Minimally invasive spinal surgery for the treatment of traumatic thoracolumbar burst fractures

The optimum management of traumatic thoracolumbar burst fractures is cause for much debate in the literature. Although minimally invasive surgery (MIS) approaches are increasingly used in the management of degenerative spinal pathology, their role in treating burst fractures is unknown. Assessing the level of evidence (LOE) for use of MIS approaches in vertebral burst fractures may impart better understanding of how to integrate MIS in the treatment schema for these fractures. A comprehensive literature review was conducted using MEDLINE for all articles published on traumatic thoracolumbar burst fractures through to July 2013. LOE was assigned according to the standards set forth by the Journal of Clinical Orthopaedics and Related Research and the Oxford Centre for Evidence Based Medicine. Full texts were reviewed to select only those articles discussing MIS approaches as a treatment modality. A total of 501 articles met both inclusion and exclusion criteria, and 403 of those were published within the past two decades. Among those, 35 articles detailed the use of MIS approaches in the management of traumatic thoracolumbar burst fractures. Only three studies provided high LOE: one level 1 study and two level 2 studies. Thirteen studies described the use of vertebroplasty or kyphoplasty, but all were level 4 or level 5 studies. Currently, the LOE for utilization of MIS approaches to manage traumatic thoracolumbar burst fractures is low. Further work in the form of prospective randomized controlled trials is needed to ascertain how MIS may be integrated into the treatment scheme for thoracolumbar burst fractures. (C) 2014 Elsevier Ltd. All rights reserved.