Minimally invasive versus open transforaminal lumbar interbody fusion for low grade lumbar spondylolisthesis: a systematic review and meta-analysis.

PURPOSE: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is used for low-grade lumbar spondylolisthesis to reduce access morbidity. However, whether this compromises construct durability versus open surgery (OS) remains uncertain. We conducted a systematic review and meta-analysis to determine whether MIS-TLIF preserves fusion and reoperation outcomes while improving perioperative outcomes compared with OS. METHODS: PubMed, Embase, and CENTRAL were searched from inception to 1 December 2025. Adult MIS-TLIF was compared with OS-TLIF. Primary outcomes were fusion, overall complications, and reoperation. Secondary outcomes were operative time, blood loss, length of stay (LOS), surgical site infection (SSI), adjacent segment disease, and patient-reported outcomes. Random-effects models were used. Risk of bias (ROBINS-I/RoB) and certainty (GRADE) were assessed. RESULTS: Nineteen studies encompassing 2117 patients (MIS 948, OS 1169) were included. Fusion was equivalent (RR 1.13; 95% CI 0.74-1.74; P = 0.51; I2 = 0.0%). Reoperation was similar (RR 0.72; 95% CI 0.46-1.14; P = 0.13; I2 = 0.0%), with no evidence of early technical failure in MIS cohorts. MIS reduced overall complications (RR 0.75; 95% CI 0.59-0.95; P = 0.02; I2 = 0.0%) and SSI (RR 0.30; 95% CI 0.14-0.65; P = 0.007; I2 = 0.0%). MIS lowered blood loss (MD -194.0 mL; 95% CI -281.98--106.04; P < 0.001; I2 = 97.6%) and LOS (MD - 2.1 days; 95% CI -2.92--1.24; P < 0.001; I2 = 96.3%). Pain and disability converged by 1-2 years. Most studies had moderate risk of bias; certainty for primary outcomes was moderate overall. CONCLUSION: MIS-TLIF achieves comparable fusion and reoperation outcomes while reducing perioperative burden, consistent with task-contingent, tissue-sparing use in appropriately selected patients.