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. 2024 Jun 20:11:1406111.
doi: 10.3389/fsurg.2024.1406111. eCollection 2024.

The feasibility and efficacy of pedicle fixation by the Wiltse approach in the thoracic spine

Lu Hao  1 , Yufeng Xiang  2 , Junhui Liu  3
Affiliations

The feasibility and efficacy of pedicle fixation by the Wiltse approach in the thoracic spine

Lu Hao et al. Front Surg. .

Abstract

Study design: Retrospective Cohort Study.

Objectives: To explore the feasibility and assess the efficacy of pedicle fixation with the Wiltse approach in the thoracic spine.

Summary of background data: The current application of Wiltse approach is mainly practiced in the lumbar and thoracolumbar spines. Its application in the thoracic spine, however, has received little attention, especially in cases that requires only pedicel screw fixation without spinal decompression.

Methods: The study analyzed the clinical records of consecutive patients with thoracic diseases who underwent pedicle fixation with either Wiltse or the conventional transmuscular approach (Wiltse group: 60 cases; Transmuscular group: 48 cases). Perioperative parameters, Visual Analogue Scale (VAS) scores, accuracy of pedicle screw placement, dead space between the muscles, Magnetic Resonance Imaging (MRI) appearance, electrophysiological changes in the multifidus muscle were compared between the two groups.

Results: Compared with the transmuscular group, the Wiltse group was significantly better in blood loss and postoperative VAS scores. No difference was observed in incision length, operation time, and hospital stay. The dead space between the muscle cross-sectional region in the transmuscular group was 315 ± 53 mm2, and no dead space was found in the Wiltse group. On MRI images, the multifidus cross-sectional area (CSA) in the Wiltse group between the preoperative period and the last follow-up reduced by only 10.1%, while transmuscular group showed 46.1% CSA reduction. Electrophysiologically, the median frequency slope of the transmuscular group grew by 47.8% with average amplitude reduced by 16.4% between the preoperative period and 12-month postoperative.

Conclusion: The Wiltse approach for pedicle fixation in the thoracic spine is a feasible and effective treatment, with fewer traumas and reliable clinical results. In particular, the Wiltse approach reduces postoperative dead space between the muscles and causes less atrophy in the multifidus muscle.

Keywords: Wiltse approach; conventional transmuscular approach; multifidus muscle; pedicle fixation; thoracic diseases.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The Wiltse approach was approached by the interspace between the spinalis thoracis and longissimus muscles.
Figure 2
Figure 2
Pedicle fixation by the Wiltse (A) and transmuscular approach (B).
Figure 3
Figure 3
Comparison of pre- and postoperative serum creatine kinase levels between the different groups.
Figure 4
Figure 4
The dead space between the muscle can be seen in the transmuscular group (A), and no dead space was found in the wiltse group (B).
Figure 5
Figure 5
MRI axial view of the lumbar spine and muscles; the Wiltse group [(A) preop, (B) last follow-up] shows less multifidus atrophy compared to the transmuscular group [(C) preoperative, (D) last follow-up].
See this image and copyright information in PMC

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