Minimally Invasive Versus Traditional Repair of Spinal Cerebral Spinal Fluid Leaks: A Systematic Review and Meta-Analysis

= 87%); MIS cohorts lacked consistent denominators for quantitative pooling. Some cohorts reported shorter length of stay and reduced postoperative pain in MIS groups, but these between-study comparisons were descriptive and confounded by case selection. However, the observational nature of the data, absence of randomization, and unmeasured selection bias-whereby more complex leaks may have been preferentially treated with open surgery-preclude definitive comparative conclusions. In selected cases, MIS dural repair may approach the success rates of open procedures with comparable complication profiles, but prospective studies controlling for selection bias are needed.