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Review
. 2016 Mar;6(2):186-94.
doi: 10.1055/s-0035-1554777. Epub 2015 Jun 5.

Open Versus Minimally Invasive Fixation Techniques for Thoracolumbar Trauma: A Meta-Analysis

Steven J McAnany  1 , Samuel C Overley  1 , Jun S Kim  1 , Evan O Baird  1 , Sheeraz A Qureshi  1 , Paul A Anderson  2
Affiliations
Review

Open Versus Minimally Invasive Fixation Techniques for Thoracolumbar Trauma: A Meta-Analysis

Steven J McAnany et al. Global Spine J. 2016 Mar.

Abstract

Study Design Systematic literature review and meta-analysis of studies published in English. Objective This study evaluated differences in outcome variables between percutaneous and open pedicle screws for traumatic thoracolumbar fractures. Methods A systematic review of PubMed, Cochrane, and Embase was performed. The variables of interest included postoperative visual analog scale (VAS) pain score, kyphosis angle, and vertebral body height, as well as intraoperative blood loss and operative time. The results were pooled by calculating the effect size based on the standardized difference in means. The studies were weighted by the inverse of the variance, which included both within- and between-study error. Confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and I (2). Results After two-reviewer assessment, 38 studies were eliminated. Six studies were found to meet inclusion criteria and were included in the meta-analysis. The combined effect size was found to be in favor of percutaneous fixation for blood loss and operative time (p < 0.05); however, there were no differences in vertebral body height (VBH), kyphosis angle, or VAS scores between open and percutaneous fixation. All of the studies demonstrated relative homogeneity, with I (2) < 25. Conclusions Patients with thoracolumbar fractures can be effectively managed with percutaneous or open pedicle screw placement. There are no differences in VBH, kyphosis angle, or VAS between the two groups. Blood loss and operative time were decreased in the percutaneous group, which may represent a potential benefit, particularly in the polytraumatized patient. All variables in this study demonstrated near-perfect homogeneity, and the effect is likely close to the true effect.

Keywords: burst fracture; chance fracture; lumbar fracture; percutaneous fixation; spinal fracture; thoracic fracture; thoracolumbar trauma; vertebral body fracture.

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Conflict of interest statement

Disclosures Steven J. McAnany, none Samuel C. Overley, none Jun S. Kim, none Evan O. Baird, none Sheeraz A. Qureshi, Consultant: Stryker, Medtronic, Orthofix, Zimmer Paul A. Anderson, Consultant: Stryker, Pioneer, Aesculap; Royalties: Stryker, Pioneer; Stock/stock options: Si-Bone, Expanding Orthopedics, Titan Surgical

Figures

Fig. 1
Fig. 1
Forest plot of the standardized mean difference for vertebral body height. Abbreviations: CI, confidence interval; Std diff, standard deviation.
Fig. 2
Fig. 2
Forest plot of the standardized mean difference for post-operative kyphosis angle. Abbreviations: CI, confidence interval; Std diff, standard deviation.
Fig. 3
Fig. 3
Forest plot of the standardized mean difference for visual analog scale. Abbreviations: CI, confidence interval; Std diff, standard deviation.
Fig. 4
Fig. 4
Forest plot of the standardized mean difference in blood loss. Abbreviations: CI, confidence interval; Std diff, standard deviation.
Fig. 5
Fig. 5
Forest plot of the standardized mean difference for operative time. Abbreviations: CI, confidence interval; Std diff, standard deviation.
See this image and copyright information in PMC

References

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