Wiltse Approach Versus Conventional Transforaminal Interbody Fusion for Unstable Thoracolumbar Fracture with Intervertebral Disc Lesions

Abstract

Objective: To compare the clinical results of two surgical techniques, Wiltse approach and conventional transforaminal interbody fusion, for the treatment of unstable thoracolumbar fracture associated with traumatic intervertebral disc lesion (TIDL).

Methods: A total of 76 patients with unstable thoracolumbar fracture associated with TIDL treated by posterior pedicle screw fixation and transforaminal thoracolumbar interbody fusion from June 2010 and July 2016 were reviewed retrospectively. These patients including 48 male and 28 female patients were divided into Wiltse approach transforaminal thoracolumbar interbody fusion (W-TLIF) group (n = 38) and conventional transforaminal thoracolumbar interbody fusion (C-TLIF) group (n = 38). Patients were followed up for about 33 months. Clinical and radiological records, kyphotic angle, fractured vertebral body height, visual analogue score (VAS), Oswestry Disability Index (ODI), complications, neurological improvement and fusion rate were compared between two groups.

Results: All patients underwent posterior surgery successfully. Blood loss, operation time and hospital stay in the W-TLIF group was 437.84 ± 143.98 ml, 118.64 ± 20.55 min and 12.32 ± 2.87 days, respectively. While those parameters in the C-TLIF group was 862.70 ± 300.24 ml, 141.35 ± 31.72 min and 15.51 ± 2.08 days, respectively. Average operation time and hospital stay time were significantly shorter, and blood loss was significantly less in the W-TLIF group than in the C-TLIF group (P < 0.05). VAS and ODI in the W-TLIF group were significantly less than those in the C-TLIF group at 1 week after operation and final follow-up. The kyphotic angle and vertebral body height were improved. There was 1-2 grade improvement in patients with neurological deficit. Thirty-three patients in the W-TLIF group and 32 patients in the C-TLIF group had achieved fusion during follow-up. No internal fixation failure was observed in two groups.

Conclusions: The both techniques of W-TLIF and C-TLIF were feasible and effective for unstable thoracolumbar fracture with TIDL. Compare to C-TLIF, The technique of W-TLIF was a relatively less invasive way to decompress the neural elements and an easy method to reconstruct the anterior column using the same posterior approach.

Keywords: Thoracolumbar fracture; Transforaminal thoracolumbar interbody fusion; Traumatic intervertebral disc lesion; Wiltse approach.