This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and com- pared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar f...This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and com- pared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches. Among them, 37 patients were treated using posterior open surgery, and 35 patients received mini-open operation via Wiltse approach. Crew placement accuracy rate, operative time, blood loss, postoperative drainage, postoperative hospitalization time, radiation exposure time, postoperative improvement in R value, Cobb＇s angle and visual analog scale （VAS） scores of the two methods were compared. There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and postoperative R value and Cobb＇s angle improvement between the two groups. However, the mini-open method had obvious advantages over the conventional open method in operative time, blood loss, postoperative drainage, postoperative hospitalization time, and postoperative improvement in VAS. The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure.展开更多
Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this ...Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.展开更多
Summary： The effect and safety of anterior debridement and fusion with a minimally invasive ap- proach combined with posterior fixation via the Wiltse approach were assessed in the single-level lum- bar pyogenic spon...Summary： The effect and safety of anterior debridement and fusion with a minimally invasive ap- proach combined with posterior fixation via the Wiltse approach were assessed in the single-level lum- bar pyogenic spondylodiscitis. Seventeen patients from 2007 to 2009 underwent anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach. Postoperative follow-up time was 24-41 months. Data included the patients＇ general information, mi- crobiology, operative time, intraoperative blood loss, postoperative complications, intervertebral fusion rate, and preoperative and final follow-up scores for American Spinal Injury Association （ASIA） im- pairment, visual analogue scale （VAS）, and Oswestry Disability Index （ODI）. Ten patients had under- gone a prior spinal invasive procedure, and 7 had hematogenous infection. The infected segments in- cluded L1-2, L2-3, L3,~, and L4-5 in 1, 2, 5, and 9 cases, respectively. Thirteen bacterial cultures were posi- tive for Staphylococcus aureus （5 cases）, Staphylococcus epidermidis （4）, Streptococcus （3）, and Es- cherichia coli （1）. The operative time was 213.8＋45.6 min, and the intraoperative blood loss was 180.6-4-88.1 mL. Postoperative complications consisted of urinary retention （2 cases）, constipation （3）, and deep vein thrombosis （2）. On the final follow-up, VAS scores and ODIs were significantly lower than those of preoperation, while the ASIA grades improved. All the cases achieved good intervertebral bony fusion. Anterior debridement and fusion with a minimally invasive approach combined with poste- rior fixation via the Wiltse approach can successfully treat single-level lumbar pyogenic spondy- lodiscitis, with less trauma and reliable immobilization. It is a viable option for clinical application.展开更多
An aggressive separation and prolonged overstretching of the paraspinal muscles in the posterior midline approach during lumbar non fusion dynamic stabilization in cases of spondylolisthesis resulting from pars intera...An aggressive separation and prolonged overstretching of the paraspinal muscles in the posterior midline approach during lumbar non fusion dynamic stabilization in cases of spondylolisthesis resulting from pars interarticularis fracture may result in postoperative flat back deformity and intractable chronic pain. It is hypothesized that utilizing Wiltse paraspinal inter-muscular approach for this purpose may result in reduction of operative time, protection of integrity, vascularity, nerve supply and strength of paraspinal muscles, shortening of hospitalization and minimizing development of chronic postoperative back pain. So, I have performed this prospective descriptive study that involved 24 patients having single level lumbar instability at L4-5 or L5-S1 levels. All patients were operated upon using Wiltse minimal access posterolateral surgical technique for non-fusion dynamic stabilization. The final results revealed that males were 66%, females were 33% and ages were 42 ± 6 years. Trauma was reported in 12%. Low back pain and tenderness were reported in 100% and root affection reported in 25%. Plain X-ray and MRI were done in 100% and C.T. was done in 8% of cases. Level L4-5 was affected in 17% while level L5-S1 was affected in 83%. Anterolisthesis “grades 0” was found in 8%, grades 1 in 88% and retrolisthesis in 4% of cases. Operative time was 1 hour ± 10 min., blood loss was 60 ± 20 ml., patients ambulation was after 6 - 8 hours, hospital stay was 12 - 24 hours. None of cases were complicated with infection, screw loosening, or fixation system break. Back pain VAS diminished from 7 preoperative to 5 in 2nd day, then became 4 by 1 week, 3 by 1 month and 0 by 6 months. It was concluded that utilizing Wiltse approach for posterolateral lumbar stabilization minimizes tissue damage and improves the speed of recovery and outcome.展开更多
BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined w...BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.展开更多
基金supported by the National Natural Science Foundation of China(Grant No.30973058, 81171694,and 81371968)the Program for Development of Innovative Research Team in the First Affiliated Hospital of NJMU(No.IRT-015)A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and com- pared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches. Among them, 37 patients were treated using posterior open surgery, and 35 patients received mini-open operation via Wiltse approach. Crew placement accuracy rate, operative time, blood loss, postoperative drainage, postoperative hospitalization time, radiation exposure time, postoperative improvement in R value, Cobb＇s angle and visual analog scale （VAS） scores of the two methods were compared. There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and postoperative R value and Cobb＇s angle improvement between the two groups. However, the mini-open method had obvious advantages over the conventional open method in operative time, blood loss, postoperative drainage, postoperative hospitalization time, and postoperative improvement in VAS. The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure.
