The purpose of this meta-analysis was to compare the fusion rate and outcomes directly between patients who underwent stand-alone lateral lumbar interbody fusion (LLIF) and LLIF with supplemental posterior instrumentation. A comprehensive literature search was performed for relevant studies using PubMed, EMBASE, Web of Science, and Cochrane Library. The stand-alone and instrumented LLIF were compared by the fusion rate, the radiographic parameters, the cage subsidence rate, the clinical outcomes, the complication rate, and the reoperation rate. A total of 13 studies comprising 1090 patients with lumbar degenerative disease (LDD) were included. There was no significant statistical difference in the complication rate, and there was no significant clinical difference in the improvement of clinical outcomes at the last follow-up between patients who underwent stand-alone and instrumented LLIF. Nevertheless, lower fusion rate (RR, 0.92; 95% CI 0.87 to 0.98, P = 0.006), inferior restoration of disk height (WMD, −0.68; 95% CI −1.04 to −0.32, P < 0.001) and segmental lordosis (WMD, −1.28; 95% CI −2.30 to −0.27, P = 0.013), higher cage subsidence rate (RR, 1.68; 95% CI 1.36 to 2.07, P < 0.001), and higher reoperation rate (RR, 2.12; 95% CI 1.02 to 4.43, P = 0.045) were observed in the stand-alone group. Both stand-alone and instrumented LLIF were effective in improving the clinical outcomes of patients with LDD. However, the stand-alone LLIF was associated with lower fusion rate, inferior maintenance of indirect decompression, and higher reoperation rate due to high-grade cage subsidence. For patients with risk factors of high-grade cage subsidence, the LLIF with posterior instrumentation may be the better choice.

本荟萃分析的目的是直接比较接受独立外侧腰椎椎间融合术 (LLIF) 和 LLIF 与辅助后路内固定术的患者的融合率和结果。使用 PubMed、EMBASE、Web of Science 和 Cochrane Library 对相关研究进行了全面的文献检索。通过融合率、影像学参数、笼子下沉率、临床结果、并发症发生率和再手术率对独立和仪器化 LLIF 进行了比较。共纳入 13 项研究，包括 1090 名腰椎退行性疾病 (LDD) 患者。并发症发生率无显着统计学差异，在最后一次随访时，接受独立和仪器化 LLIF 的患者在临床结果的改善方面没有显着的临床差异。尽管如此，融合率较低（RR，0.92；95% CI 0.87 至 0.98，P  = 0.006），椎间盘高度恢复较差（WMD，-0.68；95% CI -1.04 至 -0.32，P  < 0.001）和节段性脊柱前凸（WMD，-1.28；95% CI -2.30 至 -0.27，P  = 0.013 )、笼子下沉率更高（RR，1.68；95% CI 1.36 至 2.07，P  < 0.001）和更高的再手术率（RR，2.12；95% CI 1.02 至 4.43，P = 0.045) 在独立组中观察到。独立和仪器化 LLIF 均可有效改善 LDD 患者的临床结果。然而，独立的 LLIF 与较低的融合率、间接减压的维护较差以及由于高度笼子下沉导致的再手术率较高有关。对于有高级别笼子下沉危险因素的患者，后路内固定的 LLIF 可能是更好的选择。