A Comparative Study of Wiltse Paraspinal Approach and Conventional Posterior Approach for the Treatment of Throacolumbar Fractures_West China Medical Journal

Authors：

 MENGXiang-yu , Turghunjan·Abdurxit , XIEJiang , TIANHui-zhong

Department of Spine Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830002, P. R. China;

Corresponding author：

Keywords：

Spinal fractures; Operative approach; Internal fixation; Therapeutic effect

DOI：

10.7507/1002-0179.20150411

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Objective To compare the clinical results of throacolumbar fractures treated through Wiltse paraspinal approach and conventional posterior approach. Methods Seventy-six cases of single segmental thoracolumbar fractures (Type A) were treated by posterior reduction and pedicle screw instrumentation from January 2011 to January 2013. Thirty-five cases were treated through Wiltse paraspinal approach (group A), including 27 males and 8 females with an average age of 39.7 years. Forty-one cases were treated through conventional posterior approach (group B), including 30 males and 11 females with an average age of 41.6 years. The data including incision length, operation time, intraoperative blood loss, postoperative volume of drainage, the anterior vertebral height, Cobb angle and complications were compared between the two groups. Results All operations were finished successfully. The incision length, operation time, intraoperative blood loss and postoperative volume of drainage were (8.3±1.9) cm, (74.0±21.9) min, (125.0 ±46.7) mL, and (51.0±42.6) mL respectively in group A, and (10.7±2.8) cm, (97.0±18.2) min, (245.0±56.1) mL, and (190.0±72.3) mL in group B respectively. There was significant difference between the two groups (P<0.05). The restoration of anterior vertebral height and the correction of Cobb angle were well maintained in both groups. The difference was statistically significant before and after treatment (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no difference in the complication rate between the two groups (P>0.05). Conclusion Compared with conventional posterior approach, Wiltse paraspinal approach has the advantage of shorter operation time, less trauma and blood loss. It is a better option for the treatment of throacolumbar fractures.

Citation： MENGXiang-yu, Turghunjan·Abdurxit, XIEJiang, TIANHui-zhong. A Comparative Study of Wiltse Paraspinal Approach and Conventional Posterior Approach for the Treatment of Throacolumbar Fractures. West China Medical Journal, 2015, 30(8): 1426-1429. doi: 10.7507/1002-0179.20150411 Copy

1.	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.
2.	Palmer DK, Allen JL, Williams PA, et al. Multilevel MRI analysis of multifidus longissimus cleavage planes in the lumbar spine and potential clinical applications to Wiltse's paraspinal approach[J]. Spine (Phila Pa 1976), 2011, 36(16):1263-1267.
3.	方向前, 胡志军, 范顺武, 等. 胸腰段骨折经肌间隙入路与传统入路内固定的比较研究[J]. 中华骨科杂志, 2009, 29(4):315-319.
4.	Wild MH, Glees M, Plieschnegger C, et al. Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures:a comparison of minimally invasive percutaneously and conventionally open treated patients[J]. Arch Orthop Trauma Surg, 2007, 127(5):335-343.
5.	张锋, 张文志, 段丽群, 等. Wiltse入路与传统后正中入路治疗胸腰段骨折疗效比较[J]. 颈腰痛杂志, 2013, 34(2):136-138.
6.	Yang H, Shi JH, Ebraheim M, et al. Outcome of thoracolumbar burst fractures treated with indirect reduction and fixation without fusion[J]. Eur Spine J, 2011, 20(3):380-386.
7.	王想福, 王兴盛. Wiltse入路经椎弓根植骨治疗胸腰椎骨折[J]. 中国骨伤, 2013, 26(7):587-590.
8.	王庆锋, 王静, 马宁, 等. Wiltse入路短节段固定治疗胸腰椎骨折[J]. 宁夏医学杂志, 2013, 35(2):132-134.
9.	Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation[J]. J Spinal Disord Tech, 2010,23(5):293-301.
10.	Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture[J]. Asian Spine J, 2015, 9(1):133-146.
11.	Fu MC, Nemani VM, Albert TJ. Operative treatment of thoracolumbar burst fractures:is fusion necessary?[J]. HSS J, 2015, 11(2):187-189.
12.	Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures[J]. Spine J, 2014, 14(1):145-164.
13.	Wang ST, Ma HL, Liu CL, et al. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine? A prospective, randomized study[J]. Spine (Phila Pa 1976), 2006, 31(23):2646-2652; discussion 2653.
14.	Qian BP, Qiu Y, Wang B, et al. Effect of posterolateral fusion on thoracolumbar burst fractures[J]. Chin J Traumatol, 2006, 9(6):349-355.
15.	Kim YM, Kim DS, Choi ES, et al. Nonfusion method in thoracolumbar and lumbar spinal fractures[J]. Spine (Phila Pa 1976), 2011, 36(2):170-176.
16.	Li H, Yang L, Xie H, et al. Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with single-segment thoracolumbar fractures without neurologic injury[J]. J Biomed Res, 2015, 29(1):76-82.
17.	Wang H, Zhou Y, Li C, et al. Comparison of open versus percutaneous pedicle screw fixation using the sextant system in the treatment of traumatic thoracolumbar fractures[J/OL]. J Spinal Disord. (2014-07-11)[2015-08-01]. Tech. http://journals.lww.com/jspinaldisorders/pages/articleviewer.aspx?year=9000&issue=00000&article=99263&type=abstract.

