Abstract
Degenerative spondylolisthesis is a common etiology of low back pain characterized by the anterior displacement of one vertebral body relative to the one below it. A key contributing factor is intervertebral disc degeneration, which compromises spinal stability. In patients with a lack of neurological issues, conservative treatment is recommended. If conservative treatment is ineffective, surgery is deemed the next step, involving decompression and fusion of the vertebrae. Over the past several decades, minimally invasive surgical (MIS) techniques have been developed and refined. This systematic review aims to compare different types of MIS techniques for the treatment of degenerative spondylolisthesis to determine the advantages and disadvantages of each. We searched PubMed and manually screened The Global Spine Journal and The Journal of Orthopaedic Surgery and Research using Boolean operators to identify studies published from 2015 to 2025. Inclusion criteria encompassed retrospective cohorts, randomized controlled trials, and comparative studies of patients with degenerative spondylolisthesis. Risk of bias was qualitatively assessed based on study design and reporting. Due to heterogeneity, data were synthesized descriptively. A total of 302 studies were initially identified; only 13 met the inclusion criteria. A total of 714 patients were included in the review. The most common technique was MIS transforaminal lumbar interbody fusion (TLIF), followed by MIS OLIF. All the studies demonstrated improvement in the Oswestry Disability Index (ODI) post-operatively. Secondary outcomes such as operation time, blood loss, radiographic fusion rates, and hospital stay varied across the studies. Both MIS TLIF and MIS OLIF have demonstrated effectiveness in the surgical management of degenerative spondylolisthesis, with MIS TLIF showing favorable outcomes for single-level decompression and MIS OLIF for multilevel fusion and deformity correction. However, variability in follow-up duration, outcome reporting, and patient selection limits direct comparison. While MIS approaches may reduce perioperative morbidity compared to traditional open fusion and can be effective after failed conservative treatment, current evidence does not definitively favor one technique over the other. Further high-quality, comparative studies are needed to establish superiority in terms of long-term outcomes and complication rates.