Wiltse and midline approach for lumbar spondylolysis in adolescent: a randomized controlled trial

English Keywords:Spondylolysis  Wiltse approach  Midline approach  Effectiveness

English Abstract:

  【Abstract】 Objectives: To compare the effectiveness, advantages and disadvantages of Wiltse and midline approach for lumbar spondylolysis in adolescent by vertebral pedicle screw-vertebral plate Hook system. Methods: Randomized controlled trial was carried out on 28 cases of spondylolysis(young patients) of our hospital from March 2006 to May 2010(L3 in 4 cases, L4 in 8 cases, L5 in 16 cases), all cases underwent either Wiltse(14 cases) or midline approach(14 cases). Age, sex-ratio, segment distribution, visual analogue scale(VAS) score and Oswestry dysfunction index(ODI) scale showed no group-related difference. Operation time, operative blood loss and postoperative drainage were recorded. The VAS was used to assess pain at postoperative 3 days, 3 months, 6 months, one year and two years; the ODI was used to assess the functional recovery in preoperative and postoperative 3 months, 6 months, one year and two years; the three dimensional CT was used to evaluate fusion status one year after operation. Results: For Wiltse approach, the average operation time was 104min(100-140min)， the average intraoperative blood loss was 124ml（80-150ml）, the postoperative drainage was 54ml(35-85ml). For midline approach, the average operation time was 133min(120-160min)， the intraoperative blood loss was 197ml(120-210ml) and the postoperative drainage was 80ml(53-122ml), all showed higher value than Wiltse approach group(P＜0.05). Witlse approach group had higher VAS score(6.31±0.9) than midline approach group(4.79±1.1) in postoperative 3 days(P＜0.05), while had lower VAS and ODI(VAS: 1.13±1.2, 1.07±1.4; ODI: 0.135±0.099, 0.137±0.041) than Midline approach(VAS: 2.93±1.7, 2.36±1.3; ODI: 0.187±0.112, 0.179±0.029) in postoperative 3 and 6 months(P＜0.05), while two groups showed no difference in postoperative 12 and 24 months(P＞0.05). The three dimensional CT showed continuous bony bridging in 13 cases of both groups in postoperative one year, with the fusion rate of 92.8%, no instrument failure was noted. Conclusions: Treatment of lumbar spondylolysis in adolescent by vertebral pedicle screw-vertebral plate Hook system through Witlse approach is reliable and effective with less invasive than midline approach.