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.

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Background To compare the clinical efficacy of new-type-retractor assisted wiltse approach Transforaminal lumbar Interbody Fusion (TLIF), Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) and traditional Posterior Lumbar Interbody Fusion (PLIF)in single-level lumbar degenerative diseases. Methods A retrospective study was conducted by analyzing clinical and imaging information of consecutive patients with single-level lumbar degenerative diseases who underwent either the new-type-retractor assisted wiltse approach TLIF or the MIS-TLIF or the traditional PLIF. 87 concurrent patients with similar age ,weight and severity of the imaging and symptom between June 2016 and December 2019 were included(wiltse approach 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, bed time), creatine kinase (CK), Visual Analogue Scale(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, postoperative drainage volume and bed time in MIS-TILF group and wiltse group was significantly lower than PLIF group. The operative time and intraoperative radiation time of MIS-TILF group was significantly longer than wiltse group and PLIF group. CK level in wiltse and MIS-TILF group were significantly lower than PLIF group 1 and 3 days after surgery. PLIF group back pain VAS score was higher than wiltse and MIS-TLIF group. PLIF group displayed a higher ODI and a lower JOA score than the wiltse and MIS-TLIF group 6 months and 12 months after surgery. There was no significant statistical difference in lower limb pain VAS score and intervertebral fusion rate. Ratio of multifidus atrophy in the PLIF group was significantly higher than the wiltse group and the MIS-TILF group. Ratio of lean-to-total CSA (cross-sectional area) in PLIF group was lower than wiltse group and MIS-TLIF group after surgery. There was no significant difference between wiltse group and MIS-TLIF group except that MIS-TLIF group showed longer operation time and intraoperative fluoroscopy time while lower blood loss and drainage volume. 2 cases of durotomy and 2 cases of incision fat liquefaction occurred in PLIF group, 1 case of skin edge necrosis was found in MIS-TILF group. Patients were followed up at 3 months,6moyhs,12months after surgery, The mean follow-up time of the patients was 12.14±2.78 months in wiltse group, 13.57±2.60 months in MIS-TLIF group, and 12.73±2.80 months in PLIF group, with no significant diffirence among 3 groups. (P༞0.05) Conclusion Wiltse approach TLIF assisted with the new-type retractor is a more convenient and simple minimally invasive surgical method than traditional PLIF and MIS-TLIF, which requires a long learning curve, long operation and fluoroscopy time.