Abstract
BACKGROUND: Due to the gap and the controversy regarding whether to use the traditional open technique or the minimally invasive technique in carpal tunnel syndrome, we carried out this systematic review and meta-analysis to compare the two techniques regarding their outcomes. METHODS: A systemic computer-based search was carried out to find relevant articles. We searched the following databases: PubMed, Scopus, and Web of Science. The search was carried out from inception until April 2024 using the following search terms: "Transverse" OR "Mini-transverse" AND "Carpal tunnel syndrome" AND "Longitudinal." No filters were applied and reference lists of included papers were searched to try and include further relevant papers that were not identified during the search. RESULTS: The mini-transverse technique was associated with a lower functional status scale (FSS) and symptoms severity scale (SSS) compared to the longitudinal technique with mean difference [MD] of -0.32 (95% confidence interval [CI]: -0.52, -0.12, P = 0.002), and -0.43 (95% CI: -0.6, -0.25, P < 0.00001), respectively. Furthermore, the mini-transverse technique was associated with a lower pain score with MD of -0.5 (95% CI: -0.71, -0.3, P < 0.00001). Moreover, the time needed to return to work was statistically significantly lower in the mini-transverse group compared to the longitudinal group with an MD of -9.34 (95% CI: -13.55, -3.13, P = 0.002). No significant difference was observed between either group regarding the duration of operation (MD: -6.96, [95% CI: -16.66, 2.74, P = 0.16]) and the incidence of complications (odds ratio: 0.46, [95% CI: 0.15, 1.4, P = 0.17]). CONCLUSION: The efficacy and safety outcome measures of the mini-transverse and longitudinal surgical approaches utilized on carpal tunnel syndrome patients were compared in the current study. Mini-transverse procedures yielded superior results in this study than longitudinal techniques, as they were statistically significant in relation to decreased FSS, SSS, pain score, and time required to return to work. However, in terms of the length of the procedure and the frequency of complications, both methods were similar.