Comparison of the modified Wiltse's approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

Chang, Jie; Cao, Jiang; Huang, Ziyan; Wang, Boyao; Sui, Tao; Cao, Xiaojian

doi:10.7555/jbr.34.20200008

Cited by 6 publications

(3 citation statements)

References 35 publications

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“…Thoracolumbar fractures are the most common spinal fractures, especially fractures caused by high-energy injuries, which are different from vertebral compression fractures in the elderly, often accompanied by vertebral burst, even dislocation and spinal cord injury. 12 , 13 These fractures usually require surgical internal fixation, which requires firm fixation to restore spinal stability and decompression of the spinal canal to relieve pressure on the spinal nerves. 14 , 15 DVT is a common complication in trauma patients, particularly those with high-energy fractures.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Changes and Relevant Factors of Perioperative Deep Vein Thrombosis in Patients with Thoracolumbar Fractures Caused by High-Energy Injuries

Wang

Zhang

et al. 2023

Clin Appl Thromb Hemost

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Objective To investigate the dynamic changes and relevant factors of deep vein thrombosis (DVT) in patients with thoracolumbar fractures caused by high-energy injuries. Methods From January 2016 to June 2021, a total of 655 patients with thoracolumbar fractures who underwent surgical treatment in our hospital were retrospectively analyzed. The patients were examined by preoperative and postoperative ultrasonography, and divided into thrombus growth group, thrombus invariant group, and thrombus regression group according to the preoperative and postoperative ultrasonographic results. Medical record data, including demographic data, surgical data, and laboratory results, were collected and the differences in various factors among the groups were compared. Results DVT was found in 99 patients (15.1%, 99/655) before surgery, including 79 cases of distal thrombus, 7 cases of proximal thrombus, and 13 cases of mixed thrombus. The incidence of postoperative DVT increased to 20.6% (134/655), including 96 cases of distal thrombus, 15 cases of proximal thrombus, and 23 cases of mixed thrombus. Among them, 39.7% had thrombus growth, 49.3% had thrombus basically unchanged and 11.0% had thrombolysis. There were significant differences in age, lower extremity muscle strength, time from trauma to surgery, operation time, blood loss, blood transfusion, and post 3-D-dimer among the three groups. Conclusions In patients with thoracolumbar fractures caused by high-energy injuries, the majority of patients with DVT do not change or grow after surgery, and only a few of them have thrombolysis. Younger age, lower extremity motor, and fewer blood transfusion contribute to thrombolysis. Delayed surgical intervention, longer operation time, and higher blood loss can lead to thrombosis growth. Post 3-D-dimer is closely related to the dynamic changes of thrombus.

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Section: Discussionmentioning

confidence: 99%

Dynamic Changes and Relevant Factors of Perioperative Deep Vein Thrombosis in Patients with Thoracolumbar Fractures Caused by High-Energy Injuries

Wang

Zhang

et al. 2023

Clin Appl Thromb Hemost

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“…In recent years, minimally invasive spine has been widely used, especially in the TF without neurological symptoms, the most representative of which is pedicle screw xation through Wiltse approach. 7 The advantage of WPSF is less bleeding during operation, more importantly, it can protect soft tissue and muscle, and reduce the incidence of long-term low back pain after operation. 8; 17 What puzzles spinal surgeons at present is not the choice of surgical methods, but how to effectively restore the height of the injured vertebral body and the physiological curvature of the spine.…”

Section: Discussionmentioning

confidence: 99%

Effect of Manual Reduction Combined with Internal Fixation Through Wiltse Paraspinal Approach in the Treatment of Thoracolumbar Fracture (AO type A3)

