How to perform the wiltse posterolateral spinal approach: Technical note

Guiroy, Alfredo; Sícoli, Alfredo; Masanés, Nicolás Gonzalez; Ciancio, Alejandro Morales; Gagliardi, Martín; Falavigna, Asdrúbal

doi:10.4103/sni.sni_344_17

Cited by 41 publications

(31 citation statements)

References 8 publications

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“…All standard procedures for correction, including rod de-rotation, compression, distraction, and in-situ bending are to be performed. 7,9 (Fig. 2).…”

Section: Mis With 3 Small Incisionsmentioning

confidence: 97%

“…It approaches the lumbar facet joints through blunt dissection between the medial multifidus and lateral longissimus muscles, providing access to pedicular screws during scoliosis correction, and is considered MIS for AIS surgeries. 7 A retrospective study by Street et al comparing the results of 385 patients done with midline surgical approach and Wiltse approach found that the latter has advantages in reducing the incidence of infection, blood loss, and adjacent segment failure than the midline approach. 8…”

Section: Muscle Sparing or Wiltse Approachmentioning

confidence: 99%

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Minimal invasive surgery techniques for patients with adolescent idiopathic and early onset scoliosis

Ahmad

2020

Journal of Clinical Orthopaedics and Trauma

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Objective: Provide an update on minimal invasive surgery (MIS) techniques for surgical management of pediatric spine. Methods: Minimal Invasive surgery for pediatric spine deformity has evolved significantly over the past decade. We include updated information about the surgical management of patients with adolescent idiopathic and Early Onset Scoliosis through MIS techniques. We take into consideration the implementation of this technique in Low-to-Middle Income Countries (LMICs). Results: Although MIS began as a technique in adult and degenerative spine, recent publications on MIS in pediatric spine cases report benefits of decreased blood loss and infection incidence, and cosmetic advantages from fewer incision numbers. Adoption of MIS techniques in pediatric spine can be facilitated with pre-and intraoperative use of pertinent medical systems. Conclusion: With appropriate considerations and training, MIS is a safe procedure for pediatric spine correction surgery and can be applicable in LMICs.

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“…All standard procedures for correction, including rod de-rotation, compression, distraction, and in-situ bending are to be performed. 7,9 (Fig. 2).…”

Section: Mis With 3 Small Incisionsmentioning

confidence: 97%

Section: Muscle Sparing or Wiltse Approachmentioning

confidence: 99%

Minimal invasive surgery techniques for patients with adolescent idiopathic and early onset scoliosis

Ahmad

2020

Journal of Clinical Orthopaedics and Trauma

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“…Third, bilateral access was provided through an ‐8‐cm‐long midline skin incision. The lumbar dorsal fascia was incised longitudinally at 2.5–3 cm from the posterior midline 12 . The medial multifidus was separated from the lateral longissimus muscle using blunt dissection with fingers.…”

Section: Methodsmentioning

confidence: 99%

A Comparative Study of a New Retractor‐Assisted WILTSE TLIF, MIS‐TLIF, and Traditional PLIF for Treatment of Single‐Level Lumbar Degenerative Diseases

Liu

Sun

et al. 2022

Orthopaedic Surgery

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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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“…The surgical procedure for the minimally invasive, Wiltse, posterolateral spinal approach for TLIF has been described in the literature. 4,[15][16][17] The patient was placed prone under general anesthesia. Decompression was performed on the side that was considered the most symptomatic.…”

Section: Surgical Technique For Freehand Fg Mis-tlifmentioning

confidence: 99%

Robot-guided versus freehand fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion: a single-institution, observational, case-control study

Lin

Liu

et al. 2022

Neurosurgical Focus

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OBJECTIVE The use of robotics in spinal surgery has gained popularity because of its promising accuracy and safety. ROSA is a commonly used surgical robot system for spinal surgery. The aim of this study was to compare outcomes between robot-guided and freehand fluoroscopy-guided instrumentation in minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF). METHODS This retrospective consecutive series reviewed 224 patients who underwent MIS-TLIF from March 2019 to April 2020 at a single institution. All patients were diagnosed with degenerative pathologies. Of those, 75 patients underwent robot-guided MIS-TLIF, and 149 patients underwent freehand fluoroscopy-guided MIS-TLIF. The incidences of pedicle breach, intraoperative outcomes, postoperative outcomes, and short-term pain control were compared. RESULTS The patients who underwent robot-guided surgery had a lower incidence of pedicle breach (0.27% vs 1.75%, p = 0.04) and less operative blood loss (313.7 ± 214.1 mL vs 431.6 ± 529.8 mL, p = 0.019). Nonsignificant differences were observed in operative duration (280.7 ± 98.1 minutes vs 251.4 ± 112.0 minutes, p = 0.056), hospital stay (6.6 ± 3.4 days vs 7.3 ± 4.4 days, p = 0.19), complications (intraoperative, 1.3% vs 1.3%, p = 0.45; postoperative surgery-related, 4.0% vs 4.0%, p = 0.99), and short-term pain control (postoperative day 1, 2.1 ± 1.2 vs 1.8 ± 1.2, p = 0.144; postoperative day 30, 1.2 ± 0.5 vs 1.3 ± 0.7, p = 0.610). A shorter operative duration for 4-level spinal surgery was found in the robot-guided surgery group (388.7 ± 107.3 minutes vs 544.0 ± 128.5 minutes, p = 0.047). CONCLUSIONS This retrospective review revealed that patients who underwent robot-guided MIS-TLIF experienced less operative blood loss. They also benefited from a shorter operative duration with higher-level (> 3 levels) spinal surgery. The postoperative outcomes were similar for both robot-guided and freehand fluoroscopy-guided procedures.

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How to perform the wiltse posterolateral spinal approach: Technical note

Cited by 41 publications

References 8 publications

Minimal invasive surgery techniques for patients with adolescent idiopathic and early onset scoliosis

Minimal invasive surgery techniques for patients with adolescent idiopathic and early onset scoliosis

A Comparative Study of a New Retractor‐Assisted WILTSE TLIF, MIS‐TLIF, and Traditional PLIF for Treatment of Single‐Level Lumbar Degenerative Diseases

Robot-guided versus freehand fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion: a single-institution, observational, case-control study

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