Comparison of Wiltse’s paraspinal approach and open book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures: a randomized controlled trial

Abstract

BackgroundPosterior short-segment pedicle screw fixation is used to treat thoracolumbar burst fractures. However, no randomized controlled studies have compared the efficacy of the two approaches––the Wiltse’s paraspinal approach and open book laminectomy in the treatment of thoracolumbar burst fractures with greenstick lamina fractures.Materials and methodsPatients with burst fractures of the thoracolumbar spine without neurological deficit were randomized to receive either the Wiltse’s paraspinal approach (group A, 24 patients) or open book laminectomy (group B, 23 patients). Patients were followed postoperatively for average of 27.4 months. Clinical and radiographic data of the two approaches were collected and compared.ResultsOur results showed the anterior segmental height, kyphotic angle, visual analog scale (VAS) score, and Smiley-Webster Scale (SWS) score significantly improved postoperatively in both groups, indicating that both the Wiltse’s paraspinal approach and open book laminectomy can effectively treat thoracolumbar burst fractures with greenstick lamina fractures. The Wiltse’s paraspinal approach was found to have significantly shorter operating time, less blood loss, and shorter length of hospital stay compared to open book laminectomy. However, there were two (2/24) patients in group A that had neurological deficits postoperatively and required a second exploratory operation. Dural tears and/or cauda equina entrapment were subsequently found in four patients in group B and all two patients of neurological deficits in group A during operation. No screw loosening, plate breakage, or other internal fixation failures were found at final follow-up.ConclusionsThe results demonstrated that either of the two surgical approaches can achieve satisfactory results in treating thoracolumbar burst fractures in patients with greenstick lamina fractures. However, if there is any clinical or radiographic suspicion of a dural tear and/or cauda equina entrapment pre-operation, patients should receive an open book laminectomy to avoid a second exploratory operation. More research is still needed to optimize clinical decision-making regarding surgical approach.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0743-z) contains supplementary material, which is available to authorized users.

The feasibility of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture: a finite element analysis

“…Short-segment Schanz screw fixation implanted in an oblique downward direction can achieve an upward and forward reduction of the anterior column, middle column, and the posterior column, thus resulted in a better reduction of the downward and backward retrodisplaced vertebra. Therefore, with this method, the available reduction of burst fractured vertebra (LSC ≥ 7) and spinal canal decompression can be achieved without laminectomy even if when the spinal stenosis was severe, and therefore, it is better than the screw insertion parallel to the endplates, which hardly reduced the intraspinal bone fragments without laminectomy [ 5 , 6 ].…”

Minimally invasive short segment pedicle screw fixation for Thoraco-Lumbar Trauma: Where we stand?

“…When compared to open surgery, MISS has shown equivocal final results but with smaller incision, less intraoperative blood loss, shorter recovery time, less post-operative pain, and higher safety. 10,11 Studies have shown that percutaneous screws have minimal trauma to paraspinal musculature compared to open methods which cause denervation and devascularisation of muscles. 12 The only drawback of MISS over open surgery is a significantly higher amount of radiation exposure.…”

Two Different Minimally Invasive Approaches for Management of Thoracolumbar Fractures

“…By imaging, histology and electrophysiological assessment, Liu et al [11] found that the Wiltse approach for thoracolumbar fractures was accompanied with a lower incidence of multi dus atrophy and denervation, and less fatty in ltration compared with conventional posterior open approach. Pedicle screw xation via Wiltse paraspinal approach has been considered as an effective and minimally invasive approach in treatment of thoracolumbar fracture with neurologic intact for the advantages of simple operation and less trauma [12,13].…”