Minimally Invasive vs Open Surgery for Thoracolumbar Fractures Treatment: A Meta-analysis of Randomized Controlled Trials and Prospective Studies

Mohammad Daher; Marven Aoun; Ethan J Cottrill; Zhi Wang; Richard K Hurley; William F Lavelle; Peter G Passias; Bassel G Diebo; Alan H Daniels; Amer Sebaaly

doi:10.1097/BRS.0000000000005252

Minimally Invasive vs Open Surgery for Thoracolumbar Fractures Treatment: A Meta-analysis of Randomized Controlled Trials and Prospective Studies

Spine (Phila Pa 1976). 2025 Jan 3. doi: 10.1097/BRS.0000000000005252. Online ahead of print.

Authors

Affiliations

¹ Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, LEBANON.
² Department of Orthopedic Surgery, Brown University, Providence, RI, USA, 02906.
³ Department of Orthopedic Surgery, Duke University, Durham, NC, USA, 27710.
⁴ Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, Quebec.
⁵ Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX.
⁶ Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, USA.

PMID: 39807601
DOI: 10.1097/BRS.0000000000005252

Abstract

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 on 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 post-operative back pain, and post-operative 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- -93.76, P<0.001), a shorter LOS (MD=-3.34; 95% CI: -4.62- -2.06, P<0.001), lower pain scores during the early post-operative period (MD=-1.14; 95% CI: -1.56- -0.71, P<0.001), and less regional kyphosis (MD=-5.17; 95% CI: -7.17- -3.16, P<0.001), even when stratifying by study type. Additionally, 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.

Conclusion: Among patients with thoracolumbar fractures, treatment with MIS was associated with decreased EBL, shorter LOS, earlier pain reduction, and less regional kyphosis compared to treatment with open fixation. Additionally, 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.