Clinical Application Of Single-side Pedicle Screw Fixation By The Wiltse Approach For Lumbar Posterior Fusion Under Quadrant System

[Objective] To assess the clinical value of minimally invasive single-side pedicle screw fixation for lumbar posterior fusion.[Methods] A consecutive series of 45 patients who had undergone lumbar spinal fusion of 1 segment to treat degenerative lumbar disease was analyzed.There were 15 cases of which underwent TLIF with unilateral pedicle screw fixation by the Wiltse approach under Quadrant system.(lumbar disc herniation complicated with lumbar instability, 13cases; lumbar spondylolisthesis,2cases)including 8 males and 5 females with an average of 54.3 ± 19.2 years(A group);and 15 cases of which underwent PLIF procedures with traditional approach combined with unilateral pedicle screw fixation(lumbar disc herniation complicated with lumbar instability,14cases; lumbar spondylolisthesis,1case)including 7males and 8 females with an average of 55.1 ± 17.3 years(B group).15 cases of which underwent PLF procedures with traditional approach combined with bilateral pedicle screw fixation(lumbar disc herniation complicated with lumbar instability, 13cases; lumbar spondylolisthesis,2 cases) including 8 males and 7 females with an average of 54.1 ± 18.3 years(C group).The operative duration、blood loss、complications and CK after operation were evaluated. More than 1 year all the patients were followed up with VAS scores and Oswestry disability questionnaire. All the patients accepted X-line/CT evaluation to compare the intervertebral height/fusion rates at the operative level pre-operation with post-operation.[Results] There was less operative time、blood loss in minimally invasive approach compared to traditional group. ODI、VAS、the intervertebral height and CK in three groups shouwed statistical significance betwween pre-operation and post-operation(P<0.05).Compared with traditional group, minimally invasive approachs had lower ODI、VAS and CK(P<0.05).There were no significant difference in the intervertebral height(P>0.05) of the three groups. The fusion rate of three groups were 93.33%.A total of 2 patients with cage migration in unilateral pediele screw fixation.[Conclusions] Single-side pedicle screw fixation assisted by Wiltse approach under Quadrant system caused less iatrogenic injury than traditional approach and had positive efforts on less back pain.