基金financially supported by the National Natural Science Foundation of China(Grant No.81672152 and No.81871773)the Jiangsu Natural Science Foundation(Grant No.BE2018132)。
文摘Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.
基金supported by Hubei Provincial Natural Science Foundation of China (No.2012FFB02322)
文摘Summary： The effect and safety of anterior debridement and fusion with a minimally invasive ap- proach combined with posterior fixation via the Wiltse approach were assessed in the single-level lum- bar pyogenic spondylodiscitis. Seventeen patients from 2007 to 2009 underwent anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach. Postoperative follow-up time was 24-41 months. Data included the patients＇ general information, mi- crobiology, operative time, intraoperative blood loss, postoperative complications, intervertebral fusion rate, and preoperative and final follow-up scores for American Spinal Injury Association （ASIA） im- pairment, visual analogue scale （VAS）, and Oswestry Disability Index （ODI）. Ten patients had under- gone a prior spinal invasive procedure, and 7 had hematogenous infection. The infected segments in- cluded L1-2, L2-3, L3,~, and L4-5 in 1, 2, 5, and 9 cases, respectively. Thirteen bacterial cultures were posi- tive for Staphylococcus aureus （5 cases）, Staphylococcus epidermidis （4）, Streptococcus （3）, and Es- cherichia coli （1）. The operative time was 213.8＋45.6 min, and the intraoperative blood loss was 180.6-4-88.1 mL. Postoperative complications consisted of urinary retention （2 cases）, constipation （3）, and deep vein thrombosis （2）. On the final follow-up, VAS scores and ODIs were significantly lower than those of preoperation, while the ASIA grades improved. All the cases achieved good intervertebral bony fusion. Anterior debridement and fusion with a minimally invasive approach combined with poste- rior fixation via the Wiltse approach can successfully treat single-level lumbar pyogenic spondy- lodiscitis, with less trauma and reliable immobilization. It is a viable option for clinical application.
文摘An aggressive separation and prolonged overstretching of the paraspinal muscles in the posterior midline approach during lumbar non fusion dynamic stabilization in cases of spondylolisthesis resulting from pars interarticularis fracture may result in postoperative flat back deformity and intractable chronic pain. It is hypothesized that utilizing Wiltse paraspinal inter-muscular approach for this purpose may result in reduction of operative time, protection of integrity, vascularity, nerve supply and strength of paraspinal muscles, shortening of hospitalization and minimizing development of chronic postoperative back pain. So, I have performed this prospective descriptive study that involved 24 patients having single level lumbar instability at L4-5 or L5-S1 levels. All patients were operated upon using Wiltse minimal access posterolateral surgical technique for non-fusion dynamic stabilization. The final results revealed that males were 66%, females were 33% and ages were 42 ± 6 years. Trauma was reported in 12%. Low back pain and tenderness were reported in 100% and root affection reported in 25%. Plain X-ray and MRI were done in 100% and C.T. was done in 8% of cases. Level L4-5 was affected in 17% while level L5-S1 was affected in 83%. Anterolisthesis “grades 0” was found in 8%, grades 1 in 88% and retrolisthesis in 4% of cases. Operative time was 1 hour ± 10 min., blood loss was 60 ± 20 ml., patients ambulation was after 6 - 8 hours, hospital stay was 12 - 24 hours. None of cases were complicated with infection, screw loosening, or fixation system break. Back pain VAS diminished from 7 preoperative to 5 in 2nd day, then became 4 by 1 week, 3 by 1 month and 0 by 6 months. It was concluded that utilizing Wiltse approach for posterolateral lumbar stabilization minimizes tissue damage and improves the speed of recovery and outcome.
基金Supported by 2023 Hebei Province Medical Science Research Project Plan,No.20231958。
文摘BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.
