Minimally Invasive Spine Surgery versus Open Posterior Instrumentation Surgery for Unstable Thoracolumbar Burst Fracture

Abstract

To compare the clinical and radiological results of minimally invasive spine surgery (MISS) and open posterior instrumentation surgery for the treatment of unstable burst fractures. Overview of Literature: MISS has exhibited postoperative outcomes similar to those obtained using open posterior instrumentation in various spine diseases. There remains no consensus regarding the use of MISS in the treatment of unstable burst fracture. Methods: We enrolled 40 patients who underwent either MISS (M group, 20 patients) or open posterior instrumentation surgery (O group, 20 patients) for the treatment of traumatic unstable burst fractures. Clinical outcomes were evaluated based on postoperative back pain, operation time, blood loss, hospital stay duration, and perioperative complications. For radiologic evaluation, preoperative magnetic resonance imaging and plain radiography were performed before and after the surgery to evaluate the changes in the kyphotic angle and fracture union. Results: The change in the kyphotic angle was −8.2°±5.8° in the M group and −8.0°±7.8° in the O group. No significant difference was noted in terms of the change in the kyphotic angle (p=0.94, t-test) after 12 months of surgery. The Visual Analog Scale score was 1.5±0.7 points in the M group, while it was 5.2±1.4 points in the O group. In the M group, back pain has significantly decreased (p<0.01, t-test). The estimated blood loss was 195.5 mL in the M group and 1,077.5 mL in the O group; the operation time was significantly decreased in the O group from 290.7 to 120.7 minutes in the M group (p<0.05, t-test) (p=0.36, t-test). The average duration of hospital stay was 36.0 days in the M group and 41.9 days in the O group (p=0.36, t-test). Conclusions: For the treatment of unstable burst fractures, MISS showed significant differences in terms of postoperative back pain, operation time, and blood loss as compared to open posterior instrumentation surgery.

Retrospective Analysis of Three Posterior Open Surgical Approaches for the Intraoperative and Long-term Outcomes in the Treatment of Thoracolumbar Burst Fractures

“…The reasons for this may include the following aspects: (1) The thoracolumbar spine serves as the transition point between the thoracic and lumbar regions, with different levels of mobility. The stress of trunk movement is concentrated in this region [14]. Additionally, the physiological kyphosis in the thoracic spine and lordosis in the lumbar spine lead to a concentration of load-bearing stress in this area, resulting in higher stress on the internal xation system and making it prone to failure[16].…”

“…In recent years, with the development of percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP), and percutaneous pedicle screw xation, there have been more treatment options available for thoracolumbar burst fractures [9][10][11]. However, for patients with spinal cord compression and TLICS score ≥ 4 points, traditional open surgery, which can effectively restore vertebral height, spinal physiological curvature, and perform laminectomy for decompression in parallel [12], remains the optimal choice for such cases [2,13,14].…”

Application of Escherichia coli-Derived Recombinant Human Bone Morphogenic Protein-2 to Unstable Spinal Fractures

“…For young patients considering a short level of fusion or implant removal, applying the rhBMP-2 could be possible via percutaneous maneuver after fixation of percutaneous pedicle screws. It would be better because MISS for unstable thoracolumbar burst fracture showed significant loss of postoperative back pain, operation time, and blood loss compared to open instrumentation surgery [33,34].…”

Percutaneous Endoscopic Interbody Debridement and Fusion (PEIDF) Decreases Risk of Sepsis and Mortality in Treating Infectious Spondylodiscitis for Patients with Poor Physical Status, a Retrospective Cohort Study

“…Our results revealed significantly lower postoperative pain intensity in patients undergoing PEIDF. Percutaneous posterior instrumentation has been accepted as an effective procedure for providing secure stabilization with less surgical trauma in minimally invasive spine surgery [ 26 , 27 , 28 ]. For patients suffering from infectious spondylodiscitis, pure posterior stabilization without surgical debridement could largely diminish the intensity of back pain.…”