Open and Percutaneous Fusion are Equivalent in the Treatment of Thoracolumbar Burst Fractures

Background Burst fractures are a sequela of high-energy spine trauma. While often treated non-operatively, surgery is indicated for neurologic deficits and deformity. Open approaches are the mainstay of treatment; however, percutaneous approaches have become popular. More evidence is needed to establish if percutaneous approaches are equally efficacious and safe compared to open treatment. Thus, the objective of this study was to determine if open or percutaneous approaches were better for treatment of thoracolumbar burst fractures. Methods A retrospective review of 40 operatively treated burst fractures was undertaken. Demographic data included age, gender, BMI, Carlson Comorbidity index (CCI), and racial/ethnic background. Injury characteristics collected included mechanism, additional injury, neurologic deficits, evidence of spinal cord injury, traumatic Dural sac laceration, and pre-operative ICU admission. Intra- and post-operative data were also recorded. Chi-square and t-test analyses were used to evaluate the data. Significance was set to p > 0.05. Results No differences were noted between open (OPSF) and percutaneous (PPSF) groups with regard to age, BMI, CCI, or racial and ethnic background. There was a higher percentage of females in the PPSF group. There were no differences with regard to injury mechanism or polytraumatic presentation between the groups. The OPSF group had a higher percentage of neurologic deficits. Estimated blood loss (EBL) was significantly lower in the PPSF cohort. No differences existed in perioperative outcomes, discharge disposition, or pain medication use. Clinical Relevance OPSF and PPSF have equivalent safety profiles, with PPSF having significantly lower EBL. This suggests that PPSF may be advantageous in polytrauma. Conclusions/Level of evidence PPSF and OPSF are equivalent for the treatment of burst fractures. The lower blood loss seen in PPSF may indicate that this approach is better for polytrauma patients. Level of Evidence: 3.