Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies

• This meta-analysis compared percutaneous versus open pedicle fixation for thoracolumbar fractures.
• Operative duration was shorter in the percutaneous group.
• Hospitalization was shorter, and with lower rates of infection and superior VAS scores.
• No difference was found for postoperative Cobb angle, body angle, and anterior body height.

BackgroundThe main aims of managing thoracolumbar fractures involve stabilization of traumatized regions, to promote vertebral healing or segmental fusion. Recently, percutaneous pedicle screw fixation has evolved as an alternative approach for the treatment of thoracolumbar fractures, aiming to minimize soft tissue injury and perioperative morbidity. A systematic review and meta-analysis was conducted to compare outcomes of percutaneous versus open pedicle screw fixation for thoracolumbar fractures.MethodsRelevant articles were identified from six electronic databases from their inception to December 2014.ResultsFrom 12 relevant studies identified, 279 patients undergoing percutaneous fixation were compared with 340 open fixation procedures. Operative duration was significantly shorter in the percutaneous group by 19 min (P = 0.0002). The percutaneous approach was also associated with shorter hospital stay by 5.7 days (P = 0.0007). Whilst there was no difference in screw malpositioning (RR, 0.77; 95% CI, 0.33, 1.83; P = 0.56), the percutaneous approach had lower rates of infections (RR, 0.36; 95% CI, 0.13, 1.00; P = 0.05), and superior visual analogue scale clinical outcomes (P = 0.001). No difference was found between the groups in terms of postoperative Cobb angle (P = 0.22), postoperative body angle (P = 0.66), and postoperative anterior body height (P = 0.19).ConclusionsThe percutaneous approach was associated with shorter operative duration and hospital stay, reduced intraoperative blood loss and reduced infection rates. Given the lack of robust clinical evidence, these findings warrant verification in large prospective registries and randomized trials.