Does surgical approach or preoperative deformity better predict outcomes in thoracolumbar fractures? A comparative study of minimally invasive versus open techniques.

BACKGROUND: The optimal surgical approach for thoracolumbar fractures remains debated. However, it is unclear whether surgical technique or preoperative deformity severity better predicts final outcomes. PURPOSE: This study compares outcomes between MIS and Open surgery and identifies whether surgical approach or preoperative deformity severity better predicts final spinal alignment. METHODS: In this retrospective comparative study, 92 patients with thoracolumbar fractures (T11-L2) were divided into MIS (n = 46) and Open surgery (n = 46) groups. Radiographic parameters (fracture vertebral angle, Cobb angle, thoracolumbar angle, anterior-posterior height ratio) were assessed preoperatively, postoperatively, and at final follow-up (mean 19.6 ± 1.4 months). Perioperative outcomes and age-dependent correlations were analyzed using appropriate statistical tests (p ≤ 0.05 significant). RESULTS: The Open group demonstrated superior final fracture vertebral angle (7.1 ± 1.5° vs 8.3 ± 1.2°, p < 0.001) and Cobb angle correction (7.9 ± 1.4° vs 9.3 ± 1.2°, p < 0.001). More importantly, Open surgery showed better immediate anterior-posterior height restoration (80.4 ± 2.7% vs 79.0 ± 2.1%, p = 0.007), while MIS showed advantages in operative time (75.9 ± 10.9 vs 100.8 ± 12.9 min, p < 0.001), blood loss (85.8 ± 18.9 vs 238 ± 72.6 mL, p < 0.001), and hospital stay (5.9 ± 0.91 vs 8.4 ± 1.1 days, p < 0.001). Preoperative deformity severity was the strongest predictor of final Cobb angle in both groups (MIS: r = 0.491; Open: r = 0.646, both p < 0.001), although initial uncorrected analyses suggested some age-related correlations with other radiographic parameters, patient age was not a significant predictor of final alignment after False Discovery Rate correction. CONCLUSIONS: These study findings support a goal-stratified surgical strategy: prioritizing MIS where rapid rehabilitation is key, and favoring Open techniques where durable anatomical correction is paramount. Surgical approach is the primary determinant of perioperative recovery, whereas preoperative deformity severity is the dominant predictor of final anatomical alignment.