Comparision between paraspinal muscle space approach versus conventional posterior midline approach in thoracolumbar posterior surgery

English Keywords:Thoracic vertebrae  Lumbar vertebrae  Spinal fractures  Operative approach  Therapeutic effect

English Abstract:

  【Abstract】 Objectives: To compare the clinical results between paraspinal muscle space approach and conventional posterior midline approach in thoracolumbar posterior surgery． Methods: From June 2008 to October 2011, 67 patients underwent single segment instrumentation(pedicle screw system) or internal fixation removal(pedicle screw system). For cases with spine facture, the fracture type was single segment compressional or burst fracture with no neurological deficit. The patients were divided into 2 groups: conventional posterior midline approach group included 31 cases, 25 males and 6 females, with an average age of 31.4 years. The involved segments included 5 T11, 12 T12, 12 L1 and 2 L2. The preoperative visual analog scale was 7.9±0.6, and the Cobb angle was 20.1°±3.5°. Paraspinal approach group included 36 cases, 31 males and 5 females, with an average age of 32.9 years. The involved segments included 8 T11, 12 T12, 13 L1, 2 L2. The preoperative visual analog scale was 7.6±0.8, and the Cobb angle was 19.8°±4.1°. The data including operation time, intraoperative blood loss, postoperative volume of drainage, correction rate of Cobb angle and VAS scores between 2 groups were compared． Results: All operations were completed successfully. All patients were followed up for 3-8 months． In the conventional posterior midline approach group, the postoperative correction rate of Cobb angle and the accuracy of pedicle screw placement was (87.4±5.3)% and (96.4±2.8)% respectively, which was (86.7±6.5)% and (96.7±3.3)% in the paraspinal approach group. There were no significant differences between two groups(P＞0.05). But, the operation time, intraoperative blood loss and postoperative volume of drainage was 75.0±18.1min, 140.0±40.7ml, 85.0±25.2ml respectively in the paraspinal approach group, and 93.0±15.7min, 230.0±35.5ml, 160.0±43.5ml in the posterior midline approach group respectively. The paraspinal approach group was significantly superior than the posterior midline approach group(P＜0.05). In the paraspinal approach group, the VAS score was 7.6±0.8, 2.9±0.5, 1.5±0.4 at postoperative 1, 2 and 3 weeks respectively, which was 7.9±0.6, 4.1±0.6, 2.8±0.4 in the posterior midline approach group respectively. Although there was no significance difference at the first week(P＞0.05), the paraspinal approach group showed the significant superiority to posterior midline approach group(P＜0.05) at postoperative 2 and 3 weeks． Conclusions: The paraspinal approach is better than the posterior midline approach for posterior thoracolumbar surgery，which develops less injury and more relief of postoperative low back pain．