Objectives: To compare the clinical efficacy of a new retractor-assisted Wiltse transforaminal lumbar interbody fusion (TLIF), minimally invasive TLIF (MIS-TLIF), and traditional posterior lumbar interbody fusion (PLIF) in treating single-level lumbar degenerative diseases.Methods: A retrospective study was conducted by analyzing the clinical and imaging data of consecutive patients with single-level lumbar degenerative diseases who underwent the new retractor-assisted Wiltse TLIF, MIS-TLIF, or traditional PLIF. This study enrolled 87 concurrent patients between June 2016 and December 2019 (Wiltse TLIF 29 cases; MIS-TLIF 28 cases; PLIF 30 cases). The three groups were compared for perioperative indicators (including intraoperative blood loss, postoperative drainage volume, operation time, intraoperative fluoroscopy time, bedridden time), creatine kinase (CK), visual analog score (VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, intervertebral fusion rate, muscle atrophy, and fatty infiltration (including ratio of multifidus atrophy and ratio of lean-to-total cross-sectional area [CSA]).Results: Intraoperative blood loss (F = 62.628, p < 0.001), postoperative drainage volume (F = 72.048, p < 0.001), and bedridden time (χ 2 = 62.289, p < 0.001) were significantly lower in the MIS-TLIF and Wiltse groups than in the PLIF group. The operative and intraoperative radiation times of the MIS-TLIF group were significantly longer than those of the Wiltse and PLIF groups. The CK concentration in the Wiltse and MIS-TLIF groups were significantly lower than those in the PLIF group 1 day (F = 9.331, p < 0.001) and 3 days after surgery (F = 15.967, p < 0.001). The PLIF group's back pain VAS score was higher than those of the Wiltse and MIS-TLIF groups. The PLIF group had a higher ODI 6 months (F = 3.282, p = 0.042) and 12 months (F = 5.316, p = 0.007) after surgery and a lower JOA score than the Wiltse and MIS-TLIF groups 6 months (F = 3.234, p = 0.044) and 12 months (F = 3.874, p = 0.025) after surgery. The ratio of multifidus atrophy in the PLIF group (41.70 AE 8.84%) was significantly higher than those of the Wiltse group (24.13 AE 6.82%) and the MIS-TLIF group (22.35 AE 5.03%). The ratio of lean-to-total CSA in the PLIF group was lower than those of the Wiltse and MIS-TLIF groups after surgery (F = 8.852, p < 0.001). MIS-TLIF group showed longer operation time (169.11 AE 29.38 min) and intraoperative fluoroscopy time (87.61 AE 3.13 s) than the Wiltse group. Conclusion:Wiltse TLIF assisted by the new retractor is a more convenient and minimally invasive surgical method than the traditional PLIF and MIS-TLIF methods, which are linked to a long learning curve and long operation and fluoroscopy time.

Objective To evaluate the clinical efficacy of unilateral wiltse transforaminal lumbar interbody fusion (TLIF) combined with unilateral nail bar system fixation for single-level lumbar degenerative diseases with the assistance of a new automatic retraction device in a retrospective comparative study. Methods A total of 46 patients with single-level lumbar degenerative diseases from September 2019 to December 2021 were retrospectively analyzed. Bilateral nail bar fixation with bullet-type fusion cage (ctrl group, 24 patients) and unilateral nail bar fixation on the affected side with kidney-like fusion cage (study group, 22 patients) were performed in TLIF via wiltse intermuscular approach assisted by a new automatic retraction device. The differences in intraoperative blood loss, operative time, intraoperative fluoroscopy time, postoperative drainage, bed rest, VAS score, ODI score, JOA score, serological creatine kinase (CK), the proportion of multifidus atrophy, modified Pfirrmann classification and intervertebral space height of the upper intervertebral disc were compared between the two groups based on clinical and imaging data. Results Intraoperative bleeding, operative time, and postoperative drainage were significantly lower in study group than ctrl group, and there were no significant differences in bed rest time and intraoperative fluoroscopy time between them. In addition, there was no statistical difference in CK between the study group and the ctrl group at 24 and 48 h postoperatively. Moreover, no statistically significant difference was found in VAS score of low back pain, VAS score of lower limb pain, ODI index, modified Pfirrmann classification of the upper intervertebral disc and intervertebral space height of the upper intervertebral disc between two groups. The atrophy ratio of multifidus muscle was significantly lower in the study group. Conclusion The new automatic retraction device assisted unilateral TLIF surgery with wiltse approach combined with unilateral nail bar fixation is a simple, effective and easy to master surgical method for single-level lumbar degenerative diseases.

Objective: The aim of this study was to evaluate the clinical outcome of a modified surgical technique, enlarged unilateral posterior vertebral column resection (EU-PVCR), for treatment of spinal kyphosis accompanied with compressive vertebral fracture.Material and Methods: Between January 2015 and December 2020, data of 13 patients who underwent EU-PVCR were retrospectively collected. All patients were followed up for a minimum of 12 months. Clinical outcome was evaluated by kyphotic Cobb’s angle, sagittal vertical axis (SVA), visual analogue scale (VAS) score and Oswestry disability index (ODI). The operation time, blood loss and complications were also recorded.Results: All patients received this operation successfully. The average time of follow up was 12.3±2.1 months. At pre-operation, 1 week post-operation and 12 months post-operation, the Cobb angle were 45.5±6.1, 7.9±1.3, 8.6±1.4 (P<0.05). SVA was 3.2±0.8cm at pre-operation, and changed to 1.9±0.9cm at post-operation, and 2.1±1.1cm at the last follow up. At pre-operation, 1 weeks post-operation and 12 months post-operation, VAS were 6.1±1.3, 2.5±0.5, 1.3±0.5 (P<0.05).ODI was 28.0±2.7 before operation, and improved to 8.9±1.9 at most recent follow-up (P<0.05). No permanent neurological complication was observed during follow up.Conclusion: EU-PVCR technique is an effective surgical method for the treatment of spinal kyphosis accompanied by compressive vertebral fracture in adults, while the long-term clinical outcome remains further investigated.

Objective: The aim of this study was to evaluate the clinical outcome of a modified surgical technique, enlarged unilateral posterior vertebral column resection (EU-PVCR), for treatment of spinal kyphosis accompanied with compressive vertebral fracture.Material and Methods: Between January 2015 and December 2020, data of 13 patients who underwent EU-PVCR were retrospectively collected. All patients were followed up for a minimum of 12 months. Clinical outcome was evaluated by kyphotic Cobb’s angle, sagittal vertical axis (SVA), visual analogue scale (VAS) score and Oswestry disability index (ODI). The operation time, blood loss and complications were also recorded.Results: All patients received this operation successfully. The average time of follow up was 12.3±2.1 months. At pre-operation, 1 week post-operation and 12 months post-operation, the Cobb angle were 45.5±6.1, 7.9±1.3, 8.6±1.4 (P<0.05). SVA was 3.2±0.8cm at pre-operation, and changed to 1.9±0.9cm at post-operation, and 2.1±1.1cm at the last follow up. At pre-operation, 1 weeks post-operation and 12 months post-operation, VAS were 6.1±1.3, 2.5±0.5, 1.3±0.5 (P<0.05).ODI was 28.0±2.7 before operation, and improved to 8.9±1.9 at most recent follow-up (P<0.05). No permanent neurological complication was observed during follow up.Conclusion: EU-PVCR technique is an effective surgical method for the treatment of spinal kyphosis accompanied by compressive vertebral fracture in adults, while the long-term clinical outcome remains further investigated.

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