J Orthop Surg Res. 2026 Jul 15. doi: 10.1186/s13018-026-07094-7. Online ahead of print.
ABSTRACT
OBJECTIVE: Previous meta-analyses often lacked explicit time and included heterogeneous case types and surgical strategies. This led to substantial heterogeneity and limited the clinical applicability of these meta-analyses. This study focuses on evidence from the past 15 years, systematically comparing percutaneous pedicle screw fixation (PPSF) with open pedicle screw fixation (OPSF) for unstable traumatic thoracolumbar fractures (TTF). We aim to evaluate perioperative outcomes and radiographic correction based on contemporary practice.
METHODS: Randomized controlled trials (RCTs) published in English between January 2011 and January 2026 were retrieved from PubMed, Embase, the Cochrane Library, and the Web of Science Core Collection. Studies were screened using predefined inclusion and exclusion criteria. Six RCTs involving 305 patients were included, with 151 patients in the experimental group and 154 in the control group. Meta-analysis was performed using Review Manager 5.4. Mean difference (MD) was used as the effect size. Heterogeneity was assessed with the I2 statistic. Sensitivity analysis was used to identify the main source of heterogeneity. Publication bias was evaluated using Egger’s test.
RESULTS: The random-effects meta-analysis showed that the experimental group had significantly less intraoperative blood loss (MD = – 32.51 mL, 95% CI – 57.52 to – 7.51, P = 0.01), shorter postoperative hospital stay (MD = – 2.09 d, 95% CI – 3.89 to – 0.29, P = 0.02), and smaller postoperative Cobb angle (MD = – 1.06°, 95% CI – 1.67 to – 0.46, P < 0.001). There was no significant difference in operative time (MD = – 10.15 min, 95% CI – 28.75 to 8.46, P = 0.29) or postoperative vertebral wedging angle (MD = 0.25°, 95% CI – 1.73 to 2.24, P = 0.80) between groups. Sensitivity analyses identified the study by Yang et al. as the main source of heterogeneity for operative time. After excluding this study, the fixed-effects model showed a shorter operative time in the experimental group (MD = – 8.85 min, 95% CI – 12.74 to – 4.95, P < 0.001). Perioperative outcomes showed high heterogeneity, whereas radiographic outcomes showed low to moderate heterogeneity. Egger’s test indicated no significant publication bias. Risk-of-bias assessment classified four RCTs as having a low risk of bias and two as having some concerns; no study was judged to have a high risk of bias.
CONCLUSION: PPSF may offer perioperative advantages over OPSF in selected unstable traumatic thoracolumbar fractures, mainly by reducing visible intraoperative blood loss and shortening postoperative hospital stay. PPSF was also associated with a modestly smaller postoperative segmental Cobb angle, although its clinical relevance and long-term durability remain uncertain. The operative-time finding should be interpreted cautiously because it became significant only in exploratory sensitivity analysis.
PMID:42458487 | DOI:10.1186/s13018-026-07094-7
