A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

Street, John; Glennie, R. Andrew; Dea, Nicolas; DiPaola, Christian P.; Wang, Zhi; Boyd, Michael; Paquette, Scott; Dvorak, Marcel F.; Fisher, Charles G.

doi:10.3171/2016.2.spine151018

Cited by 32 publications

(30 citation statements)

References 39 publications

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“…3.1.2 Less damage to the multifidus. The traditional approach requires extensive dissection of the paravertebral multifidus muscle, which will damage the blood supply and nerve innervation of the muscle, and a series of degeneration phenomena such as muscle atrophy, fibrosis and fat accumulation will occur in the multifidus muscle postoperatively [2]. The direct result is that the normal physiological function of the multifidus is affected postoperatively, and the incidence of postoperative chronic low back pain is increased [3].…”

Section: Figure1mentioning

confidence: 99%

A retrospective study of lumbar spine fusion surgery with the Wiltse approach and the traditional approach

Cheng

Zeng

Gui

2020

Preprint

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Background：This study aim to compare the clinical results such as functional improvement, complications, intraoperative parameters etc. between the Wiltse approach and traditional approach in lumbar spine fusion. Methods: In this retrospective controlled study, from May 2016 to May 2017, 70 patients undergone lumbar spine fusion surgery for lumbar disc herniation or lumbar spondylolisthesis within degree II were randomly divided into 2 groups which include Wiltse approach group (N=35, M:F= 1.06:1, mean age= 52 years) and traditional approach group (N=35, M:F= 1.18:1, mean age= 51 years). Actually, all the 70 cases were consisted of 38 lumbar-disc-herniation patients and 32 degree II lumbar-spondylolisthesis patients. In order to specify the clinical curative effects of the two group patients, several indicators including the operation time, the amount of blood loss and post-operation drainage, the ODI, the concentration of peripheral blood creatine phosphokinase (CK) and the cross sectional area (CSA) in magnetic resonance imaging (MRI) were compared. Results: Compared with traditional group, the Wiltse approach group had a statistically significant small figure on operative time, intraoperative blood loss, post-operative drainage and post-operative ODI (p＜0.05).As for the peripheral blood CK levels, the concentration of the Wiltse approach group was lower in 1 day and 3 days after the operation(p＜0.05), while the difference of the CK concentration for 7 days post-operation has no statistical significance(p>0.05). Furthermore, for the MRI CSA three months after the operation , the Wiltse approach side,s was bigger than the traditional side,s in the Wiltse approach group; the Wiltse approach group,s was bigger than the traditional group,s of the two group,s non-decompression side(p＜0.05).Conclusion: For lumbar spinal fusion surgery, the Wiltse approach do have such advantages as shorter operation time, smaller vertebral side muscle injury and better lumbar functional recovery compared with the traditional approach, but as a surgeon, while determining operation program, we should take into account the may influence of the inconsistency of paravertebral muscle anatomy in different levels.

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Section: Figure1mentioning

confidence: 99%

A retrospective study of lumbar spine fusion surgery with the Wiltse approach and the traditional approach

Cheng

Zeng

Gui

2020

Preprint

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“…The advantage of this approach stems from its muscle-splitting technique, which prevents muscle damage. In degenerative conditions of the spine, this technique demonstrated a decreased risk of wound breakdown, postoperative infection, blood loss, and reoperation 14) . Subsequent modification of this approach led to an even less-invasive technique using microscopy and tubular microendoscopy 4) .…”

Section: Discussionmentioning

confidence: 99%

“…Nerve root compression usually occurs at the dorsal root ganglion, causing intractable pain and neurologic deficits. Various paraspinal approaches are used for treating this condition 11,17) , and are associated with fewer complications and better outcomes than midline approaches with respect to decompression, preservation of facets, and spinal stability 14) . However, most surgeons are not conversant with the surgical anatomy of these approaches, especially at the lumbosacral junction, where the anatomy is more complex.…”

Section: Introductionmentioning

confidence: 99%

Large Retroperitoneal Hematoma and Lumbosacral Plexopathy Following Microsurgical Decompression via the Wiltse Paraspinal Approach: A Case Report

Suen

Lin

et al. 2018

J Minim Invasive Spine Surg Tech

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Paraspinal approaches are associated with fewer complications and better outcomes than midline approaches. However, most surgeons are not conversant with the surgical anatomy in these approaches, especially at the lumbosacral junction, where the anatomy is more complex. This paper reports a case of concomitant vascular and neurological complication following the use of the microscopic Wiltse approach. A 71-year-old woman presented with symptoms of spinal stenosis and right L5 radiculopathy. She underwent microsurgical decompression of a foraminal stenosis at the lumbosacral junction via the Wiltse approach, and a midline decompression from L3 to L5. The tubular retractor was docked inappropriately, being too deep and lateral. It directly punctured through the intertransverse membrane and injured the retroperitoneal segmental vessel and lumbosacral plexus. Postoperatively, she developed a large retroperitoneal hematoma and lumbosacral plexopathy, which were treated with surgery and intensive rehabilitation. This report highlights the importance of accurate retractor docking, familiarity with the surgical anatomy, and recognition of the potential complications of this technique.

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“…After the third month, the patient is referred to aerobics to start a supervised muscular recovery program. 19,20 Comparison between the Midline and the Muscle-splitting Approaches…”

Section: Postoperative Recommendationsmentioning

confidence: 99%

Paraspinal Lumbar Spine Approach - Wiltse Access

et al. 2017

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Introduction Technical developments in spinal surgery have reduced the number of surgical incisions and of the length of time for the procedure. Objective Describe topographical landmarks, anatomy and characteristics of the Wiltse access, a paraspinal approach to the lumbar spine. Methods A review of the literature was performed using as databases: PubMed, Embase, Science Direct, the Cochran Database and Google Scholar. Total 22 papers met the inclusion criteria, and they were all published between 1959 and 2016. Discussion The Wiltse approach is performed by median skin incision with lateral muscle dissection between the multifidus and the longissimus muscles, in a natural pathway. This approach allows access to the pedicles and to the lateral recess, enabling the performance of posterior spinal fusion and decompression and minimally invasive discectomy techniques. This access is less traumatic than the median approach, and it is ideal for lower levels, like L4–5 and L5-S1. Conclusion The authors strongly encourage this approach because they believe that, when well-indicated, the benefits outweigh the disadvantages and complications due to the fact that it is a less invasive procedure.

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A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

Cited by 32 publications

References 39 publications

A retrospective study of lumbar spine fusion surgery with the Wiltse approach and the traditional approach

A retrospective study of lumbar spine fusion surgery with the Wiltse approach and the traditional approach

Large Retroperitoneal Hematoma and Lumbosacral Plexopathy Following Microsurgical Decompression via the Wiltse Paraspinal Approach: A Case Report

Paraspinal Lumbar Spine Approach - Wiltse Access

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