al., \u003cem\u003eShort-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis.\u003c/em\u003e Journal of Orthopaedic Surgery and Research, 2023. \u003cstrong\u003e18\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eYang, H., et al., \u003cem\u003eUnilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis.\u003c/em\u003e Frontiers in Neurology, 2023. \u003cstrong\u003e13\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eKim, J.-E., et al., \u003cem\u003eBiportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis.\u003c/em\u003e Asian Spine Journal, 2019. \u003cstrong\u003e13\u003c/strong\u003e(2): p. 334-342.\u003c/li\u003e\n\u003cli\u003ePao, J.-L., \u003cem\u003eBiportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Double Cages: Surgical Techniques and Treatment Outcomes.\u003c/em\u003e Neurospine, 2023. \u003cstrong\u003e20\u003c/strong\u003e(1): p. 80-91.\u003c/li\u003e\n\u003cli\u003eHeo, D.H., J.W. Jang, and C.K. Park, \u003cem\u003eEnhanced recovery after surgery pathway with modified biportal endoscopic transforaminal lumbar interbody fusion using a large cage. Comparative study with minimally invasive microscopic transforaminal lumbar interbody fusion.\u003c/em\u003e European Spine Journal, 2023. \u003cstrong\u003e32\u003c/strong\u003e(8): p. 2853-2862.\u003c/li\u003e\n\u003cli\u003eDai, M., et al., \u003cem\u003eEnhanced recovery after unilateral biportal endoscopic lumbar interbody fusion combined with unilateral biportal endoscopy for the treatment of severe lumbar spinal stenosis.\u003c/em\u003e Asian Journal of Surgery, 2024. \u003cstrong\u003e47\u003c/strong\u003e(5): p. 2435-2437.\u003c/li\u003e\n\u003cli\u003eJu, C.I. and S.M. Lee, \u003cem\u003eComplications and Management of Endoscopic Spinal Surgery.\u003c/em\u003e Neurospine, 2023. \u003cstrong\u003e20\u003c/strong\u003e(1): p. 56-77.\u003c/li\u003e\n\u003cli\u003eKim, D.-G., et al., \u003cem\u003eComparison of Hidden Blood Loss in Biportal Endoscopic Spine Surgery and Open Surgery in the Lumbar Spine: A Retrospective Multicenter Study.\u003c/em\u003e Journal of Clinical Medicine, 2025. \u003cstrong\u003e14\u003c/strong\u003e(11).\u003c/li\u003e\n\u003cli\u003eZhu, Z., et al., \u003cem\u003eUnilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of degenerative lumbar spondylolisthesis: a retrospective analysis.\u003c/em\u003e BMC Musculoskeletal Disorders, 2025. \u003cstrong\u003e26\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eTabaraee, E., et al., \u003cem\u003eQuantification of Multifidus Atrophy and Fatty Infiltration Following a Minimally Invasive Microdiscectomy.\u003c/em\u003e International Journal of Spine Surgery, 2015. \u003cstrong\u003e9\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eAhn, J.-S., et al., \u003cem\u003eMultifidus Muscle Changes After Biportal Endoscopic Spinal Surgery: Magnetic Resonance Imaging Evaluation.\u003c/em\u003e World Neurosurgery, 2019. \u003cstrong\u003e130\u003c/strong\u003e: p. e525-e534.\u003c/li\u003e\n\u003cli\u003eMa, T., et al., \u003cem\u003eUnilateral biportal endoscopic vs. open surgery in the treatment of young obese patients\u0026rsquo; lumbar degenerative diseases: a retrospective study.\u003c/em\u003e Frontiers in Surgery, 2024. \u003cstrong\u003e11\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eYang, L., et al., \u003cem\u003eA Novel Unilateral Bi/Multi‐Portal Endoscopic Transforaminal Interbody Fusion Utilizing Uniaxial Spinal Endoscope Instead of Arthroscope: Technical Note and Preliminary Clinical Results.\u003c/em\u003e Orthopaedic Surgery, 2024. \u003cstrong\u003e17\u003c/strong\u003e(1): p. 192-201.\u003c/li\u003e\n\u003cli\u003eWang, Y., et al., \u003cem\u003eEfficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis.\u003c/em\u003e Bmj, 2020.\u003c/li\u003e\n\u003cli\u003eZhai, W.-J., et al., \u003cem\u003eComparison between minimally invasive and open transforaminal lumbar interbody fusion for the treatment of multi‑segmental lumbar degenerative disease: A systematic evaluation and meta‑analysis.\u003c/em\u003e Experimental and Therapeutic Medicine, 2024. \u003cstrong\u003e27\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eZhang, X., et al., \u003cem\u003eComparison of midline lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion for treatment of lumbar degeneration disease.