Percutaneous Versus Open Management of Thoracic and Lumbar Hyperostotic Fractures: A Case-Control Study

Background This study aims to examine the surgical outcomes and complications associated with minimally invasive stabilization using percutaneous pedicle screws (MIS-PPS) versus open surgical management (OSM) among patients with spine fractures in the setting of hyperostotic spine diagnosis. Methodology This retrospective, case-control study was conducted at a single Level I Trauma Center, including 30 consecutive patients (nine ankylosing spondylitis patients and 21 diffuse idiopathic skeletal hyperostosis patients) who underwent surgery for thoracolumbar extension-distraction fractures. Collected data included patient demographics, comorbidities, injury mechanism, spine region, fracture level, and intraoperative and postoperative complications. Continuous variables included age, body mass index, estimated blood loss, operative time, number of levels instrumented, and length of stay. Results Between 2002 and 2020, 15 patients underwent MIS-PPS (3 females, 12 males, average age of 75.3 years) and 15 underwent OSM (3 females, 12 males, average age of 73.6 years). The MIS-PPS group had significantly lower blood loss (95 ± 31.6 mL vs. 643.3 ± 534.4 mL; p < 0.001) and shorter operative time (130.7 ± 36.4 minutes vs. 208.7 ± 41.8 minutes; p < 0.001). They also required fewer levels of instrumentation (5.2 vs. 6.8; p < 0.001). There were no significant differences in postoperative infection rates, epidural hematomas, or implant revisions between the groups. Conclusions MIS-PPS provides the benefits of reduced blood loss, shorter operative time, and fewer levels of instrumentation compared to OSM, with no significant differences in postoperative complications.