Minimally invasive posterior surgery for thoracolumbar fractures. New trends to decrease muscle damage

High-energy spine fractures mainly affect the thoracolumbar junction. Surgery helps restore spine stability and sagittal realignment and improves long-term outcomes of patients. Posterior instrumentation ensures stability in most cases, some patients with unstable fractures benefitting from an additional anterior approach. This article discusses the indications for surgery with a view to conservative treatment and presents the advantages of posterior and anterior approaches. It also describes posterior, minimally invasive surgical techniques that have been developed in the past decade. In the light of scientific arguments, posterior minimally invasive surgery, combined with balloon-assisted vertebroplasty (or kyphoplasty) when necessary, appears to be at least as efficient as other posterior techniques, including open surgery. It has the advantage of being less aggressive towards soft tissues and of generating fewer complications than open surgery. Minimally invasive surgery may have better long-term outcomes for patients and may be cost-effective for health budgets, but these points need to be confirmed by further investigations.