Minimally invasive surgical techniques for the treatment of thoracolumbar burst fractures

Surgeons are often faced with complex decision-making when deciding on the optimum surgical management of thoracolumbar (TL) burst fractures. The magnitude of surgical techniques is vast from standard open techniques to minimally invasive surgery (MIS). In recent years, the application of MIS has grown in popularity in parallel to impressive technological advances. In this narrative review, we discuss the available literature focusing on minimally invasive surgical techniques for TL burst fractures. The aim of this article is to help guide spinal surgeons who wish to include MIS as part of their surgical portfolio and to identify remaining knowledge gaps. We aimed to present a review on the choice of long vs short construct, cement augmentation techniques, reduction and realignment techniques, surgical nuances in incomplete (A3) versus complete (A4) burst fractures, as well as discuss the role of implant removal. Percutaneous pedicle screw fixation including the index fracture level and subsequent implant removal has shown promise for the surgical treatment of TL AO Type A3 fractures, and A4 fractures. This technique may be best considered as internal bracing while fracture heals with the prototypical patient being a young active individual without severe kyphotic deformity. These techniques can be enhanced with cement augmentation as well as reduction and realignment techniques. With ongoing technological advancement, the armentarium of MIS surgical techniques applicable to TL burst fractures will certainly continue to expand. Despite rapid technological advances, a comprehensive understanding of optimal application of those techniques is lacking creating knowledge gaps.