Minimally invasive spine surgery as treatment for persistent infectious lumbar spondylodiscitis: a systematic review and meta-analysis

Background: Antibiotic resistant infectious spondylodiscitis (IS) can cause significant morbidity for patients. Open surgical techniques were previously the only option for patients who failed antibiotic therapy. However, advances in minimally invasive surgical techniques may provide a new alternative for some patients. Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify studies that reported inflammatory [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] and functional outcomes [visual analog scale (VAS)] for patients with antibiotic resistant IS treated with either minimally invasive or open surgery. Searches were preformed using PubMed, Embase, and Scopus from January 2015 to June 2021. Fourteen articles met inclusion criteria. One study was a Level III evidence study and the other 13 included studies were Level IV. Results: The minimally invasive surgery group showed significantly lower post-operative CRP and VAS pain scores and significantly higher post-operative ESR levels than the open group. All studies included were measured by the Downs and Black tool for potential bias. Discussion: This study showed that minimally invasive surgery is efficacious in the treatment of antibiotic resistant IS. These outcomes support minimally invasive surgery (MIS) as an effective alternative to previous open surgery techniques in certain patients after failed trails of antibiotic therapy.