Percutaneous Fixation versus Open Fusion for Traumatic Thoracolumbar Fractures: A Comparative Effectiveness Review

Introduction: Traumatic thoracolumbar fractures require effective stabilization to restore spinal alignment and mitigate neurological risks. Percutaneous fixation and open fusion are two primary techniques used in treatment, yet comparative data on their effectiveness and safety remain limited. This study evaluates these two methods to provide insights into surgical outcomes, complication rates, and recovery profiles.

Methods: A systematic review and meta-analysis were conducted using studies published from 2010 to 2023, comparing percutaneous fixation and open fusion for thoracolumbar fractures. Data from 12 studies covering 800 patients were included. Outcome measures included surgical time, blood loss, length of hospital stay, kyphosis correction, Visual Analogue Scale (VAS) for pain, and Oswestry Disability Index (ODI) for functional recovery. Statistical analysis, including risk ratio and weighted mean difference, was performed using Python and R.

Results: Percutaneous fixation demonstrated shorter operative times (mean reduction of 2.1 hours; p< 0.01) and reduced intraoperative blood loss (mean difference of 600 mL; p< 0.01) compared to open fusion. Hospital stays were also shorter with percutaneous fixation (mean reduction of 3.7 days). Kyphosis correction was achieved with both techniques, though open fusion showed slightly better correction (mean improvement of 15.2° vs. 13.1°; p=0.04). Both methods yielded significant pain reduction (VAS) and functional improvement (ODI) at follow-up, with no substantial difference in complication rates, including infection and implant-related issues.

Conclusion : Percutaneous fixation offers a less invasive alternative to open fusion for thoracolumbar fractures, with benefits of reduced operative time, blood loss, and hospital stay, making it suitable for stable fractures without severe deformity. Open fusion may be preferable for cases requiring greater alignment correction. Both techniques demonstrated effective pain and functional outcomes, supporting individualized treatment based on patient condition and fracture characteristics. Further research is warranted to refine surgical criteria for optimal technique selection.