1. 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.
2. Palmer DK, Allen JL, Williams PA, et al. Multilevel MRI analysis of multifidus longissimus cleavage planes in the lumbar spine and potential clinical applications to Wiltse's paraspinal approach[J]. Spine (Phila Pa 1976), 2011, 36(16):1263-1267.
3. 方向前, 胡志军, 范顺武, 等. 胸腰段骨折经肌间隙入路与传统入路内固定的比较研究[J]. 中华骨科杂志, 2009, 29(4):315-319.
4. Wild MH, Glees M, Plieschnegger C, et al. Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures:a comparison of minimally invasive percutaneously and conventionally open treated patients[J]. Arch Orthop Trauma Surg, 2007, 127(5):335-343.
5. 张锋, 张文志, 段丽群, 等. Wiltse入路与传统后正中入路治疗胸腰段骨折疗效比较[J]. 颈腰痛杂志, 2013, 34(2):136-138.
6. Yang H, Shi JH, Ebraheim M, et al. Outcome of thoracolumbar burst fractures treated with indirect reduction and fixation without fusion[J]. Eur Spine J, 2011, 20(3):380-386.
7. 王想福, 王兴盛. Wiltse入路经椎弓根植骨治疗胸腰椎骨折[J]. 中国骨伤, 2013, 26(7):587-590.
8. 王庆锋, 王静, 马宁, 等. Wiltse入路短节段固定治疗胸腰椎骨折[J]. 宁夏医学杂志, 2013, 35(2):132-134.
9. Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation[J]. J Spinal Disord Tech, 2010,23(5):293-301.
10. Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture[J]. Asian Spine J, 2015, 9(1):133-146.
11. Fu MC, Nemani VM, Albert TJ. Operative treatment of thoracolumbar burst fractures:is fusion necessary?[J]. HSS J, 2015, 11(2):187-189.
12. Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures[J]. Spine J, 2014, 14(1):145-164.
13. Wang ST, Ma HL, Liu CL, et al. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine? A prospective, randomized study[J]. Spine (Phila Pa 1976), 2006, 31(23):2646-2652; discussion 2653.
14. Qian BP, Qiu Y, Wang B, et al. Effect of posterolateral fusion on thoracolumbar burst fractures[J]. Chin J Traumatol, 2006, 9(6):349-355.
15. Kim YM, Kim DS, Choi ES, et al. Nonfusion method in thoracolumbar and lumbar spinal fractures[J]. Spine (Phila Pa 1976), 2011, 36(2):170-176.
16. Li H, Yang L, Xie H, et al. Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with single-segment thoracolumbar fractures without neurologic injury[J]. J Biomed Res, 2015, 29(1):76-82.
17. Wang H, Zhou Y, Li C, et al. Comparison of open versus percutaneous pedicle screw fixation using the sextant system in the treatment of traumatic thoracolumbar fractures[J/OL]. J Spinal Disord. (2014-07-11)[2015-08-01]. Tech. http://journals.lww.com/jspinaldisorders/pages/articleviewer.aspx?year=9000&issue=00000&article=99263&type=abstract.

West China Medical Journal

A Comparative Study of Wiltse Paraspinal Approach and Conventional Posterior Approach for the Treatment of Throacolumbar Fractures

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