Two-Level Circumferential Lumbar Fusion Comparing Midline and Paraspinal Posterior Approach

Buttermann, Glenn R.; Mullin, W.J.

doi:10.1097/bsd.0000000000000029

Cited by 13 publications

(30 citation statements)

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“…The postoperative muscle abnormalities are believed to be related to the pressure and duration of retraction of the muscles during surgery [ 5 – 7 ] and may be due to denervation [ 26 ]. In recent years, the paraspinal approach has been widely used for thoracolumbar fractures in order to decrease the damage to the back muscle and the risks of postoperative back pain [ 12 , 13 , 27 , 28 ]. The paraspinal approach to lumbar spine surgery goes between the lateral border of the sacrospinalis muscles and the quadratus lumborum muscle, and the original use was for spinal fusion [ 27 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the paraspinal approach has been widely used for thoracolumbar fractures in order to decrease the damage to the back muscle and the risks of postoperative back pain [ 12 , 13 , 27 , 28 ]. The paraspinal approach to lumbar spine surgery goes between the lateral border of the sacrospinalis muscles and the quadratus lumborum muscle, and the original use was for spinal fusion [ 27 , 29 , 30 ]. With this approach, a one-level or multilevel fusion could be performed.…”

Section: Discussionmentioning

confidence: 99%

“…With this approach, a one-level or multilevel fusion could be performed. In Wiltse’s study, the fascial incision was made only 2 cm lateral to the midline [ 27 , 29 ]. In our present study, the distances of the fascial incision to the midline were about 1.5 cm at T10; 2 cm at T11, T12, and L1; and 2.5 cm at L2 and were similar to those of another study [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…In Wiltse’s study, the fascial incision was made only 2 cm lateral to the midline [ 27 , 29 ]. In our present study, the distances of the fascial incision to the midline were about 1.5 cm at T10; 2 cm at T11, T12, and L1; and 2.5 cm at L2 and were similar to those of another study [ 27 ]. The approach was simple, allowed access to the articular and transverse processes, and had great advantage in thoracolumbar vertebral fracture surgery without decompression.…”

Section: Discussionmentioning

confidence: 99%

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Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures: a retrospective study

Cai

2016

J Orthop Surg Res

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BackgroundComplications in posterior pedicle screw fixation using a conventional posterior approach for thoracolumbar fractures include vertebral height loss, kyphosis relapse and breakage, or loosening of instrumentation. The purpose of this study was to evaluate the clinical effects of transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures.MethodsWe retrospectively analyzed 50 patients with thoracolumbar fractures treated with transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach. Operative time, blood loss, visual analog scale (VAS) scores for back pain, and the relative height and Cobb angle of the fractured vertebrae were measured.ResultsThe average operative time was 71.8 min, and the blood loss was 155 ml. Postoperative VAS scores were significantly lower than preoperative scores (P = 0.08), but there was no difference between 1 week and 1 year postoperatively (P = 0.18). The postoperative relative heights of the fractured vertebrae were higher than the preoperative heights (P = 0.001, 0.005, 0.001), but there were no differences between 1 week and 1 or 2 years postoperatively (P = 0.24/0.16). The postoperative Cobb angles were larger than the preoperative angles (P = 0.002, 0.007, 0.001), but there were no differences between 1 week and 1 or 2 years postoperatively (P = 0.19/0.23).ConclusionsTranspedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures achieved satisfactory results and can restore vertebral height, increase the stability of the anterior and middle columns of injured vertebrae, and decrease the risk of back pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures: a retrospective study

Cai

2016

J Orthop Surg Res

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“…The Wiltse approach has been shown to have many surgical applications (Anand et al, 2008;Buttermann and Mullin, 2015;Cho et al, 2016;Fujibayashi et al, 2010;Jiang, Wu, Wang, Li, and Wang, 2011;Liu et al, 2015;Ota et al, 2010;Sun et al, 2017). It can be useful for many procedures in the lumbar spine such as decompression, discectomy (both medial and far lateral), resection of tumors, stabilization of fractures, and correction of deformities.…”

Section: Discussionmentioning

confidence: 99%

The Paraspinal Wiltse Approach to the Lumbar Spine: A Literature Review and Anatomical Guide

Rapp¹,

Shah²,

Tkachenko³

et al. 2017

The Spine Scholar

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Dr. Leon Wiltse, a renowned orthopedic surgeon, described a novel paraspinal approach to the lumbar spine, which consists of dissection through the natural cleavage plane between the multifidus and longissimus. He originally created this technique for fusion of the lower lumbar spine, but studies have shown that it can be used in a precise manner at each level of the entire lumbar spine. The Wiltse approach is now performed for many minimally invasive and open surgeries including decompression, discectomy, tumor resection, stabilization for fracture, and deformity correction. PubMed was searched for articles that included historical information, uses and adaptations, and anatomical descriptions for the Wiltse approach. A literature review is presented with an anatomical guide to the surgical approach, including the important landmarks and measurements that describe the steps for it in detail. The numerous applications of the Wiltse approach and how it will continue to be useful in spine surgery are explained. Spine Scholar 1: [108][109][110][111][112][113][114] 2017

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Virtually bloodless posterior midline exposure of the lumbar spine using the “para-midline” fatty plane

et al. 2015

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Two-Level Circumferential Lumbar Fusion Comparing Midline and Paraspinal Posterior Approach

Abstract: Midline and paraspinal approaches result in similar outcomes in 2-level spinal fusions. We were unable to demonstrate that a paraspinal muscle-splitting approach to 2-level fusion was superior to the muscle-stripping midline approach. However, the study has low statistical power.

Cited by 13 publications

References 50 publications

Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures: a retrospective study

Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures: a retrospective study

The Paraspinal Wiltse Approach to the Lumbar Spine: A Literature Review and Anatomical Guide

Virtually bloodless posterior midline exposure of the lumbar spine using the “para-midline” fatty plane

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