Dr. Marc Greenberg Co-Authors Peer-Reviewed Spine Meta-Analysis on Minimally Invasive vs. Open Posterior Fixation

A systematic review and meta-analysis published in the journal Spine in May 2026 adds to the evidence base for minimally invasive spine stabilization.

Dr. Marc Greenberg, a fellowship-trained minimally invasive spine surgeon in Fort Wayne, Indiana, is a co-author of a systematic review and meta-analysis published in the journal Spine in May 2026. The study compares two approaches to stabilizing the spine with screws and rods after an anterior or lateral lumbar interbody fusion.

The analysis pooled comparative studies. Its findings describe group averages across selected operations and should not be read as a promise about an individual procedure or recovery.

Full Citation

Sadh P, Sheth S, Greenberg M, Khan Z, Tripathi P, Khan N, Basques BA.

Open Versus Percutaneous Posterior Fixation Following Anterior or Lateral Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis.

Spine. 2026 May 15;51(10):E243-E253. doi:10.1097/BRS.0000000000005625.

What the Study Examined

The review compared two ways of stabilizing the spine with screws and rods after an anterior or lateral lumbar interbody fusion (ALIF or LLIF):

Traditional Open Approach

A midline incision with direct visualization and muscle dissection to place pedicle screws and rods.

Percutaneous (Minimally Invasive) Approach

Screws are placed through small incisions using fluoroscopic guidance, without the extensive muscle dissection required in open surgery.

The study pooled data from multiple prior studies to compare outcomes across these two approaches when used as the posterior fixation step after an ALIF or LLIF procedure.

What the Evidence Suggests

The pooled evidence from the meta-analysis indicates the following differences between the percutaneous minimally invasive approach and the traditional open approach:

Percutaneous Approach

• Associated with less blood loss
• Shorter operating time
• Shorter length of stay
• Fewer transfusions
• Comparable fusion rates
• No significant pooled difference in fusion, reoperation, or adjacent-segment-disease incidence
• Small differences in some patient-reported measures; statistical significance does not establish a clinically meaningful benefit for every patient

Open Approach

• Advantage for correcting overall spinal alignment in adult spinal deformity cases

Important: Thirteen comparative studies involving 912 patients met the review criteria. The included studies were not all randomized, techniques and indications varied, and pooled results may not apply to a different operation or patient. The authors also disclosed industry consulting relationships for one author.

What This Means for Patients

The study compared posterior-fixation techniques after ALIF or LLIF. It does not determine whether a patient needs fusion in the first place.

Minimally Invasive When Appropriate

A percutaneous approach may reduce surgical exposure in selected cases, but anatomy, deformity correction, prior surgery, fixation goals, and available imaging all affect whether it fits.

Motion Preservation

Motion preservation and the need for fusion are separate decisions from the choice between open and percutaneous screw placement.

Evidence-Based Decisions

Research findings should be integrated with diagnosis, imaging, examination, surgical objective, health factors, and patient goals.

Read the Original Article

The PubMed record for the peer-reviewed meta-analysis includes the citation, author list, and abstract.

Related Resources

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About Dr. Marc Greenberg, MD

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