Comparison between Wiltse approach and conventional approach for lumbar instrumentation and fusion
Chinese Journal of Clinical Anatomy ›› 2015, Vol. 33 ›› Issue (6) : 717-720.
Comparison between Wiltse approach and conventional approach for lumbar instrumentation and fusion
Objective To compare the influence of Wiltse approach and conventional approach on short-term postoperational recovery and muscle injury for patients received lumbar instrumentation and fusion. Method This is a Random Control Trial. Patients were randomized into bilateral Wiltse approach group (Group A) or bilateral conventional approach group (Group B). Decompression and fusion was performed unilaterally. Baseline Creatine kinase (CK), Aspartate aminotransferase (AST), Visual Analog Scale (VAS), Oswetry Disability Index (ODI) were measured. Drainage was placed on both side, and removed 48 hours after surgery. Operation duration and blood loss were recorded. CK and AST on postoperational Day 1 and Day 3, bilateral drainage volume within 48 hours after surgery, wound fluid volume measured by Ultrasonogram on postoperational Day 3, VAS and ODI on postoperational Day 5 and 3-month were recorded. Result There were 57 patients in total, with 27 patients in Group A and 30 patients in Group B. There were no significant difference between the two groups in age, baseline CK, AST, VAS and ODI (P>0.05). Operation duration and blood loss were similar. There was no significant difference in drainage volume on fusion side within 48 hours after operation, but significant difference in contralateral drainage volume (P<0.05). There was significant difference in CK and AST on postoperational Day 1 but not on Day 3. There were significant differences in VAS and ODI between two groups on postoperational Day 5 and 3-month. Conclusion It is plausible to complete lumbar instrumentation and intervertebral fusion through Wiltse approach. Wiltse approach could reduce muscle injury during operation, which is favorable for short-term recovery of patients.
[1] Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion [J]. Spine (Phila Pa 1976), 2006, 31(6): 712-716.
[2] Stevens KJ, Spenciner DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies[J]. J Spinal Disord Tech, 2006, 19(2): 77-86.
[3] Wiltse LL. The paraspinal sacrospinalis-splitting approach to the lumbar spine [J]. J Bone Joint Surg Am, 1968, 50(5): 919-926.
[4] Palmer S, Davison L. Minimally invasive surgical treatment of lumbar spinal stenosis: Two-year follow-up in 54 patients[J]. Surg Neurol Int, 2012, 3:41.
[5] 黎庆初,胡辉林,刘宝戈,等. 多裂肌间隙入路微创手术治疗腰椎滑脱症 [J]. 中国脊柱脊髓杂志, 2011, 21(4): 303-307.
[6] 江渟, 郭风劲, 张锟, 等. 椎旁肌间隙入路选择性治疗腰椎退行性病变 [J]. 临床外科杂志, 2012, 20(3): 189-191.
[7] Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review [J]. PM R, 2010, 2(2): 142-146; quiz 1 p following 167.
[8] Tsutsumimoto T, Shimogata M, Ohta H, et al. Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction [J]. Spine (Phila Pa 1976), 2009, 34(18): 1923-1928.
[9] Ohtori S, Miyagi M, Takaso M, et al. Differences in damage to CGRP immunoreactive sensory nerves after two lumbar surgical approaches: investigation using humans and rats [J]. Spine (Phila Pa 1976), 2012, 37(3): 168-173.
[10] Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis [J]. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
[11] Arts M, Brand R, van der Kallen B, et al. Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial [J]. Eur Spine J, 2011, 20(1): 51-57.
[12] Vialle R, Wicart P, Drain O, et al. The Wiltse paraspinal approach to the lumbar spine revisited: an anatomic study [J]. Clin Orthop Relat Res, 2006. 445: 175-180.
[13] Warren A, Prasad V, Thomas M. Pre-operative planning when using the Wiltse approach to the lumbar spine [J]. Ann R Coll Surg Engl, 2010, 92(1): 74-75.
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