Comparison Of Percutaneous Minimally Invasive Spine Surgery Versus Open Approach Posterior Spine Surgery For Fixation Of Thoracolumbar Fractures: A Retrospective Matched Cohort Analysis

Presented at SMISS Annual Forum 2014
By Abimbola Obafemi-Afolabi MD
With Jacqueline Karp MD, Daniel Gelb MD, Steven Ludwig MD, Ebrahim Paryavi MD, Zachary Ewart MS, Kelley Banagan MD, Eugene Koh MD, PhD,

Disclosures: Abimbola Obafemi-Afolabi MD None Jacqueline Karp MD , Daniel Gelb MD A; AOSpine North America: faculty at courses. D; Advanced Spinal Intellectual Property(ASIP). F; Depuy-Synthes Spine: IP royalties, paid presenter or speak, Globus Medical: IP Royalties., Steven Ludwig MD A; Globus Medical Inc. B; DePuy Synthes, Globus Medical Inc., K2Medical. C; DePuy Synthes. D; Globus Medical Inc., Alphatec Spine, ASIP, Spinicity, ISD. F; DePuy Synthes, Globus Medical Inc., Thieme, , Ebrahim Paryavi MD None, Zachary Ewart MS None, Kelley Banagan MD None, Eugene Koh MD, PhD B; Biomet: Paid Consultant.,

Introduction:
Percutaneous minimally invasive posterior spinal stabilization is sometimes the only option in the treatment of critically ill poly-trauma patients who require spinal stabilization but are physiologically incompetent to undergo traditional open procedures.

Aims/Objectives:
The objective is to assess whether percutaneous minimally invasive spine surgery (MISS) is associated with reduced level of postoperative complications and morbidity compared with traditional open posterior approach for treatment of thoracolumbar fractures.

Methods:
We reviewed all patients with thoracolumbar fractures treated with
posterior spine instrumentation. Exclusion criteria were use of posterior spine instrumentation for treatment of cervical spine disorders, infection, osteomyelitis, tumor, pathological fractures, deformity, degenerative spine disease, sacral fractures, and posterior procedures in combination with
anterior approach.

Results:
425 posterior spine instrumentation cases identified from January 2007-May 2013. 256 patients met inclusion criteria. 157 cases done via traditional open approach while 99 were done percutaneously. A statistical significant difference, favoring percutaneous fixation, was seen in median operative time (MISS, 94 minutes; open approach, 130 minutes; P < 0.0001), Six-fold decrease in median intraoperative blood loss was observed in the percutaneous group (MISS, 75 mL; open approach, 450 mL; P < 0.0001), correlated with 3-fold decrease in number of patients requiring postoperative blood transfusions within 48 hours after surgery (24 versus 81 patients; P < 0.0001). A statistically significant difference was shown in reoperation rate, favoring the open approach. 14 reoperations were performed in the MISS group and 10 in the open approach group (P < 0.001). After excluding revisions for routine device removal, there was no statistically significant difference in reoperation rate (MISS 7, open 10).

Conclusions:
With less operative time, blood loss and transfusion requirements, percutaneous posterior spine fixation is a valid treatment option for thoracolumbar fractures; however, there is a higher reoperation rate with this approach compared to the traditional open posterior spine approach.