The minimally invasive operation by Wiltse approach versus traditional posterior open surgery in treatment of dural-level lumbar spinal stenosis

English Keywords:Lumbar spinal stenosis  Minimally invasive  Wiltse approach  Transforaminal lumbar interbody fusion  Posterior lumbar interbody fusion

English Abstract:

  【Abstract】 Objectives:　To compare the clinical results between minimally invasive operation by wiltse approach and traditional posterior open surgery in treatment of dural-level lumbar spinal stenosis. Methods: From March 2006 to June 2011, a total of 215 cases with dural-level lumbar spinal stenosis underwent surgical intervention were retrospectively analyzed. Among them, 113 cases received minimally invasive operation（transforaminal lumbar interbody fusion, TLIF, group A）: male 54 cases， female 59 cases， 6 cases in L2/3-L3/4, 27 cases in L3/4-L4/5, 80 cases in L4/5-L5/S1, with an average age of 57(range from 43 to 84); preoperative ODI and the VAS of low back pain/leg pain was (59.16±21.47)%, 6.1±3.0, and 4.1±2.3 respectively. 102 cases received open surgery(posterior lumbar interbody fusion, PLIF, group B): male 50 cases, female 52 cases, 5 cases in L2/3-L3/4, 30 cases in L3/4-L4/5, 67 cases in L4/5-L5/S1, with an average age of 55(range from 48 to 76); preoperative ODI and the VAS of low back pain/leg pain was (53.14±20.32)%, 5.4±2.9, and 4.3±2.2 respectively. Operation time, intraoperative bleeding, and length of incision were recorded. Low back pain/leg pain was assessed by visual analogue scale(VAS), and lumbar function was evaluated by Oswestry Disability Index(ODI) during postoperative follow-up, then by statistical analysis. Results: There were no significant differences among age, sex, surgery segment between group A and group B(P>0.05). The mean follow-up time was 19 months in group A and 21 months in group B, no significant difference was detected(P>0.05). Both of the two groups got satisfactory clinical outcome and osseous fusion. Operation time, ODI and the VAS score of leg pain at the final follow-up in group A was 140-190min(165±37min), （13.20±7.9）% and 1.1±0.9 respectively; and which in group B was 130-220min(155±46min), （15.20±6.72）% and 1.3±1.1 respectively; there was no significant difference between group A and group B(P>0.05). Length of incision, intraoperative bleeding, rate of residual low back pain at the final follow-up and the VAS of low back pain in group A was 4-5cm(4.5±1.1cm), 140-400ml（260±215ml）, 2.7% and 1.2±1.1 respectively; and which in group B was 11-18cm(14.2±2.4cm), 300-1200ml（420±437ml）, 18.6% and 1.9±1.5 respectively; group A was superior to group B(P<0.05). There were significant improvements of ODI and the VAS of back/leg pain in two groups between preoperation and postoperation(P<0.05). Conclusions: Minimally invasive operation by wiltse approach as well as open surgery can get satisfactory clinical outcome. Minimally invasive operation by wiltse approach has advantages as follows: less invasive, less intraoperative bleeding, lower incidence of back pain in the duration of follow-up.