A comparative study of transforaminal lumbar interbody fusion between Wiltse approach and posterior midline approach in the treatment of lumbar disc herniation

HUANG Xiao-chuan; LIN Bin; LIU Hui; ZHOU Liang; HE Yong-zhi; HUANG Zhuan-zhi

doi:10.3969/j.issn.2095-252X.2017.01.008

Abstract：Objective To investigate the clinical effects and the differences of adjacent segment degeneration between Wiltse approach and posterior midline approach in the treatment of lumbar disc herniation by transforaminal lumbar interbody fusion ( TLIF ). Methods A total of 100 patients with lumbar disc herniation were treated with TLIF between June 2014 and June 2015. Each patient had a serial number according to admission order and were treated by Wiltse approach or posterior midline approach at random by the SPSS software. Ninety patients were followed up, including 46 patients treated by Wiltse approach and 44 patients treated by posterior midline approach. The 2 groups were compared in creatine kinase ( CK ) value, visual analogue scale ( VAS ) score, Oswestry disability index( ODI ) score, fatty inifltration score of the multiifdus muscle and modiifed MRI index of the upper adjacent segment preoperatively, postoperatively and at the ifnal follow-up. Results All the patients had no positioning errors, nerve injury, cerebrospinal lfuid leak, disc space infection or other serious complications. The average time of follow-up was ( 15.8 ± 3.7 ) months ( range:11-23 months ). The CK values preoperatively and at 1 day after the operation were ( 83.84 ± 24.79 ) U/L and ( 164.26 ± 23.74 ) U/L respectively in Wiltse approach group, which were ( 79.93 ± 23.50 ) U / L and ( 419.27 ± 40.94 ) U / L respectively in posterior midline approach group. The VAS scores preoperatively, at 3 months after the operation and at the ifnal follow-up were 7.00 ± 1.23, 1.52 ± 0.67 and 1.48 ± 0.51 respectively in Wiltse approach group, which were 7.27 ± 1.24, 2.09 ± 0.61 and 2.18 ± 0.66 in posterior midline approach group. The ODI scores preoperatively, at 3 months after the operation and at the ifnal follow-up were 68.26 ± 8.97, 22.78 ± 4.30 and 22.96 ± 3.95 respectively in Wiltse approach group, which were 69.18 ± 9.83, 27.55 ± 2.82 and 27.82 ± 3.54 respectively in posterior midline approach group. The fatty inifltration scores of the multiifdus muscle preoperatively and at the ifnal follow-up were 1.26 ± 0.45 and 1.35 ± 0.57 respectively in Wiltse approach group, which were 1.36 ± 0.49 and 2.05 ± 0.58 respectively in posterior midline approach group. The modiifed MRI index of the upper adjacent segment preoperatively and at the ifnal follow-up were 69.98 ± 16.68 and 68.85 ± 12.38 respectively in Wiltse approach group, which were 67.98 ± 14.84 and 55.19 ± 11.99 respectively in posterior midline approach group. No statistically significant differences were found between the 2 groups in CK value, VAS, ODI, fatty infiltration score of the multiifdus muscle and modiifed MRI index of the upper adjacent segment preoperatively, but there were statistically signiifcant differences between the 2 groups in CK value at 1 day after the operation, VAS and ODI at 3 months after the operation and at the ifnal follow-up and fatty inifltration score of the multiifdus muscle and modiifed MRI index of the upper adjacent segment at the ifnal follow-up. Wiltse approach was superior to posterior midline approach in postoperative pain, curative effects, multifidus muscle injury and degeneration of the upper adjacent segment. Conclusions Compared with posterior midline approach, the treatment of lumbar disc herniation by TLIF through Wiltse approach has more advantages, which can delay adjacent segment degeneration and promote the quality of patients’ life.