Wiltse approach via pedicle screw intra vertebral bone grafting for sagittal spinal balance reconstruction and clinical efficacy in thoracolumbar degenerative kyphotic deformity
SHEN Yuxin
HE Shouyu
DENG Minjun
SHEN Zheyuan
Abstract：Objective To explore the advantages of intravertebral bone grafting via the pedicle screw through the Wiltse approach in the reconstruction of sagittal spinal balance and clinical efficacy in thoracolumbar degenerative kyphotic deformity.Method A single-center prospective randomized controlled design was adopted.A total of 100 patients with thoracolumbar degenerative kyphotic deformity with Cobb angle＞20°,abnormal sagittal vertical axis(SVA),and ineffective conservative treatment were randomly divided into the Wiltse-approach intravertebral bone grafting group(observation group,n=50)and the traditional posterior pedicle screw bone grafting group(control group,n=50).Dynamic differences in SVA,Cobb angle,Visual Analogue Scale(VAS),Oswestry Disability Index(ODI),bony fusion rate,and complications were compared between the two groups.Results Repeated measures analysis of variance for the primary outcomes showed statistically significant difference in SVA and Cobb angle(P＜0.001).At 1 week after operation,VAS in the observation group was lower than that in the control group,with statistically significant difference(P＜0.001).At 12 months,the gap was still maintained(P＜0.001),with between-group differences of-4.8 mm and-2.8°,respectively.For the secondary outcomes,preoperative VAS and ODI baselines of the two groups were comparable.There were still statistically significant differences in the observation group at 1 week,3 months and 12 months after operation(P＜0.001).ODI at 3 months and 12 months after operation was also markedly lower(P＜0.001).There was no statistically significant difference in the total incidence of complications and Clavien-Dindo grading between the two groups(all P＞0.05).The intraoperative blood loss(P＜0.001)and length of hospital stay(P=0.003)were better in the observation group,and no statistically significant differences were found in other individual events such as related failures.Conclusion Intravertebral bone grafting through the Wiltse approach is superior to the traditional posterior approach in reconstructing sagittal balance of thoracolumbar degenerative kyphotic deformity,enhancing correction precision,accelerating rehabilitation,reducing pain and functional disability,and has high safety,providing strong evidence for minimally invasive deformity correction.
Keywords：Wiltse approachintravertebral bone graftingthoracolumbar degenerative kyphosissagittal balancepedicle screw fixationspinal fusionkyphotic deformity correctionclinical efficacy evaluation
Publication Date：2025-09-30
Online Publishing Date：2026-08-26(First online date of this platform, not the publication date of the document)
Pages：8( 1195-1201,1210 )