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

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.