\u003c/em\u003e Scientific Reports, 2024. \u003cstrong\u003e14\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eZhang, J., et al., \u003cem\u003eComparative study on the technique and efficacy of microscope-assisted MI-TLIF and naked-eye MI-TLIF in lumbar revision surgery.\u003c/em\u003e Journal of Orthopaedic Surgery and Research, 2024. \u003cstrong\u003e19\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003ePark, M.-K., et al., \u003cem\u003eClinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up.\u003c/em\u003e Neurosurgical Review, 2019. \u003cstrong\u003e42\u003c/strong\u003e(3): p. 753-761.\u003c/li\u003e\n\u003cli\u003eHeo, D.H., et al., \u003cem\u003eTechnique of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion.\u003c/em\u003e Neurospine, 2020. \u003cstrong\u003e17\u003c/strong\u003e(Suppl 1): p. S129-S137.\u003c/li\u003e\n\u003cli\u003eZhuo, C., et al., \u003cem\u003eComparison of the short-term efficacy of MIS-TLIF and Endo-LIF for the treatment of two-segment lumbar degenerative disease.\u003c/em\u003e BMC Musculoskeletal Disorders, 2024. \u003cstrong\u003e25\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eAhn, Y., et al., \u003cem\u003eLearning curve for minimally invasive transforaminal lumbar interbody fusion: a systematic review.\u003c/em\u003e European Spine Journal, 2022. \u003cstrong\u003e31\u003c/strong\u003e(12): p. 3551-3559.\u003c/li\u003e\n\u003cli\u003eWu, K., et al., \u003cem\u003eEvolving Paradigms in Spinal Surgery: A Systematic Review of the Learning Curves in Minimally Invasive Spine Techniques.\u003c/em\u003e Neurospine, 2024. \u003cstrong\u003e21\u003c/strong\u003e(4): p. 1251-1275.\u003c/li\u003e\n\u003cli\u003eGuo, W., et al., \u003cem\u003eEvaluation of the learning curve and complications in unilateral biportal endoscopic transforaminal lumbar interbody fusion: cumulative sum analysis and risk-adjusted cumulative sum analysis.\u003c/em\u003e Journal of Orthopaedic Surgery and Research, 2024. \u003cstrong\u003e19\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eLiu, S.-X., et al., \u003cem\u003eUnilateral biportal endoscopic spine surgery: a meta-analysis unveiling the learning curve and clinical benefits.\u003c/em\u003e Frontiers in Surgery, 2024. \u003cstrong\u003e11\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eDemirtaş, O.K. and M.İ. \u0026Ouml;zer, \u003cem\u003eUnilateral biportal endoscopic discectomy for lumbar disc herniation: Learning curve analysis with CUSUM analysis and clinical outcomes.\u003c/em\u003e Clinical Neurology and Neurosurgery, 2025. \u003cstrong\u003e249\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eHu, W., et al., \u003cem\u003eThe Degeneration of Paraspinal Muscles and Its Correlation with the Postoperative Clinical Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF).\u003c/em\u003e Journal of Pain Research, 2025. \u003cstrong\u003eVolume 18\u003c/strong\u003e: p. 1827-1836.\u003c/li\u003e\n\u003cli\u003eCummock, M.D., et al., \u003cem\u003eAn analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion.\u003c/em\u003e Journal of Neurosurgery: Spine, 2011. \u003cstrong\u003e15\u003c/strong\u003e(1): p. 11-18.\u003c/li\u003e\n\u003cli\u003eFessler, R., et al., \u003cem\u003eBilateral neurological deficits following unilateral minimally invasive TLIF: A review of four patients.\u003c/em\u003e Surgical Neurology International, 2014. \u003cstrong\u003e5\u003c/strong\u003e(8).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":false,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"neurosurgical-review","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nrev","sideBox":"Learn more about [Neurosurgical Review](https://www.springer.com/journal/10143)","snPcode":"10143","submissionUrl":"https://submission.nature.com/new-submission/10143/3","title":"Neurosurgical Review","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Unilateral Laminotomy for Interbody Fusion, TLIF, Lumbar Degenerative Diseases, Quantitative Analysis, Cohort Studies","lastPublishedDoi":"10.21203/rs.3.rs-8966841/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8966841/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003e This study aimed to systematically review and compare the efficacy and safety of unilateral laminotomy for interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative diseases (LDD).