title: Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies.
abstract: BACKGROUND
  The main aims of managing thoracolumbar fractures involve stabilization of traumatized regions, to promote vertebral healing or segmental fusion. Recently, percutaneous pedicle screw fixation has evolved as an alternative approach for the treatment of thoracolumbar fractures, aiming to minimize soft tissue injury and perioperative morbidity. A systematic review and meta-analysis was conducted to compare outcomes of percutaneous versus open pedicle screw fixation for thoracolumbar fractures.
  
  
  METHODS
  Relevant articles were identified from six electronic databases from their inception to December 2014.
  
  
  RESULTS
  From 12 relevant studies identified, 279 patients undergoing percutaneous fixation were compared with 340 open fixation procedures. Operative duration was significantly shorter in the percutaneous group by 19 min (P = 0.0002). The percutaneous approach was also associated with shorter hospital stay by 5.7 days (P = 0.0007). Whilst there was no difference in screw malpositioning (RR, 0.77; 95% CI, 0.33, 1.83; P = 0.56), the percutaneous approach had lower rates of infections (RR, 0.36; 95% CI, 0.13, 1.00; P = 0.05), and superior visual analogue scale clinical outcomes (P = 0.001). No difference was found between the groups in terms of postoperative Cobb angle (P = 0.22), postoperative body angle (P = 0.66), and postoperative anterior body height (P = 0.19).
  
  
  CONCLUSIONS
  The percutaneous approach was associated with shorter operative duration and hospital stay, reduced intraoperative blood loss and reduced infection rates. Given the lack of robust clinical evidence, these findings warrant verification in large prospective registries and randomized trials.
authors.affiliation: Neuro Spine Clinic, Suite 7a, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, New South Wales 2031, Australia; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Neuro Spine Clinic, Suite 7a, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, New South Wales 2031, Australia; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
authors.forename: Prashanth J
authors.initials: PJ
authors.lastname: Rao
authors.affiliation: Neuro Spine Clinic, Suite 7a, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, New South Wales 2031, Australia; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia. Electronic address: ralphmobbs@hotmail.com.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
mesh_terms: D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D065289:Pedicle Screws; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
keywords: Fixation; Pedicle screw; Percutaneous; Spine; Thoracolumbar; Trauma