TLIF by Wiltse Approach versus OLIF for degenerative lumbar scoliosis: A retrospective study

Abstract

To assess the differences in the clinical and radiological outcomes between Wiltse-TLIF and OLIF for treating degenerative lumbar scoliosis.In this retrospective controlled study, 65 patients with Lenke-Silva treatment level III, IV degenerative lumbar scoliosis. who were operated in our hospital from January 2018 and December 2022 were analyzed retrospectively. The patients were randomly assigned to Wiltse approach group (group A，31 cases) and conventional open approach group (group B，34 cases). Patient’s assessment of pain and disability were evaluated by the visual analogue scale (VAS) and the Oswestry disability index (ODI) before and after surgery. The incision length, operative time, intraoperative blood loss, hidden blood loss, time to ambulation, total length of hospitalization, X-rays, CT and MRI were also evaluated. There were no differences in sex, age, pre-operative ODI score, VAS score between the two groups (P > 0.05). The Wiltse approach group had a shorter incision length( 24.34vs. 31.51 cm, P＜0.05). The average operative time was shorter in OLIF group( 5.21 vs. 4.81 hours , P＜0.05). The OLIF group also have less intraoperative blood loss (672.32 vs. 370.11 ml, P＜0.001) and hidden blood loss (245.56 vs. 109.23 ml, P＜0.001). The Wiltse approach group were ambulatory(3.23 vs. 2.13 days, P＜0.05) and remained in the hospital(11.48 vs. 8.31 days, P＜0.05) for more time compared with OLIF group. Both groups showed no significant differences in the VAS scores of lower back and leg pain and the ODI scores. OLIF surgery is significantly better than Wiltse-TLIF in improving Sagittal vertical axis (t=2.13, P＜0.05) , lumbar lordosis (t=5.36, P＜0.001). There was no significant difference in the improvement of the lumbar cobb angle, Pelvic tilt angle and Sacral slope angle between the two groups.The complications rate was significantly lower in the Wiltse-TLIF group than in the OLIF group (23.5% vs. 12.9%).Wiltse-TLIF and OLIF showed similar patient-reported outcomes, however, the complication rate of OLIF was higher than that of Wiltse-TLIF, which do not adversely affect the clinical and radiographic outcomes. We also concluded that OLIF surgery is suitable for patients with dynamic raidcular pain, for the patients with static raidcular pain, wiltse-TLIF may be a better chosen.