Comparison of Intraoperative and Postoperative Outcomes Between Open versus Wiltse versus Percutaneous Approach to Instrumentation of Traumatic Thoracolumbar Spine Fractures

Introduction: Common techniques for traumatic thoracolumbar spine fracture fixation include the traditional open, mini-open wiltse, and minimally invasive percutaneous approaches. The purpose of this study was to perform a meta-analysis to clarify the differences in these approaches with a focus on intraoperative and post-operative outcomes.

Methods: We comprehensively searched PubMed, Web of Science, Scopus, Embase, and the Cochrane Library and performed a systematic review and meta-analysis of all randomized controlled trial and observational comparative studies using a combination of the search terms “wiltse”, “open”, “percutaneous”, “spine”, “spine surgery”, “fracture” and Boolean operators. Pooled odds ratios (ORs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CI) were estimated to summarize the effect of the Wiltse approach in comparison to the open approach or percutaneous approach on the surgical outcomes.

Results: 5 randomized trials and 27 comparative cohort studies met inclusion criteria. Compared to the traditional open approach (N=1067), the Wiltse approach (N=432) was associated with significantly lower operative time, intraoperative blood loss (TBL), postoperative length of stay (LOS), and immediate postoperative visual analog scale (VAS). Compared to the percutaneous approach (N=1063), the Wiltse approach was associated with shorter operative time, less intraoperative TBL and fluoroscopy time. However, the percutaneous approach was associated with lower immediate postoperative VAS and shorter LOS. Compared to the traditional open approach, the percutaneous approach was associated with shorter incision length, shorter operative time, less intraoperative TBL, shorter hospital LOS and better postoperative VAS and Oswestry Disability Index. The only benefit for the open approach was a lower intraoperative fluoroscopy time.

Conclusion : For fixation of traumatic spine injuries, the mini-open Wiltse approach appears to lessen morbidity and risk associated with surgery, while the percutaneous approach has greatest utility in reducing postoperative pain. A prospective trial is needed to answer this question best.