Comparison Study Between Wiltse Paraspinal Approach And Conventional Approach Of Transforaminal Lumbar Interbody Fusion For The Treatment Of Lumbar Spondylolisthesis

Background:Transforaminal lumbar interbody fusion (TLIF) has been widely used in the treatment of lumbar spondylolisthesis. Because of extensive dissection and distraction of multifidus, the conventional approach of TLIF causes many complications, such as postoperative flat back syndrome, intractable low back pain, and adjacent segment degeneration, In 1968, Wiltse and his team reported the posterior lumbar fusion through paraspinal approach and they found that this approach could reduce the damage of multifidus. Then in 1988, they reported that they found the paraspinal approach was extremely useful for internal transpedicular fixation and cutting herniated discs in the far lateral zone. But the Wiltse paraspinal approach of TLIF has not been focused until now.Purpose:To compare the Wiltse paraspinal approach and conventional approach of transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis.Method:In this research, totally 41 patients with lumbar spondylolisthesis were treated with TLIF through Wiltse paraspinal approach (23 cases) and conventional approach (18 cases). The effects were evaluated by operation time, bleeding volume, postoperative drainage volume, incision pain, dysfunction and interbody fusion. Incision pain was measured by visual analog scale (VAS) on the 3rd day and the 14th day after operation. Dysfunction was measured by Oswestry disability index (ODI) on the day before operation, in the 1st month and the 6th month after operation. Interbody fusion was measured by X-ray in the 6th month after operation.Results:Results showed that the differences of operation time and ODI on the day before operation, as well as interbody fusion after 6 months were statistical insignificance (P=0.586; P=0.800; P=0.786). Less bleeding volume, postoperative drainage volume in the Wiltse paraspinal approach group (P<0.001; P<0.001). Incision pain on the 3rd day and the 14th day after operation, ODI in the 1st month and the 6th month after operation were all statistical significance (P<0.001, P<0.001; P=0.008; P<0.001). Those above mentioned proved the Wiltse paraspinal approach method was more effective than conventional approach method concerning on treatment of lumbar spondylolisthesis.Conclusions:The Wiltse paraspinal approach of TILF is a better way for treating lumbar spondylolisthesis, minimize the trauma caused by degeneration of multifidus, and reduce the incidence of postoperative chronic low back pain.