Safety and feasibility of mini-open Wiltse approach in posterolateral lumbar stabilization and fusion: intra- and post-operative evaluation

Abstract

Abstract Background Expected operative challenges in minimally invasive spine surgeries as a result of restricted surgical field, unfamiliarity with surgical approaches and fear of complications are behind the preference of using traditional "open" spine surgery. Objectives To evaluate the safety and feasibility of mini-open Wiltse approach in comparison with the conventional midline approach for posterolateral lumbar stabilization and fusion. Patients and methods A retrospective comparative study conducted on 49 patients with low grade single level lumbar spondylolithesis who were surgically treated in our Department between May 2020 and May 2022. Patients who were surgically treated with traditional midline approach were included in group (A) and patients in whom the mini-open Wiltse approach was used, were assigned to group (B). The two groups were compared regarding various intra and postoperative parameters. Results Group (A) included 27 patients (55.1%) operated upon with the classic midline approach and 22 patients (44.9%) were surgically treated using the Wiltse approach (group B). The mean patients' age (50.43 ± 5.538) years and L4-5 was the most commonly affected level (71.4%). The intra-operative parameters (operation time, blood loss and fluoroscopy time) showed significant lower results (P < 0.001) among patients of group (B). No cases in the group (B) required blood transfusion versus 5 cases in group (A) (P = 0.033). Postoperatively, the Oswestry Disability Index (ODI) and Visual analogue scale (VAS) scores were significantly improved in each group in comparison to the preoperative scores (P < 0.001). However, after 3 months the ODI score in group (B) was superior to that in group (A) (P = 0.045) and postoperative VAS score in group (B) was significantly improved compared to that in group (A) at discharge (P = 0.016), and also after 1 and 3 months (P < 0.001). Patients operated with Wiltse approach had a shorter duration of hospital stay but the difference was not statistically significant (P = 0.090). Conclusions Because of minimal trauma to the muscles and soft tissues, the mini-open Wiltse approach can be faster, safer and requires less recovery time as opposed to the classic midline approach.

Keywords

• Wiltse approach
• Classic midline approach
• Spondylolisthesis
• Minimally invasive