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Updated: Apr 10, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
From Open to MIS, evolving practice for posterior approaches in high-energy thoracolumbar vertebral fractures: a
Simone Grannò1,2, Barbara Vukic1, Francesca Brigatti1
1Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
Introduction:
thoracolumbar fractures often require fixation. Minimally invasive surgery (MIS), including Wiltse and percutaneous techniques, aims to reduce morbidity compared to open surgery.
Research Question:
to evaluate multidimensional outcomes in high-energy thoracolumbar fractures treated via MIS versus open surgery.
Methods:
a single-centre retrospective cohort study including 82 neurologically intact adults (43.2 ± 18.5 y) who underwent open or MIS posterior fixation. Patients were divided into the Open (n = 23), versus MIS Wiltse (n = 30) and Percutaneous (n = 29) cohorts. The primary outcome was length of stay. Secondary outcomes included intraoperative blood loss, radiographic correction, second-stage surgery, concomitant kyphoplasty, pain and return-to-work status.
Results:
Length of stay was reduced for Wiltse (11.2 ± 4.5 d, p < 0.001) and Percutaneous (16.5 ± 7.8 d; p<0.05) versus Open patients (21.6 ± 10 d). Return-to-work delay was shorter in Wiltse (34 ± 12 d; p < 0.01) versus Open patients (72 ± 48 d). Intraoperative estimated blood loss was significantly reduced in Wiltse (929.5 ± 453.9 ml; p < 0.003) and Percutaneous (653 ± 429 ml; p < 0.0001) compared to Open surgery (1584 ± 1027 ml). This was mirrored in peri-operative ΔHb (37 g/L Open, 25 g/L Wiltse, p < 0.05; 17 g/L Percutaneous, p < 0.001). Pain recovery was faster in MIS. Second-stage corpectomy was performed in 47.8% (Open), 3.3% (Wiltse) and 33.2% (Percutaneous). Kyphoplasty was more frequent in Wiltse (66.6%) than Percutaneous (31%). Radiographic correction was maintained in all cohorts.
Conclusions:
MIS approaches were associated with comparable fracture stabilisation to open surgery, with shorter hospital stay and lower estimated blood loss.
