Percutaneous versus traditional open approaches for the treatment of thoracolumbar fractures in patients without neurologic deficits: a meta-analysis of 35 cohort studies

Abstract

At present, percutaneous surgery is widely used to treat thoracolumbar fractures. However, the actual safety, feasibility, and effectiveness of percutaneous surgery are not clear. Through systematic review and meta-analysis, we compared the efficacies of percutaneous pedicle screw fixation and open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve root symptoms. We systematically searched the PubMed, Embase, and Cochrane libraries for articles published on or before June 2023. All results were evaluated by standard methods recommended for meta-analysis, continuous data were expressed by standard mean differences (SMDs), and binary variables were analyzed by odds ratios (ORs) and 95% confidence intervals (95% CIs). We also explored the main sources of heterogeneity and the stability of the results through sensitivity analysis, Begg's funnel plots, and Egger's test. Thirty-five cohort studies with a total of 3039 patients were included. The study found that patients who undergo percutaneous approaches have less intraoperative blood loss (IBL), shorter length of hospital stay (LOS), shorter operation time, and shorter incision. Moreover, percutaneous approaches had more advantages in terms of visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and infection rates. However, there was no significant difference in anterior vertebral body height (AVB), Cobb angle (CA), or screw errors between the two groups. In the long run, the clinical and surgical results of the percutaneous approach are better than those of the open approach, but the radiological results of both operations do not seem to show an advantage for any specific approach. Because of publication bias and heterogeneity, our findings must be interpreted with caution. However, this paper will provide some support for clinicians to choose suitable surgical methods for the treatment of thoracolumbar fractures.

Keywords: Meta-analysis and cohort studies; Percutaneous; Thoracolumbar fractures; Traditional open approaches.