The goals of surgical fixation include stabilization of the spine, fracture reduction, and, as appropriate, decompression of neurological structures. Pedicle screw systems, which were first introduced by Boucher, have been widely utilized in the instrumentation of the lumbar spine. Compared to the open approach, the minimal approach has many advantages for the treatment of thoracolumbar fractures, like small incision, no paraspinous muscle dissection and fewer blood loss.

The quality of the included studies was evaluated using the Cowley criteria. A Cowley score of a minimum of 9 out of a possible 17 was considered indicative of high methodological quality.

• The primary author’s surname, study year, country and study design;
• Basic study characteristics, including the amount and ages of enrolled patients and therefore the gender ratio for these patients;
• Perioperative results, such as operative duration, blood loss, and hospitalization;
• Rates of complications (e.g., infection or screw misplacement);
• Data regarding both intraoperative and postoperative complications were extracted.

Statistical Analysis was conducted using the statistical software Review Manager, version 5.3 (Cochrane Collaboration). Because the included studies reported similar findings, only results produced by a random effects model were presented. Continuous outcomes were assessed by calculating weighted mean differences (WMDs) and 95% confidence intervals (CIs). The essential search strategy yielded 144 records. Eighty-two articles were screened by title and abstract. Thirty-one case reports, reviews, biomechanical studies, and cadaveric studies were excluded. Sensitivity analysis was conducted by reanalyzing the info after the sequential omission of individual studies. Significant funnel plot asymmetry was observed for blood loss, operative time, and postoperative VAS outcomes. This finding indicated that there was significant publication bias among the studies included during this meta-analysis.

Although open posterior instrumented spinal procedures cause extensive damage to soft tissue that inevitably leads to a high incidence of syndromes related to failed back surgery, such procedures are widely accepted approaches for managing various sorts of thoracolumbar fractures25. In recent decades, there has been a clear trend toward minimizing soft tissue injury during spinal surgery.

Evidence from this updated meta-analysis, which was supported epidemiological studies of high methodological quality, indicated that relative to the open approach, the minimal approach resulted during a lower VAS score, less correction loss, shorter operative time and fewer blood

loss. However, high heterogeneity existed among the included studies. a big difference was observed between Chinese studies and other studies with reference to blood loss.

The results of our research address previously reported advantages of percutaneous pedicle fixation compared to the open approach. Reductions in blood loss due to the utilization of a minimal approach are demonstrated in many domains of surgery. Although high heterogeneity among studies was detected, our findings are consistent with these observations.