Comparison of Clinical and Radiologic Outcome Between Mini-Open Wiltse Approach and Fluoroscopic-Guided Percutaneous Pedicle Screw Placement: A Randomized Controlled Trial

Zou, Peng; Yang, Jun-Song; Wang, Xiang-Fu; Wei, Jiacheng; Liu, Peng; Chen, Hao; Hao, Dingjun; Li, Qing-Da; Wei, Dongmei; Gong, Hanlin; Wu, Xucai; Liu, Benyin; Zhang, Yuting; Zhang, Xuefang; Zhao, Yuan-Ting

doi:10.1016/j.wneu.2020.08.145

Cited by 15 publications

(12 citation statements)

References 31 publications

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“…The traditional surgical method is to strip the paraspinal muscle through an open approach, and use the pedicle-screw fixation system to stabilize the injured vertebra and restore the height of the fractured vertebral body [ 4 , 6 ]. However, traditional surgical method has many disadvantages, including large incision, excessive blood loss, delayed postoperative functional recovery, high incidence of back pain, and aggravated posterior ligament complex (PLC) injury [ 6 – 8 ]. An increasing number of studies have shown that minimally invasive surgery is a better choice for the treatment of neurologically intact thoracolumbar fractures [ 6 – 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, traditional open surgery often leads to longer incisions and more severe soft tissue injuries, which may lead to chronic pain and limited motion [ 6 , 7 ]. Therefore, minimally invasive surgery may be a better choice for neurologically intact thoracolumbar fractures [ 8 – 10 ]. Currently, there are mainly two minimally invasive surgical approaches—the percutaneous pedicle screw fixation (PPSF) and the mini-open Wiltse approach with pedicle screw fixation (MWPSF).…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there are mainly two minimally invasive surgical approaches—the percutaneous pedicle screw fixation (PPSF) and the mini-open Wiltse approach with pedicle screw fixation (MWPSF). Compared with the traditional open surgical approach, the minimally invasive approach can reduce the damage of soft tissues, intraoperative blood loss, postoperative pain, and lead to better postoperative functional recovery [ 3 , 8 – 11 ]. Our hospital has been treating neurologically intact thoracolumbar fractures through minimally invasive surgery since 2015.…”

Section: Introductionmentioning

confidence: 99%

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Hidden blood loss between percutaneous pedicle screw fixation and the mini-open Wiltse approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: a retrospective study

et al. 2023

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Background The aim of this study was to determine the proportion of hidden blood loss (HBL) in patients treated with minimally invasive surgery, and to compare the HBL between patients treated with percutaneous pedicle screw fixation (PPSF) and the mini-open Wiltse approach with pedicle screw fixation (MWPSF). Methods From January 2017 to January 2019, a total of 119 patients with thoracolumbar fractures were included in the analysis, of which 58 cases received PPSF and 61 cases received MWPSF. The clinical information and demographic results were collected and compared. And the HBL of the patients is calculated by the combination formulas of Nadler, Gross and Sehat. Results Compared with the PPSF group, operation time of MWPSF is shorter. The fluoroscopy times are 13.6 ± 3.0 in PPSF group and 5.6 ± 1.6 in MWPSF group (p < 0.001). As shown in Table 3, the intraoperative blood loss in PPSF group is 31.9 ± 9.6 ml, which is significantly less than that in the MWPSF group (44.0 ± 14.9 ml). The HBL (445.7 ± 228.9 ml), and HBL% (91.2 ± 7.7%) of the PPSF group are significantly higher than that in the MWPSF group (P < 0.05). And the total blood loss (TBL) of the PPSF group (477.6 ± 228.8 ml) is also more than that in the MWPSF group (401.0 ± 171.3 ml). Conclusions Our results suggest that in the minimally invasive surgical treatment of thoracolumbar fractures, the perioperative HBL is much higher than visible blood loss (VBL). Although PPSF has less intraoperative blood loss, it has higher TBL and HBL than those of MWPSF. Compared with MWPSF, we should pay more attention to the postoperative anemia status of patients with thoracolumbar fractures undergoing PPSF surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hidden blood loss between percutaneous pedicle screw fixation and the mini-open Wiltse approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: a retrospective study

et al. 2023

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“…In the PPSF, there were 16 the 49 patients is summarized in Table 1. There was no significant difference between the two groups in terms of age, gander, BMI, and fracture type (p > 0.05).…”

Section: General Population Informationmentioning

confidence: 99%

A Comparison of Outcomes between the Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Multi‐Segmental Thoracolumbar Fractures

