A Comparative Study of a New Retractor‐Assisted WILTSE TLIF, MIS‐TLIF, and Traditional PLIF for Treatment of Single‐Level Lumbar Degenerative Diseases

Abstract

Objectives: To compare the clinical efficacy of a new retractor-assisted Wiltse transforaminal lumbar interbody fusion (TLIF), minimally invasive TLIF (MIS-TLIF), and traditional posterior lumbar interbody fusion (PLIF) in treating single-level lumbar degenerative diseases.Methods: A retrospective study was conducted by analyzing the clinical and imaging data of consecutive patients with single-level lumbar degenerative diseases who underwent the new retractor-assisted Wiltse TLIF, MIS-TLIF, or traditional PLIF. This study enrolled 87 concurrent patients between June 2016 and December 2019 (Wiltse TLIF 29 cases; MIS-TLIF 28 cases; PLIF 30 cases). The three groups were compared for perioperative indicators (including intraoperative blood loss, postoperative drainage volume, operation time, intraoperative fluoroscopy time, bedridden time), creatine kinase (CK), visual analog score (VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, intervertebral fusion rate, muscle atrophy, and fatty infiltration (including ratio of multifidus atrophy and ratio of lean-to-total cross-sectional area [CSA]).Results: Intraoperative blood loss (F = 62.628, p < 0.001), postoperative drainage volume (F = 72.048, p < 0.001), and bedridden time (χ 2 = 62.289, p < 0.001) were significantly lower in the MIS-TLIF and Wiltse groups than in the PLIF group. The operative and intraoperative radiation times of the MIS-TLIF group were significantly longer than those of the Wiltse and PLIF groups. The CK concentration in the Wiltse and MIS-TLIF groups were significantly lower than those in the PLIF group 1 day (F = 9.331, p < 0.001) and 3 days after surgery (F = 15.967, p < 0.001). The PLIF group's back pain VAS score was higher than those of the Wiltse and MIS-TLIF groups. The PLIF group had a higher ODI 6 months (F = 3.282, p = 0.042) and 12 months (F = 5.316, p = 0.007) after surgery and a lower JOA score than the Wiltse and MIS-TLIF groups 6 months (F = 3.234, p = 0.044) and 12 months (F = 3.874, p = 0.025) after surgery. The ratio of multifidus atrophy in the PLIF group (41.70 AE 8.84%) was significantly higher than those of the Wiltse group (24.13 AE 6.82%) and the MIS-TLIF group (22.35 AE 5.03%). The ratio of lean-to-total CSA in the PLIF group was lower than those of the Wiltse and MIS-TLIF groups after surgery (F = 8.852, p < 0.001). MIS-TLIF group showed longer operation time (169.11 AE 29.38 min) and intraoperative fluoroscopy time (87.61 AE 3.13 s) than the Wiltse group. Conclusion:Wiltse TLIF assisted by the new retractor is a more convenient and minimally invasive surgical method than the traditional PLIF and MIS-TLIF methods, which are linked to a long learning curve and long operation and fluoroscopy time.

Comparison Of A Novel Hand-held Retractor-Assisted Transforaminal Lumbar Interbody Fusion By The Wiltse Approach And Posterior TLIF

“…In the present prospective study, we introduced a novel hand-held retractor system for Wiltse approach. the results of this study showed the novel hand-held retractor assisted Wiltse TLIF is signi cantly superior to P-TLIF in terms of intraoperative bleeding, postoperative drainage, mobilization time, and discharge time, and the results were consistent with previous studies 10,18 . In the Wiltse TLIF procedure under this novel hand-held retractor system, pedicle screw placement, facet joint resection and interbody bone implantation is conducted under direct vision, which can be easily completed through the natural gap between the longissimus muscles and multi dus muscles, without distraction of the paraspinal muscles, thereby minimizing the extent and duration of muscle distraction compared to the traditional approach, which result in less intraopreative blood lose and pstopreative drainage.…”

“…Accordingly, peripheral blood CK levels can re ect the degree of intraoperative paraspinal muscle injury. Liu et al 9,10,18 showed that postoperative serum creatine kinase levels were signi cantly lower in the Wiltse TLIF group compared with the P-TLIF group. In our study, the CK levels in the P-TLIF group at 24h after surgery (84.10 ± 141.99 U/L) were signi cantly higher than in the Wiltse TLIF group (532.76 ± 225.76 U/L), indicating that the Wiltse TLIF using hand-held retractors yielded less lumbar paraspinal muscle injury.…”

“…In recent years, hand-held retractors have been applied to assist in Wiltse approach to perform canal decompresion, causing less paraspinal muscle injury and yielding better postoperative clinical outcomes than P-TLIF 9,10 . However, few prospective studies have been conducted comparing the clinical and radiological outcomes between Wiltse TLIF and P-TLIF, both assisted by hand-held retractors.…”

Development and validation of a nomogram to predict the risk of surgical site infection within 1 month after transforaminal lumbar interbody fusion

“…With LDD reaching a specific stage, surgical treatment becomes an effective method to alleviate the symptoms of patients. Transforaminal lumbar interbody fusion (TLIF) is one of the common surgical procedures for the treatment of LDD, which can significantly reduce the damage to muscles and nerves [4][5][6].…”

Comparison of minimally invasive transforaminal lumbar interbody fusion and endoscopic lumbar interbody fusion for lumbar degenerative diseases: a retrospective observational study

“…With the development of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion (TLIF) in the 1950s, the posterior approach has been widely recognized as a typical surgical procedure [1][2][3] . However, the posterior approach is still unacceptable to many patients due to the signi cant pain, tissue damage, and postoperative complications associated with open surgery [4] .…”