Neurosurgical Resident University of Minnesota Minneapolis, MN, US
Introduction: Posterior fixation of the lumbosacral spine is a widely practiced technique for the treatment of many spinal pathologies. While open procedures remain the gold standard in this treatment, percutaneous techniques have become increasingly favored due to reduced soft tissue injury. However, studies show limited, if any, improvement in complication rates for percutaneous approaches, especially at the L5-S1 level, as the unique anatomy of the lumbosacral junction adds greater challenges for fixation. The purpose of this study was to compare reported complication rates between open and percutaneous procedures for fixation of the L5-S1 spine.
Methods: The literature search was executed across Medline via PubMed. Study inclusion criteria were patients undergoing L5-S1 open or percutaneous posterior fixation, reported rates and types of complications, patients over 18 years of age, minimum 1-year follow-up. From each study, we collected general demographic information (age, gender, body mass index), type of posterior operation (open or percutaneous), complication rate, and mode of complication (e.g., pseudarthrosis, instrumentation failure, infection).
Results: Of 290 studies queried, 8 met inclusion criteria comprising 634 patients who underwent L5-S1 percutaneous or open fixation (mean age 57 years). Overall complication rates resulted in 14% (percutaneous, p < 0.01) and 11% (open, p = 0.016). Two-armed comparison demonstrated a 6% reduced complication rate in the open group though not significant (p = 0.55). Stratification for type of complication resulted in a mean infection rate of 3% (percutaneous, p = 0.06) and 14% (open, p = 0.09). Pseudarthrosis was only reported in two percutaneous studies. Instrumentation failure was indicated in one percutaneous and two open cases.
Conclusion : Open fixation of L5-S1 demonstrated a reduced overall complication but increased infection rate compared to percutaneous fixation. Despite the known advantages of percutaneous fixation, the higher risk of complication at L5-S1 is an important factor in proper planning of surgical treatment.
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