Zhang

Wang

Bai

et al. 2023

Orthopaedic Surgery

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ObjectiveMulti‐segmental thoracolumbar fracture (MSF) generally refers to fractures occurring in two or more segments of the thoracolumbar spine. With the development of minimally invasive concept, there is little research on its application in the field of MSF. The purpose of this study is to compare two minimally invasive surgical techniques and determine which one is more suitable for treating patients with neurologically intact MSF.MethodsWe retrospectively analyzed the clinical data of 49 MSF patients with intact nerves who were admitted from January 2017 to February 2019. Among them, 25 cases underwent percutaneous pedicle screw fixation (PPSF), and 24 cases underwent Wiltse approach pedicle screw fixation (WAPSF). The operation time, number of fixed segments, blood loss, length of incision, postoperative ambulation time, accuracy of pedicle screw placement, facet joint violation (FJV), number of C‐arm exposures, as well as pre‐ and postoperative visual analogue scale (VAS), Oswestry disability index (ODI), local Cobb's angle (LCA), and percentage of anterior vertebral body height (PAVBH) were recorded for both groups. Paired sample t‐test was used for intra‐group comparison before and after surgery while independent sample t‐test was used for inter‐group comparison.ResultsThe differences in the number of fixed segments, intraoperative bleeding, postoperative bed time, accuracy rate of pedicle screw placement, VAS, and ODI between the two groups were not statistically significant (p > 0.05). However, the operative time and total surgical incision length were significantly shorter in the WAPSF group than in the PPSF group (p < 0.05), and the FJV was significantly higher in the PPSF group than in the WAPSF group (p < 0.05). Also, the PPSF group received more intraoperative fluoroscopy (p < 0.05). The result of LCA and PAVBH in the WAPSF group were significantly better than in the PPSF group (p < 0.05).ConclusionsBoth PPSF and WAPSF were found to be safe and effective in the treatment of MSF without neurological deficits through our study. However, considering radiation exposure, FJV, vertebral height restoration, correction of kyphosis, and learning curve, WAPSF may be a better choice for neurologically intact MSF.

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“…6,7 Thoracolumbar fractures are the most common fractures of the spine, which are usually cured using surgical treatment. [7][8][9] For patients with thoracolumbar fractures caused by high-energy injuries, vascular injuries can occur as a result of high external energy events such as falls, traffic accidents, or industrial traumas. Furthermore, immobility paired with prolonged bed rest slows venous return, making patients vulnerable to DVT.…”

Section: Introductionmentioning

confidence: 99%

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

Wang

et al. 2022

Clin Appl Thromb Hemost

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Objective To investigate the dynamic variation of D-dimer and to evaluate the efficacy and accuracy of D-dimer level in patients with thoracolumbar fractures caused by high-energy injuries. Methods A total of 121 patients with thoracolumbar fractures caused by high-energy injuries were retrospectively identified and included in this study. There were 83 males and 38 females, with an average age of 48.6 ± 11.2 years. All patients were treated with either screw fixation surgery or decompression fixation surgery. The D-dimer levels were measured 1 day before surgery and on the first, third, and fifth days after surgery. The dynamic variation of D-dimer and the effects of risk factors on D-dimer levels were analysed. A receiver operating characteristic (ROC) curve analysis was performed and the appropriate D-dimer cut-off level was determined for deep vein thrombosis (DVT) screening. Results Due to a trough on the third day, D-dimer levels grew in an unsustainable manner following surgery (P < 0.001). Patients with the operation time >120 min (P = 0.009) and those with an American Spinal Injury Association (ASIA) score A-C (P < 0.001) had higher D-dimer levels. The area under the curve of D-dimer was the greatest on the third day. Applying stratified cut-off values did not change the sensitivity, specificity and negative predictive value in the group with an operation time >120 min, and ASIA score A-C group. Conclusions D-dimer levels elevated with fluctuation in patients with thoracolumbar fractures caused by high-energy injuries after surgery. Both operation time and ASIA score had an impact on D-dimer levels. Regarding DVT diagnoses, the diagnostic value of D-dimer was highest on the third day postoperatively, and stratified cut-off values by these two factors did not show better diagnostic efficacy compared with a collective one.

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Comparison of Clinical and Radiologic Outcome Between Mini-Open Wiltse Approach and Fluoroscopic-Guided Percutaneous Pedicle Screw Placement: A Randomized Controlled Trial

Cited by 15 publications

References 31 publications

Hidden blood loss between percutaneous pedicle screw fixation and the mini-open Wiltse approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: a retrospective study

Hidden blood loss between percutaneous pedicle screw fixation and the mini-open Wiltse approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: a retrospective study

A Comparison of Outcomes between the Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Multi‐Segmental Thoracolumbar Fractures

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

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