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

Abstract

Background: Previously, achieving spinal canal decompression through the traditional Wiltse approach has been challenging due to limitations of assisted hand-held retractors. However, recent improvements to the retractors by some surgeons have facilitated spinal canal decompression in the Wiltse approach and have resulted in successful surgical outcomes. Nevertheless, there is a paucity of literature to assess the safety and efficacy of hand-held retractor assisted Wiltse approach TLIF. This study aims to compare the clinical outcomes and safety of a novel hand-held retractor system-assisted Wiltse TLIF with that P-TLIF and assess whether this hand-held retractor system assisted Wiltse TLIF can yield less paraspinal muscle injury. Methods: 56 patients(P-TLIF: 26, Wiltse TLIF: 30) were included in this prospective controlled study. The operation time, intraoperative blood loss, postoperative drainage, mobilization time, and discharge time were recorded. The clinical outcomes were evaluated by ODI, VAS, JOA, and SF-36 scores.Paraspinal muscle injury was assessed by postoperative MRI. CK and C-reaction protein were measured pre and postoperatively, and CT or X-ray was used to assess bony union/non-union. Results: The Wiltse (study) group was associated with significantly less estimated blood loss, postoperative drainage, and shorter mobilization and discharge times than the P-TLIF (control) group. Serum CK activity at 24h postoperatively in the study group was significantly lower than in the control group.. The incidence of complications in the two groups was comparable. At 7 days after surgery, VAS and ODI scores were lower, while the JOA score was higher in the control group than in the study group. Results observed at 3 months of follow-up were consistent with those at 7 days. After six months postoperatively, paraspinal muscle degeneration in the control group was more significant than in the study group Conclusion:Our study showed that this novel hand-held retractor system assisted Wiltse approach TLIF can achieve satisfactory surgical efficacy, and the Wiltse approach TLIF can significantly reduce paraspinal muscle injury, postoperative drainage, and intraoperative blood loss, as well as shorten mobilization and discharge time, resulting in better short-term outcomes compared to P-TLIF. Furthermore, both methods yield similar fusion rates and incidence of complications . Trial registration:, 25/09/2023 NCT06052579