Interdisciplinary Neurosurgery (Mar 2021)
Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures
Abstract
Introduction: Thoracolumbar fractures account for approximately 20% of fractures of the spinal column, the majority of which are unstable. In terms of management the aims proposed are to prevent further neurological injury, decompress the spinal canal in the presence of canal stenosis, and stabilize the spine. Materials and methods: We performed a prospective cohort study of 32-patients who presented to the Department of Orthopaedics, Lahore General Hospital, in Pakistan, from the 01 April 2018–31 March 2019, with unstable thoracolumbar fractures that were operatively stabilized. Sixteen subjects underwent a mini-open muscle splitting Wiltse approach (Cohort A), and 16-subjects underwent a traditional open midline approach (Cohort B). The data captured and analysed in this study included subject age; gender; type of surgical approach performed; length of operative procedure; volume of intra-operative blood loss; and amount of post-operative thoracolumbar pain assessed by the Visual Analogue Pain Scale Score. Results: The mean age of subjects in Cohort A was 36 ± 9.7 years, and the mean age of subjects in Cohort B was 36 ± 8.0 years. The male to female ratio was 1.7:1 in Cohort A, and 2.2:1 in Cohort B. Considering duration of surgery, a significant difference was demonstrated between Cohort A and Cohort B, favouring a shorter duration of surgery in Cohort A (p < 0.05). considering intra-operative blood loss, a significant difference was demonstrated between Cohort A and Cohort B, favouring less intra-operative blood loss in Cohort A (p < 0.05). At 8-weeks post-operatively, a significant difference was demonstrated between the amount of thoracolumbar pain between Cohort A and Cohort B, favouring less pain in Cohort A (p = 0.03). Conclusion: Due to the results of our study, we recommend the mini-open Wiltse approach be used, in select patients without significant spinal stenosis, to treat unstable single level thoracolumbar fractures.
