Percutaneous Versus Open Management of Thoracic and Lumbar Hyperostotic Fractures: A Case-Control Study

Area of Science:

• Orthopedics
• Neurosurgery
• Spine Surgery

Background:

• Hyperostotic spine conditions like ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis present unique challenges for managing thoracolumbar fractures.
• Traditional open surgical management (OSM) may involve significant morbidity.
• Minimally invasive percutaneous pedicle screw (MIS-PPS) stabilization offers a potential alternative.

Purpose of the Study:

• To compare surgical outcomes and complications of MIS-PPS versus OSM in patients with spine fractures and hyperostotic conditions.
• To evaluate the efficacy and safety of MIS-PPS in this specific patient population.

Main Methods:

• Retrospective case-control study at a Level I Trauma Center.
• Inclusion of 30 patients with thoracolumbar extension-distraction fractures (9 ankylosing spondylitis, 21 diffuse idiopathic skeletal hyperostosis).
• Comparison of data including demographics, injury details, operative parameters, and postoperative complications between MIS-PPS and OSM groups.

Main Results:

• The MIS-PPS group demonstrated significantly lower estimated blood loss (95 mL vs. 643.3 mL) and shorter operative times (130.7 min vs. 208.7 min) compared to the OSM group.
• Fewer instrumentation levels were required in the MIS-PPS group (5.2 vs. 6.8).
• No significant differences were observed in postoperative infection rates, epidural hematomas, or implant revisions between the two groups.

Conclusions:

• MIS-PPS is a viable surgical option for spine fractures in hyperostotic patients, offering advantages in blood loss, operative time, and instrumentation extent.
• MIS-PPS achieves comparable safety profiles to OSM regarding major postoperative complications.
• This minimally invasive approach may improve patient recovery and reduce surgical burden.