Yang

Gao

et al. 2023

Preprint

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Background: Thoracolumbar fractures (TF) are the most frequent fractures of the spine, and the current treatment for TF (AO Type A3) is the Wiltse approach with pedicle screw fixation or percutaneous pedicle screw fixation. However, secondary collapse often occurs after operation. To reduce the incidence of such events, preoperative manual reduction (MR) is an efficient method. The purpose of this study is to investigate the impact of successful PMR on prognosis of patients with TF. Methods: From 2018 to 2022, 97 patients are enrolled to the study. Patients are divided into three groups, MR failure (MRF), succeeded (MRS) and instrument reduction (IR). The different time of the Cobb angel (CA) and vertebral body height ratio (VBHR) are obtained for three groups. The visual analog scale (VAS) is used to help patients assess the intensity of their pain, and oswestry disability index (ODI) is regarded as the gold standard for evaluating the degree of dysfunction caused by TF. Results: The recovery of CA and VBHR, MRS and IR is significantly better than MRF at 2 days and 6 months after operation. The CA and VBHR are found to be different between preoperative and 2 days, 6 months after operation. The CA and VBHR in MRF are decreased at 6 months after surgery compared with 2 days after surgery. In the results of VBHR 6 months after operation, there is significant difference between MRS and IR. Conclusion: Successful preoperative manual reduction can greatly improve and maintain vertebral height and spinal physiological curvature. In addition, according to the success of manual reduction, TF of AO Type A3 can be divided into A3a and A3b.

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“…One patient belongs to group (A) required repeated surgery for realignment of screws. Nearly all previous studies didn't report significant difference in postoperative complications between the conventional or the wilts approaches [13,15,[18][19][20].…”

Section: Study Limitationsmentioning

confidence: 92%

Safety and feasibility of mini-open Wiltse approach in posterolateral lumbar stabilization and fusion: intra- and post-operative evaluation

Elkholy,

Elnoamany,

Hussein

2024

Egypt J Neurosurg

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Background Expected operative challenges in minimally invasive spine surgeries as a result of restricted surgical field, unfamiliarity with surgical approaches and fear of complications are behind the preference of using traditional "open" spine surgery. Objectives To evaluate the safety and feasibility of mini-open Wiltse approach in comparison with the conventional midline approach for posterolateral lumbar stabilization and fusion. Patients and methods A retrospective comparative study conducted on 49 patients with low grade single level lumbar spondylolithesis who were surgically treated in our Department between May 2020 and May 2022. Patients who were surgically treated with traditional midline approach were included in group (A) and patients in whom the mini-open Wiltse approach was used, were assigned to group (B). The two groups were compared regarding various intra and postoperative parameters. Results Group (A) included 27 patients (55.1%) operated upon with the classic midline approach and 22 patients (44.9%) were surgically treated using the Wiltse approach (group B). The mean patients' age (50.43 ± 5.538) years and L4-5 was the most commonly affected level (71.4%). The intra-operative parameters (operation time, blood loss and fluoroscopy time) showed significant lower results (P < 0.001) among patients of group (B). No cases in the group (B) required blood transfusion versus 5 cases in group (A) (P = 0.033). Postoperatively, the Oswestry Disability Index (ODI) and Visual analogue scale (VAS) scores were significantly improved in each group in comparison to the preoperative scores (P < 0.001). However, after 3 months the ODI score in group (B) was superior to that in group (A) (P = 0.045) and postoperative VAS score in group (B) was significantly improved compared to that in group (A) at discharge (P = 0.016), and also after 1 and 3 months (P < 0.001). Patients operated with Wiltse approach had a shorter duration of hospital stay but the difference was not statistically significant (P = 0.090). Conclusions Because of minimal trauma to the muscles and soft tissues, the mini-open Wiltse approach can be faster, safer and requires less recovery time as opposed to the classic midline approach.

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Comparison of the modified Wiltse's approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

Cited by 6 publications

References 35 publications

Dynamic Changes and Relevant Factors of Perioperative Deep Vein Thrombosis in Patients with Thoracolumbar Fractures Caused by High-Energy Injuries

Dynamic Changes and Relevant Factors of Perioperative Deep Vein Thrombosis in Patients with Thoracolumbar Fractures Caused by High-Energy Injuries

Effect of Manual Reduction Combined with Internal Fixation Through Wiltse Paraspinal Approach in the Treatment of Thoracolumbar Fracture (AO type A3)

Safety and feasibility of mini-open Wiltse approach in posterolateral lumbar stabilization and fusion: intra- and post-operative evaluation

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