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Minimally Invasive Versus Open Surgery for Thoracolumbar Fractures Treatment : A Meta-analysis of Randomized
Mohammad Daher1,2,3, Marven Aoun1, Ethan J Cottrill3
1Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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 of 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 postoperative back pain, and postoperative 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 to -93.76, P <0.001), a shorter LOS (MD=-3.34; 95% CI: -4.62 to -2.06, P <0.001), lower pain scores during the early postoperative period (MD=-1.14; 95% CI: -1.56 to -0.71, P <0.001), and less regional kyphosis (MD=-5.17; 95% CI: -7.17 to -3.16, P <0.001), even when stratifying by study type. In addition, 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.
Conclusions:
Among patients with thoracolumbar fractures, treatment with MIS was associated with decreased EBL, shorter LOS, earlier pain reduction, and less regional kyphosis compared with treatment with open fixation. In addition, 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.
Insights
Minimally invasive surgery (MIS) for thoracolumbar fractures shows reduced complications like blood loss and shorter hospital stays compared to open surgery. However, MIS involves higher radiation exposure, with both methods being safe and effective.
Area of Science:
- Orthopedic Surgery
- Spine Surgery
- Trauma Surgery
Background:
- Debate exists on minimally invasive surgery (MIS) versus open fixation for thoracolumbar fractures.
- Existing studies have limitations due to small sample sizes.
Purpose of the Study:
- To conduct a systematic review and meta-analysis comparing MIS and open surgery for thoracolumbar fractures.
- To provide a comprehensive assessment of outcomes for both surgical approaches.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched PubMed, Cochrane, and Google Scholar databases.
- Extracted data on complications, surgical parameters, pain, and kyphosis.
Main Results:
- Included 10 studies (5 RCTs, 5 prospective) with 584 patients.
- MIS group showed significantly less estimated blood loss (EBL), shorter length of stay (LOS), lower early postoperative pain, and less regional kyphosis.
- MIS group had longer fluoroscopy time, but this was not significant in RCTs alone.
Conclusions:
- MIS for thoracolumbar fractures is associated with decreased EBL, shorter LOS, earlier pain reduction, and less regional kyphosis compared to open fixation.
- Higher radiation exposure was noted with MIS.
- Both MIS and open fixation are safe and reliable treatment options.
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