Wiltse approach and posterior midline approach transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis: a comparative study

Abstract

Objective To compare the clinical outcomes of transforaminal lumbar interbody fu- sion （TLIF） through Wiltse approach and posterior midline approach in the treatment of degenerative lum- bar spondylolisthesis. Methods A total of 37 patients with degenerative lumbar spondylolisthesis were treated between March 2008 and March 2010, including 23 patients managed by TLIF via posterior mid- line approach （posterior midline approach group） and 14 by TLIF via Wiltse approach （Wiltse approach group）. The Japanese Orthopaedic Association （JOA） score and visual analogue scale （VAS） before and after operation, and the interbody fusion condition in both the Wiltse approach group and posterior midline approach group were reviewed and the clinical outcomes of both groups were compared. Results The follow-up lasted for 6-26 months （mean, 15.7 months） , during which both groups had obvious relief in clinical symptoms like pain of waist and legs. X-ray photographs showed good spondylolisthesis reduction and interbody fusion, with no loosening or breakage of the internal fixators. The fusion rate of Wiltse ap- proach group and posterior midline approach group at the last follow-up were 86% and 87% , respectively.The operation time of Wiltse approach group and poslerior midline approach group was （ 117. 8 ± 25.6） minutes and （ 128.5±38.7） minutes respeetively （ P 〉 0.05 ）. The intra-operative blood loss of Willse approach group and poslerior midline approach group was （203.5± 16.4） ml and （284.4 ±27.6） ml respectively （ P 〈 0.05 ）. Both groups presented significant decrease of JOA score post-opera- tively （P 〈0.05）. Also, the two groups showed significant difference concerning the VAS score in low back pain one week post-operatively （P 〈0.05）, but no significant difference in terms of VAS score in leg pain at one week after operation （ P 〈 0. 05） and VAS score in pain of low back and legs at the final tollow-up （ P 〉 0. 05 ）. Conclusions In the management of lumbar spondylolisthesis, TLIF via Wihse approaeb and via posterior midline approach can both achieve satisfactory interbody fusion rate anti elini- eal outcomes, but the Wiltse approach results in relatively less intra-operative blood loss and faster post- operative recovery. Key words: Spondylolisthesis; Internal fixators; Transfiraminal lumbar inlerbody fusion