Wiltse Approach Combined With Ligmentotaxis For Indirect Reduction And Decompression For Treatment Of Thoracolumbar Fractures

ObjectiveThis paper introduces a minimally invasive theory and technique of ligamentotaxis in the treatment of thoracolumbar burst fractures via the Wiltse approach.Through the natural space approach of paraspinal muscles combined with the tension of the posterior longitudinal ligament(PLL),the fracture can be reset well and achieve the purpose of indirect decompression of the spinal canal,which can be used to replace parts of the traditional surgery that posterior approach to the spine and Laminectomy.The purpose of this study is to discuss the advantage of the minimally invasive method that Wiltse approach ligamentaotaxis through anatomical study and clinical case analysis.MethodsThe author performed a retrospective review of 312 patients with2009.07-2015.06 spinal fracture internal fixtation osteosynthesis operation for Denis A,B type thoracolumbar burst fracture,including the Wiltse approach ligament tension method of indirect decompression and reduction in 152 cases(Wiltse Approach group),the traditional posterior decompression and reduction in 160 cases(Posterior Approach group).The operation time,the amount of bleeding,incision length,vertebral height ratio,ODI scores were compared between the two groups before and after surgical reduction of fractures,analysis of ligmentotaxis..Statistical variance analysis of all kinds of data.ResultsThe Wiltse approach group operation time(84.1±13.7min),blood loss(61.6±12.9ml),incision length(9.6±0.8cm),the traditional posterior approach group operation time(141.8±19.6min),blood loss(118.7±32.3ml),incision length17.4±2.1cm).The difference between the two groups was significant(P<0.001).Preoperative ODI,WAS score and the recovery of vertebral height were similar,and there was no significant difference(P>0.05).Postoperative neurological Frankel classification was similar.ConclusionThe combination of the Wiltse approach and ligamentotaxis can make most of the thoracolumbar fractures to achieve the ideal reduction,thus achieving the purpose of indirect decompression.The advantages of Wiltse approach:(1)having less bleeding and shorter operation time;(2)using paraspinal approach to avoid large amplitude traction and dissection of the paravertebral muscle;(3)not easily damaged the posterior branch of the lumbar nerve and the dorsal branch of the lumbarartery to prevent the atrophy of the sacral spinous muscle;(4)the approach can provide enough for the placement of the pedicle screw.The visual field of operation is good;(5)shorter time and more quick recovery after operation.The advantages of the tension reduction of the PLL:(1)retaining the structure of the posterior ligament complex to provide support for the long-term stability of the fracture segment;(2)without the need to remove the skeletal structures such as the vertebral lamina and the pedicle,the posterior column structure of the spine is retained;(3)trauma is less,and the spinal canal is not needed to avoid the advantages of the spinal nerve traction during the operation.It not only avoids the dissection of the paravertebral muscles,but also avoids the excision of the laminae and other structures,thus avoiding the iatrogenic injury of the spinal canal decompression,which can significantly reduce the complications of the paraspinal muscle degeneration and the incidence of postoperative lumbar back pain,which can be used for the complete thoracolumbar burst bone in the large part of the posterior longitudinal ligament.Denis A and B type cases,the clinical curative effect is consistent with the traditional operation,and the advantages are many,the operation is simple,it is a practical operation technique which conforms to the minimally invasive idea of the thoracolumbar fractureoperation.It has the value of popularization and application.