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Minimally Invasive Versus Open Fusion for Traumatic Thoracic Vertebral Fractures: Patterns in Patient Selection and
Sean Inzerillo1, Sandra Leskinen1, Mert Karabacak2
1College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY.
Study Design:
A retrospective cohort study.
Objective:
To identify factors associated with minimally invasive surgery (MIS) utilization and compare inpatient outcomes between MIS and open fusion for traumatic thoracic vertebral fractures using a multicenter trauma registry.
Summary Of Background Data:
MIS is increasingly utilized in spine surgery due to its potential to reduce perioperative morbidity. However, its role in managing traumatic thoracic vertebral fractures remains unclear, and large-scale comparisons of MIS versus open fusion in this setting are limited.
Methods:
Adult patients (≥18 y) who underwent thoracic fusion for traumatic thoracic fractures between 2019 and 2021 were identified from the American College of Surgeons Trauma Quality Program database using ICD-10 codes. Patients were stratified by surgical approach (MIS vs. open), and demographic, injury, and clinical characteristics-as well as inpatient outcomes-were compared using chi-squared and t-tests. Multivariable logistic regression was performed to identify patient and injury factors associated with MIS utilization. A P-value < 0.05 was considered statistically significant.
Results:
Of 8999 patients undergoing thoracic fusion, 370 (4.1%) received MIS. MIS utilization was associated with older age, lower Injury Severity Scores, and less severe neurological impairment. The number of vertebral levels fused did not differ by approach. MIS patients had significantly shorter length of stay, higher home discharge rates, and lower rates of complications, intensive care unit admission, and mechanical ventilation.
Conclusion:
This multicenter cohort study identifies key patient and injury characteristics associated with MIS utilization in thoracic trauma. While MIS was associated with some favorable inpatient outcomes, this may be due to selection bias rather than procedural effect. Further prospective studies are needed to clarify appropriate indications and long-term outcomes.
Insights
Minimally invasive surgery (MIS) for traumatic thoracic fractures was used in 4.1% of cases and associated with better inpatient outcomes. However, patient selection may influence these results, requiring further study.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Spine Surgery
Background:
- Minimally invasive surgery (MIS) is gaining traction in spine procedures to lower perioperative morbidity.
- The efficacy and outcomes of MIS for traumatic thoracic vertebral fractures are not well-established.
- Large-scale comparisons between MIS and open fusion for these fractures are limited.
Purpose of the Study:
- To identify factors linked to minimally invasive surgery (MIS) use in traumatic thoracic fractures.
- To compare inpatient outcomes between MIS and open fusion for these injuries.
- To analyze data from a multicenter trauma registry.
Main Methods:
- A retrospective cohort study analyzed adult patients undergoing thoracic fusion for traumatic fractures (2019-2021) from the ACS Trauma Quality Program database.
- Patients were divided into MIS and open fusion groups.
- Multivariable logistic regression identified factors associated with MIS utilization.
Main Results:
- Only 4.1% of 8999 patients received MIS, associated with older age, lower injury severity, and less neurological impairment.
- MIS patients experienced shorter hospital stays, higher home discharge rates, and fewer complications, ICU admissions, and mechanical ventilation days.
- The number of fused vertebral levels did not differ between approaches.
Conclusions:
- Key patient and injury factors associated with MIS use in thoracic trauma were identified.
- While MIS showed improved inpatient outcomes, selection bias may play a role.
- Further prospective research is needed to determine optimal indications and long-term results for MIS in this patient population.
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