Efficacy Of Modified Wiltse Intermuscular Approach And Traditional Posterior Median Approach For Lumbar Spondylolisthesis: A Meta-analysis

Objective:A meta-analysis was conducted to compare the efficacy of the modified Wiltse intermuscular approach and the traditional posterior median approach in lumbar spondylolisthesis. Method:CNKI,Wanfang,Pub Med,Cochrane Library,Embase,Web of Science,Medline,and other databases were searched by computer.Randomized controlled trials or clinical controlled trials of modified muscular space versus traditional posterior median approach for lumbar spondylolisthesis were searched in Chinese and English.The retrieval period is from the establishment of the database to March 2021.Literature was screened according to the established inclusion and exclusion criteria,and the quality was evaluated.Relevant data were extracted and analyzed using Review Manager 5.3 software.The evaluation indexes of this study included operative time,blood loss,postoperative drainage volume,postoperative JOA,ODI,VAS score,complications,and vertebral fusion rate,etc.Results:A total of 15 literatures were included,including 961 cases,including 476 cases in the modified Wiltse intermuscular approach group and 485 cases in the traditional posterior midline approach group.Meta-analysis results showed that the modified Wiltse intermuscular space group could shorten the operation time [MD=-0.81,95%CI(-1.41,-0.26),P =0.004],reduce the amount of blood loss [MD=-3.25,95%CI(-4.21,-2.29),P <0.00001] and the postoperative drainage volume [MD=-2.37,95%CI(-2.62,-2.13),P <0.00001].and improve the JOA score after lumbar spine surgery [MD=0.83,95%CI 为(0.55,1.11),p <0.00001],3 months [MD=-1.62,95%CI(-2.65,-0.58),p =0.002],6 months [MD=-0.85,95%CI(-1.5,-0.19),p=0.01],12 months MD=-0.60,95%CI(-0.78,-0.41),p<0.00001],and 2 weeks [MD=-1.69,95%CI(-2.5,-0.88),p< 0.00001),3 month MD=-1.27,95%CI 为(-1.61,-0.93),p< 0.00001),and 6 month [MD=-0.33,95%CI 为(-0.65,-0.02),p = 0.04),12 month[MD=-1.11,95%CI 为(-1.79,-0.44),p= 0.001] VAS score.However,there were no significant differences in complications and vertebral fusion rate(p>0.05)between the modified Wiltse and the traditional posterior midline approach.Conclusion:In this study,the modified Wiltse intermuscular approach group was able to shorten the operative time,reduce blood loss and postoperative drainage volume,and improve lumbar functional scores,but there was no significant difference in complications and vertebral fusion rate.