A Comparison of the Mini-Open Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Neurologically Intact Thoracolumbar Fractures

Abstract

BackgroundThe thoracolumbar AO type A3 fracture is an incomplete burst fracture, which affects one vertebral body endplate. The objective of this study was to determine which of two minimal invasive techniques was more suitable for A3 fractures based on clinical and radiographic results.Material/MethodsWe studied 112 patients with A3 subtype fractures without neurological deficits. A total of 63 patients received percutaneous pedicle screw fixation (PPSF), and 49 patients were treated using mini-open Wiltse approach with pedicle screw fixation (MWPSF). The clinical outcomes, surgery-related results, and the pre-operative and post-operative radiological findings were compared between the two groups.ResultsThe length of incision, intra-operative blood loss, post-operative hospitalization time, visual analog score (VAS), Oswestry disability index (ODI), and accuracy rate of pedicle screw placement were compared between the PPSF and MWPSF groups, with no significant differences found (p>0.05). However, the vertebral body angle (VBA) and Cobb’s angle in the MWPSF group was much better than in the PPSF group (p<0.05). The operating time and C-arm exposure time of the MWPSF group were significantly lower than the PPSF group (p<0.05). The operative and post-operative costs of the PPSF group were significantly higher than the MWPSF group (p<0.05).ConclusionsOur study found no significant differences in some clinical outcomes between the two groups. Both treatments were safe and effective for A3 subtype fractures. Nevertheless, given the radiation exposure, reduction of kyphosis, special equipment required, learning curve and hospitalization costs associated with PPSF, we concluded that MWPSF was a better choice for A3 subtype fractures.

A novel retractor for reducing operation time and radiation exposure in percutaneous pedicle screw placement

“…These limitations included [1,3,10,20]: longer operation time and greater fluoroscopy frequencies for both medical staffs and the patients. The traditional percutaneous methods showed a high incidence of erroneous placement [21] of the pedicle screws and a steep learning curve [22]. In the traditional method, the accurate percutaneous pedicle screw placement relies heavily on fluoroscopy in order to obtain a proper screw trajectory.…”

Comparison of the clinical efficacy of the Wiltse paraspinal approach and O-arm navigation for the treatment of thoracolumbar fractures

“…The traditional surgical treatment for thoracolumbar fracture is open posterior pedicle screw instrumentation. However, the operative approach involves detaching the paravertebral muscles from the bone portion of the spine, which can lead to several problems such as increased intraoperative bleeding, soft tissue ischemia, muscle denervation and atrophy, and chronic back pain [3][4][5].…”

“…Nevertheless, for many minimally invasive techniques, we required a better understanding of the surgical indications to guide the selection of appropriate and better minimally invasive methods. Fan et al [4] compared the paraspinal muscle approach and percutaneous pedicle screw placement under uoroscopy for thoracolumbar burst fracture, and found that both surgical methods are safe and reliable; ultimately, they preferred the Wiltse approach as a better choice in terms of radiation exposure, operative cost, learning curve and reduction of kyphosis. In this study, we rst performed a comparsion of the Wiltse approach and percutaneous pedicle screw xation under O-arm navigation for the treatment of thoracolumbar fracture, to study which minimally invasive technique was more bene cial for patients.…”

Comparison of the clinical efficacy of Wiltse paraspinal approach and O-arm navigation for the treatment of thoracolumbar fractures

“…The traditional surgical treatment for thoracolumbar fracture is open posterior pedicle screw instrumentation. However, the operative approach is to detach paravertebral muscles from the bone portion of the spine, which will produce several problems in relation to increased intraoperative bleeding, soft tissue ischemia, muscle denervation and atrophy, and chronic back pain [3][4][5].…”

“…Nevertheless, for many minimally invasive techniques, we required to grasp the surgical indications to guide the selection of appropriate and better minimally invasive methods. Fan et al [4] compared the paraspinal muscle approach and percutaneous pedicle screw placement under fluoroscopy for the thoracolumbar burst fracture, and found that both surgical methods are safe and reliable, and finally they preferred Wiltse approach as a better choice while considering radiation exposure, operative cost, learning curve and reduction of kyphosis. In this study, we first performed a comparsion of Wiltse approach and percutaneous pedicle screw fixation under O-arm navigation for the treatment of thoracolumbar fracture, to study which minimally invasive technology was more beneficial for patients.…”