An institutional review of percutaneous stabilization versus open stabilization of unstable thoracolumbar fractures

Aim: Thoracolumbar fractures are commonly hyper-flexion distraction/compression injuries and, in the context of motor vehicle accidents, are frequently unstable. We aimed to determine the significance of the minimally invasive percutaneous stabilization of these injuries compared to the traditional open surgical approach in 51 patients admitted over a 5-year period. Methods: Retrospective chart review of 51 patients admitted with unstable thoracolumbar fractures over a 5-year period, 01 January 2014–29 November 2018, 24 of which underwent an open stabilization of an unstable thoracolumbar fracture and 27 of which underwent a minimally invasive percutaneous stabilization of an unstable thoracolumbar fracture. Medical records were analyzed for Age; Gender; Mechanism of injury; Whether an open stabilization or minimally invasive percutaneous stabilization was performed; Vertebral level/s injured; Admission neurological status assessed by the American Spinal Injury Association (ASIA) Scale; Time from injury to operative intervention; Length of operative procedure; Volume of intra-operative blood loss; Levels instrumented; Amount of immediate post-operative surgical site pain utilizing the Visual Analogue Pain Score; Post-operative neurological status assessed by the ASIA scale; Complications; Length of hospital stay; and Patient satisfaction at a 1-year follow-up end point utilizing the scale of non-satisfied, partially satisfied, satisfied, very satisfied and extremely satisfied. Results: When comparing the open surgical stabilization cohort versus the percutaneous stabilization cohort a significant reduction was demonstrated in Length of surgery (p = 0.007); Volume of intra-operative blood loss (p < 0.001); Early post-operative pain (p < 0.001); Length of hospital stay (p = 0.0017) and; One-year patient satisfaction (p < 0.001), all of which favored the percutaneous surgery group. Conclusion: Our study confirms the significant intra-operative, post-operative, and 1-year benefit of percutaneous stabilization versus the open approach in unstable thoracolumbar fractures. Our study findings support several other studies which confirm this same benefit. We recommend percutaneous stabilization to be the preferred surgical intervention to manage these injuries.