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Minimally Invasive vs Open Surgery for Thoracolumbar Fractures in Patients With Ankylosing Spinal Diseases: A
Mohammad Daher1, Marven Aoun, Ethan J Cottrill
1From the Department of Orthopedic Surgery (Daher, Aoun, Sebaaly), Hotel Dieu de France Hospital, Beirut, LEBANON, the Department of Orthopedic Surgery (Daher, Diebo, Daniels), Brown University, Providence, RI, the Department of Orthopedic Surgery (Daher, Cottrill, Passias), Duke University, Durham, NC, the Department of Orthopedic Surgery (Hurley), San Antonio Military Medical Center, San Antonio, TX, and the Orthopedic Surgery (Lavelle), State University of New York Upstate Medical University, Syracuse, NY.
Minimally invasive surgery (MIS) for thoracolumbar fractures in patients with ankylosing spinal disorders shows lower complication rates and shorter procedures than open surgery. MIS offers benefits, but long-term outcomes and suitability for all injury patterns require further study.
Area of Science:
- Spinal surgery
- Orthopedic surgery
- Traumatology
Background:
- Surgical management of thoracolumbar fractures in patients with ankylosing spinal disorders is debated.
- Minimally invasive surgery (MIS) versus open fixation comparison studies exist, but a meta-analysis is lacking.
Purpose of the Study:
- To conduct a meta-analysis comparing minimally invasive surgery (MIS) to open fixation for thoracolumbar fractures in patients with ankylosing spinal disorders.
- To evaluate complications, mortality, surgical parameters, and postoperative outcomes.
Main Methods:
- PRISMA guidelines followed for literature search across PubMed, Cochrane, and Google Scholar until October 2024.
- Extracted data included complications, mortality, surgical parameters, postoperative back pain, and Cobb angle.
- Continuous data analyzed using mean differences with 95% confidence intervals; dichotomous data using odds ratio.
Main Results:
- Eight retrospective studies with 295 patients (164 MIS, 131 open) were included.
- MIS group showed significantly lower overall complications (OR=0.43), shorter surgical time (MD=-67.79 min), shorter hospital stay (MD=-14.08 days), and less blood loss (MD=-1.52 L).
- No significant differences were found in postoperative back pain or Cobb angle between MIS and open fixation groups.
Conclusions:
- Minimally invasive surgery (MIS) for thoracolumbar fractures in ankylosed spines is associated with reduced complications, less blood loss, and shorter surgical time and hospital stay.
- Further long-term follow-up studies are needed to assess the durability of MIS fixation.
- Open fixation remains a safe and reliable option, especially for certain injury patterns or when MIS resources are unavailable.
