Minimally Invasive vs Open Surgery for the Treatment of Spinal Spondylodiscitis: A Systematic Review and Meta-Analysis.

BACKGROUND: Despite common conservative management for spondylodiscitis, surgical intervention is indicated in specific clinical scenarios. While open techniques are traditionally favored, the role and efficacy of minimally invasive surgery (MIS) vs conventional open approaches remain actively debated. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis identified studies comparing MIS and open techniques for spondylodiscitis from PubMed, Embase, and Cochrane. The primary outcome was postoperative pain score. Secondary outcomes included wound revision rates, intraoperative blood loss, hospital stay, operative time, and postoperative C-reactive protein/white blood cell levels. Statistical analysis utilized RevMan 5.1.7; heterogeneity was assessed via I². RESULTS: Eleven observational studies (933 patients; 432 MIS) were included. MIS showed superiority in postoperative pain scores (standardized mean difference: -1.03; 95% CI: -1.73 to -0.33; P = 0.004) and lower wound revision rates (OR: 0.46; 95% CI: 0.23-0.89; P = 0.020). Intraoperatively, MIS provided reduced blood loss (mean difference [MD]: -321.27 mL; 95% CI: -407.35 to -247.79; P < 0.0001) and shorter operative time (MD: -32.47 minutes; 95% CI: -47.12 to -17.83; P < 0.0001). Postoperatively, MIS resulted in shorter hospital stay (MD: -3.96 days; 95% CI: -5.30 to -2.62; P < 0.0001), lower C-reactive protein (MD: -0.40; 95% CI: -1.73 to 0.93; P = 0.56), and reduced white blood cell counts (MD: -0.75; 95% CI: -0.98 to -0.52; P < 0.0001). CONCLUSION: Our findings suggest that MIS offers significant advantages over open techniques for spondylodiscitis, representing a valuable and effective management option. CLINICAL RELEVANCE: For appropriately selected patients with spondylodiscitis requiring surgical treatment, minimally invasive techniques may offer meaningful perioperative advantages over conventional open surgery, including reduced postoperative pain, wound revision rates, blood loss, operative time, and hospital stay. These findings support MIS as a valuable surgical option, particularly when minimizing surgical morbidity is a priority.