Minimally invasive or open surgery? Decoding the safer path in thoracolumbar burst fractures through systematic review and meta-analysis

The main concern in managing thoracolumbar burst fractures is choosing between minimally invasive surgery (MIS) and open surgery (OS). To optimize decision-making, outcomes, and complication prevention, this study compared complication rates and blood loss between the two approaches. This study used a systematic review from Cochrane, PubMed, Scopus, and ScienceDirect to identify relevant studies prior to 15 September 2024. The variables of interest included complication rates and estimated mean blood loss by comparing minimally invasive surgery as the intervention group and open surgery to the control group. Following the abstract and full-text screening, six observational studies were included, of which four were considered appropriate for inclusion in this meta-analysis. The assessment of quality was performed using the ROBINS-I assessment tool. Complications were more frequent in OS compared to MIS. These complications included dural tears, infections, hardware failure, and more severe issues such as pulmonary embolism. Minimally invasive surgery was associated with fewer complications, primarily minor issues like transient nerve irritation and hardware prominence. A meta-analysis demonstrated a significant reduction in blood loss favoring MIS, with a pooled mean difference of 233.03 mL (95% CI: -461.15 to -4.91; P<0.01). However, given the high variability in study populations and surgical techniques, these results should be interpreted cautiously. Minimally invasive surgery shows fewer complications and less blood loss than open surgery in thoracolumbar burst fractures, though the high heterogeneity warrants cautious interpretation.