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-S1levels. 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.
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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
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.
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.
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.
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
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.
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