Comparision Research Of Modified Posterior Approach And Paraspinal Musclespace Approach For Thoracolumbar Surgery

Background After the advent of pedicle screw technology,it has been widely used in thoracolumbar internal fixation surgery,due to its unique advantages in the effective fixation of the three pillars of the spine,Subsequently,posterior approach surgery has become the preferred and most commonly surgical approach in the course of surgical treatment of thoracolumbar.Most studies at present have found that the traditional posterior midline approach greatly damaged the original tissue,resulting in long-term postoperative low back pain.Therefore,the paraspinal musclespace approach has been proposed in recent years,which develops less injury and more relief of postoperative low back pain.However,the scope of application of this approach is small,in order to reduce the incidence of complications such as postoperative low back pain and expand the scope of surgery,we improved the traditional approach and studied the clinical efficacy of the improved approach.Methods 69 patients required surgical treatment(including 23 cases of thoracolumbar fractures were treated with internal fixation and 46 cases of lumbar degenerative diseases treated with lumbar intervertebral fusion surgery TLIF)who were admitted to the second affliated hospital of Soochow university from October 2016 to December 2017.Two sides of the spines of the same patient were treated with different surgical approache during the operation.One side was modified posterior approach through limited subperiosteal dissecting paravertebral muscle to the pedicle screw entry points,completed pedicle puncture and decompression if needed,avoiding extensive stripping and pulling of paravertebral muscles which traditional approach did,while the other side was subjected to the paraspinal musclespace approach.To evaluate the clinical effects of the tAvo surgical approaches,the data of the two approaches were compared,including duration and the volume of blood loss of exposure,miss probability of pedicle puncture,post-operative drainage and VAS score of back pain,degree of soft tissue swelling around the incision,as well as the VAS score at the last follow-up,degree of adipose tissue deposition and the area of paravertebral muscles measured with MRI scan.Results All patients were successfully operated and followed up for 10-18 months.For the two approaches,there was no significant difference in the exposure time,volume of blood loss during exposure,miss probability of pedicle puncture,VAS score of back pain,degree of soft tissue swelling around the incision,and the deposition of adipose tissue in the paravertebral muscles and the area of paravertebral muscles at the last follow-up(P>0.05).Only the volume of post-operative drainage in the modified posterior approach group was larger than that in the paraspinal musclespace approach group(P<0.05).Conclusions In the course of surgical treatment of thoracolumbar intermal fixation surgery,compared with paraspinal musclespace approach,the modified posterior approach can also achieve good surgical effects,both of them accord with the idea of minimally invasion,while the modified posterior approach have the advantages of wider indication,simple operation and shorter learning curve.