Minimally Invasive vs Open Surgery for Thoracolumbar Fractures Treatment

Study Design. Meta-Analysis Objective. The purpose of this systematic review and meta-analysis was to pool the available data comparing MIS to open surgery for thoracolumbar fractures and provide a more comprehensive assessment on this topic. Background. There remains a debate over whether minimally invasive surgery (MIS) or open fixation provides superior outcomes for patients with thoracolumbar fractures. While several randomized controlled trials and prospective studies have compared these two approaches, the published studies are limited by sample size. Methods. Following PRISMA guidelines, a systematic review of the PubMed, Cochrane, and Google Scholar (pages 1-20) databases was performed on October 1, 2024. The extracted data consisted of complications, surgery-related parameters, early and late post-operative back pain, and post-operative regional kyphosis. Results. Five RCTs and five prospective studies were included in the meta-analysis, including 584 patients, with 299 in the MIS group and 285 in the open group. MIS patients were shown to have less EBL (MD=-155.86; 95% CI: -217.97– -93.76, P <0.001), a shorter LOS (MD=-3.34; 95% CI: -4.62– -2.06, P <0.001), lower pain scores during the early post-operative period (MD=-1.14; 95% CI: -1.56– -0.71, P <0.001), and less regional kyphosis (MD=-5.17; 95% CI: -7.17– -3.16, P <0.001), even when stratifying by study type. Additionally, fluoroscopy time was longer in the MIS group (MD=0.60; 95% CI: 0.21–0.98, P =0.003), although this difference was not seen when looking at RCTs only. Conclusion. Among patients with thoracolumbar fractures, treatment with MIS was associated with decreased EBL, shorter LOS, earlier pain reduction, and less regional kyphosis compared to treatment with open fixation. Additionally, higher radiation-exposure was seen among patients treated with MIS. While MIS offers several potential benefits, both MIS and open fixation remain safe and reliable options for the treatment of thoracolumbar fractures.