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify clinical cohort studies published up to April 15, 2025, that compared ULIF with MIS-TLIF for LDD. Standard meta-analytic methods were applied to evaluate outcomes, including pain scores, fusion rates, operative time, length of hospital stay, and intraoperative blood loss. Continuous variables were pooled using standardized mean differences (SMDs), whereas dichotomous variables were assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity across studies was examined using the I\u0026sup2; statistic, and sensitivity analyses were performed to explore potential sources of heterogeneity and assess the robustness of the results. Publication bias was evaluated using Begg\u0026rsquo;s test and funnel plots.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFourteen cohort studies involving 1,158 patients were included. Compared with MIS-TLIF, ULIF was associated with a significantly shorter hospital stay (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.02, 95% CI: \u0026minus;1.59 to \u0026minus;\u0026thinsp;0.45) and reduced intraoperative blood loss (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.88, 95% CI: \u0026minus;3.78 to \u0026minus;\u0026thinsp;1.79). However, ULIF required a longer operative time (SMD\u0026thinsp;=\u0026thinsp;1.87, 95% CI: 1.15 to 2.59). ULIF demonstrated superior short-term pain improvement, whereas long-term pain outcomes were comparable between the two techniques. Both procedures achieved high fusion rates (ULIF: 93.4%, MIS-TLIF: 93.7%) with no significant differences.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis meta-analysis indicates that both ULIF and MIS-TLIF are effective surgical options for LDD. ULIF offers advantages in reducing hospital stay, intraoperative blood loss, and short-term postoperative pain, although it requires longer operative time. Both techniques yield similarly high fusion rates and comparable long-term pain relief.\u003c/p\u003e","manuscriptTitle":"Unilateral Laminotomy for Interbody Fusion versus Minimally Invasive TLIF for Lumbar Degenerative Diseases: A Quantitative Analysis of 14 Cohort Studies Involving 1,158 Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 15:22:26","doi":"10.21203/rs.3.rs-8966841/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-18T15:55:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T14:17:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T10:38:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267462916341322822879800410372783441644","date":"2026-03-13T10:17:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167454566272928962922449027214509781476","date":"2026-03-11T14:04:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330347099556300513738164991640082452903","date":"2026-03-10T08:10:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-10T02:03:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-05T04:02:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-27T08:46:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Neurosurgical Review","date":"2026-02-25T10:45:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"neurosurgical-review","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nrev","sideBox":"Learn more about [Neurosurgical Review](https://www.springer.com/journal/10143)","snPcode":"10143","submissionUrl":"https://submission.nature.com/new-submission/10143/3","title":"Neurosurgical Review","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a27c6f83-9b19-4784-9058-036f19e1e013","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T14:53:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 15:22:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8966841","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8966841","identity":"rs-8966841","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}