| Objective:After the middle of the traditional approach lumbar interbody fusion,as a wide range of anatomical dissection of paraspinal soft tissue and damaged the starting and ending point of paravertebral muscles,paraspinal muscle injury in the dominant blood supply and nerves,leading to paraspinal muscle degeneration and scarring will inevitably lead to low back pain with patients,even failed back surgery syndrom,in order to reduce the paraspinal muscles is mainly multifidus muscle injury,one of a variety of minimally invasive posterior approach,The paraspinal approach to the lumbar spine was first described by Watkins in 1959.A plane is developed between the lateral border of the sacrospinalis muscles and the quadratus lumborum muscle.Wiltse et al described a modified transmuscular paraspinal approach consisting of a longitudinal separation of the sacrospinalis muscle between its multifidus and longissimus parts.The original description was for spinal fusion,especially regarding lumbosacral spondylolisthesis treatment.After nearly 10 years of basic research and clinical application of anatomy,Wiltse equal in 1968 on the Watkins modify surgical approach, first proposed by the multifidus muscle and the longest space approach method,successfully used in clinical treatment.Spinous process of the approach originally adopted next two incisions,1988Wiltse and Spencer take into account aesthetics and other reasons,the two-incision into a single incision,which is only for a posterior midline incision,isolated from the muscles on both sides of space back to the Ministry, the formation of Now Wiltse surgical approach.This study of 50 cases of lumbar degenerative disease were used Wiltse surgical approach TLIF and PLIF posterior midline approach compared two methods of clinical efficacy, and to summarize Wiltse clinical advantages of surgical approach.Methods:From March 2008 to February 2010,50 consecutive cases with degenerated lumbar disease were used Wiltse approach TLIF and PLIF posterior midline approach in the treatment of two methods to compare the two groups mean operative time,blood loss,drainage tube indwelling time,postoperative drainage volume,postoperative bed time and depth of S1 pedicle screw placement, Comparison of score by using the JO A score low back pain rating (1986) and the VAS score of the preoperative and postoperative 1 week and 6 months after low back pain, leg pain and nerve function.Result:Wiltse approach TLIF group and the posterior midline approach PLIF group no significant difference in operative time(P>0.05);However,to blood loss,drainage retention time,postoperative drainage,postoperative bed time,S1 spondylolysis insertion depth of the root screw Wiltse approach TLIF group has significant advantages,there was significant difference(P< 0.05).1 week after Wiltse approach TLIF group low back pain VAS score decreased more significantly(P<0.05);after 1 week and 6 months leg pain VAS score in group 2 showed no significant difference(P>0.05);after 1 week Wiltse surgical approach TLIF group JOA score PLIF with posterior midline approach was significant difference between groups(P<0.05).Conclusion:comparison to traditional posterior midline approach, Wiltse approach gap into multifidus and longissimus to expose surgical field,not damage spinal nerve dorsal branch and dorsal branch of lumbar artery to prevent loss of nerve sacral spinal muscle atrophy;to avoid the side side substantial traction,stripping paraspinal muscle injury in the muscle,to maintain the integrity of tension-band;for pedicle screw insertion to provide adequate surgical field.Less blood loss,less postoperative drainage,post-operative short duration pain,pain intensity light,the advantages of rapid recovery,conforming to concept of minimally invasive and BO.However posterior midline approach needs stripping paraspinal muscle stripping, Wiltse surgical approach has obvious advantages compared with posterior midline approach,which is worth popularizing a surgical approach. |
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