A comparative study on the clinical effects of Wiltse approach and percutaneous pedicle screw internal fixation in the treatment of thoracolumbar fractures

English Keywords:Thoracic and lumbar fracture  Wiltse approach with pedicle screw fixation  Percutaneous pedicle screw fixation  Minimally invasive surgery  Spine

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacies of the Wiltse approach pedicle screw fixation(WAPSF) and percutaneous pedicle screw fixation(PPSF) in treating thoracolumbar fractures. Methods: Patients with thoracolumbar(T10-L4) fractures who underwent pedicle screw fixation from July 2024 to June 2025 were selected. Eligible patients were divided into a WAPSF group and a PPSF group based on the surgical approach. A total of 68 patients diagnosed with thoracolumbar fractures were included in this study, comprising 38 patients in the WAPSF group and 30 in the PPSF group. General data such as causes of trauma, gender, age, body mass index(BMI), bone mineral density(BMD), fractured vertebra, and comorbidities were recorded. Operative parameters including incision length, operation duration, blood loss, fluoroscopy times of C-arm X-ray machine, surgical cost, and perioperative complications were collected. Postoperative outcomes including postoperative hidden blood loss, visual analogue scale(VAS) scores, Oswestry disability index(ODI), as well as radiographic parameters including vertebral height ratio(VHR), anterior vertebral height ratio(AVHR), vertebral body angle(VBA), and local Cobb angle(LCA) were also collected. The data collected were statistically analyzed. Results: The WAPSF group was shorter than the PPSF group in surgical incision, less in intraoperative blood loss(54.34mL vs 81.83mL, P<0.01) and postoperative hidden blood loss(172.7mL vs 349.1mL, P<0.05), fewer fluoroscopy times during surgery(7.95 vs 12.23, P<0.01), and lower surgical costs(9038 yuan vs 10451 yuan, P<0.01). Postoperatively, both groups showed significant improvements in VAS scores, ODI, and radiographic parameters. In patients with vertebral body compression less than 20%, the WAPSF group showed a greater VHR and a smaller VBA after operation. In patients with vertebral body compression over 20%, no obvious difference was found between the preoperative and postoperative LCA in the PPSF group(P>0.05). Conclusions: Both the WAPSF and PPSF can achieve favorable clinical outcomes for thoracolumbar fractures. Wiltse approach offers advantages in terms of total incision length, intraoperative blood loss, postoperative hidden blood loss, fluoroscopy frequency, and surgical cost. For mild compression fractures, it allows for more precise and effective distraction reduction of the injured vertebra.