All Title Author
Keywords Abstract


Utilizing Wiltse Approach for Minimal Access Posterolateral Lumbar Stabilization

DOI: 10.4236/ojmn.2018.81008, PP. 101-108

Keywords: Lumbar Spine Instability, Posterolateral Wiltse Approach, Minimal Access Lumbar Stabilization

Full-Text   Cite this paper   Add to My Lib

Abstract:

An aggressive separation and prolonged overstretching of the paraspinal muscles in the posterior midline approach during lumbar non fusion dynamic stabilization in cases of spondylolisthesis resulting from pars interarticularis fracture may result in postoperative flat back deformity and intractable chronic pain. It is hypothesized that utilizing Wiltse paraspinal inter-muscular approach for this purpose may result in reduction of operative time, protection of integrity, vascularity, nerve supply and strength of paraspinal muscles, shortening of hospitalization and minimizing development of chronic postoperative back pain. So, I have performed this prospective descriptive study that involved 24 patients having single level lumbar instability at L4-5 or L5-S1 levels. All patients were operated upon using Wiltse minimal access posterolateral surgical technique for non-fusion dynamic stabilization. The final results revealed that males were 66%, females were 33% and ages were 42 ± 6 years. Trauma was reported in 12%. Low back pain and tenderness were reported in 100% and root affection reported in 25%. Plain X-ray and MRI were done in 100% and C.T. was done in 8% of cases. Level L4-5 was affected in 17% while level L5-S1 was affected in 83%. Anterolisthesis grades 0 was found in 8%, grades 1 in 88% and retrolisthesis in 4% of cases. Operative time was 1 hour ± 10 min., blood loss was 60 ± 20 ml., patients ambulation was after 6 - 8 hours, hospital stay was 12 - 24 hours. None of cases were complicated with infection, screw loosening, or fixation system break. Back pain VAS diminished from 7 preoperative to 5 in 2nd day, then became 4 by 1 week, 3 by 1 month and 0 by 6 months. It was concluded that utilizing Wiltse approach for posterolateral lumbar stabilization minimizes tissue damage and improves the speed of recovery and outcome.

References

[1]  Spoor, A. and Oner, F. (2013) Minimally Invasive Spine Surgery in Chronic Low Back Pain Patients. Journal of Neurosurgical Sciences, 57, 203-218.
[2]  Wiltse, L.L., Bateman, J.G., Hutchinson, R.H. and Nelson, W.E. (1968) The Paraspinal Sacrospinalis-Splitting Approach to the Lumbar Spine. Journal of Bone and Joint Surgery American, 50, 919-926.
https://doi.org/10.2106/00004623-196850050-00004
[3]  Anand, N., Baron, E. and Bray, R. (2007) Benefits of the Paraspinal Muscle-Sparing Approach versus the Conventional Midline Approach for Posterior Nonfusion Stabilization: Comparative Analysis of Clinical and Functional Outcomes. SAS Journal, 1, 93-99.
https://doi.org/10.1016/S1935-9810(07)70053-1
[4]  Kim, C.W. (2010) Scientific Basis of Minimally Invasive Spine Surgery: Prevention of Multifidus Muscle Injury during Posterior Lumbar Surgery. Spine (Phila Pa 1976), 35, S281-286.
https://doi.org/10.1097/BRS.0b013e3182022d32
[5]  Vialle, R., Wicart, P., Drain, O., Dubousset, J. and Court, C. (2006) The Wiltse Paraspinal Approach to the Lumbar Spine Revisited: An Anatomic Study. Clinical Orthopaedics and Related Research, 445, 175-180.
[6]  Li, H., Yang, L., Xie, H., Yum, L., Wei, H. and Cao, X. (2015) Surgical Outcomes of Mini-Open Wiltse Approach and Conventional Open Approach in Patients with Single-Segment Thoracolumbar Fractures without Neurologic Injury. Journal of Biomedical Research, 29, 76-82.
[7]  Mahar, A., Kim, C., Wedemeyer, M., Mitsunaga, L., Odell, T., Johnson, B. and Garfin, S. (2007) Short-Segment Fixation of Lumbar Burst Fractures Using Pedicle Fixation at the Level of the Fracture. Spine (Phila Pa 1976), 32, 1503-1507.
https://doi.org/10.1097/BRS.0b013e318067dd24
[8]  Anekstein, Y., Brosh, T. and Mirosky, Y. (2007) Inter-Mediate Screws in Short Segment Pedicular Fixation for Thoracic and Lumbar Fractures: A Wiltse Approach for Thoracolumbar Fractures. International Journal of Clinical and Experimental Medicine, 9, 13733-13742.
https://doi.org/10.1097/01.bsd.0000211240.98963.f6
[9]  Lee, S., Jahng, T. and Kim, H. (2016) Facet Joint Changes after Application of Lumbar Nonfusion Dynamic Stabilization. Neurosurgical Focus, 40, E6.
https://doi.org/10.3171/2015.10.FOCUS15456
[10]  Palmer, D., Allen, J., Williams, P., Voss, A., Jadhav, V., Wu, D. and Cheng, W. (2011) Multilevel Magnetic Resonance Imaging Analysis of Multifidus-Longissimus Cleavage Planes in the Lumbar Spine and Potential Clinical Applications to Wiltse’s Paraspinal Approach. Spine (Phila Pa 1976), 36, 1263-1267.
https://doi.org/10.1097/BRS.0b013e3181f520e8
[11]  Lee, Y., Cha, J. and Park, J. (2010) Clinical Outcome of Minimally Invasive Tubular Retractor Assisted Microscopic Discectomy in Far Lateral Lumbar Disc Herniation. Kor J Spine, 7, 155-160.
https://doi.org/10.1097/00003086-197303000-00009
[12]  Wiltse, L.L. (1973) The Paraspinal Sacrospinalis-Splitting Approach to the Lumbar Spine. Clinical Orthopaedics and Related Research, No. 91, 48-57.

Full-Text

comments powered by Disqus