Mini-invasive Transforaminal Lumbar Interbody Fusion through Wiltse Approach to Treating Lumbar Spondylolytic Spondylolisthesis

Objective: To assess the clinical efficacy of mini-invasive transforaminal lumbar interbody fusion (TLIF) through the Wiltse approach for treating lumbar spondylolytic spondylolisthesis.

Methods: In this retrospective controlled study, 69 cases with lumbar spondylolytic spondylolisthesis treated in Qilu hospital from April to November 2014 were randomly assigned to Wiltse approach (31 cases, 16 male, 15 female; mean age 45.1 years) and traditional approach groups (38 cases, 21 male, 17 female; 47.2 years. In the Wiltse approach group, the affected level was L4, 5 in 19 cases and L5 S1 in 12, 9 of whom had low back pain (LBP) only and 21 both LBP and leg pain. There were 17 cases of I degree and 14 of II degree spondylolisthesis. Pre-operative Japanese Orthopedic Association (JOA) score was 13.1 ± 2.6; visual analog scale (VAS) for LBP 7.4 ± 1.2; VAS for leg pain 6.1 ± 2.0 and Oswestry disability index (ODI) score 42.2% ± 1.2%. In the traditional approach group, the affected level was L4, 5 in 22 cases and L5 S1 in 16, 11 of whom had LBP only and 27 both LBP and leg pain. There were 21 cases of I degree and 17 of II degree spondylolisthesis. Pre-operative JOA score was 12.8 ± 1.2; VAS for LBP 6.9 ± 1.1; VAS for leg pain 7.1 ± 2.0 and ODI score 41.2% ± 2.0%. The JOA score, VAS for LBP and leg pain, ODI dynamic X-rays, CT and/or MR were evaluated 3 and 6 months and 1 year postoperatively.

Results: There were no differences in sex, age, affected levels, spondylolisthesis degree, pre-operative JOA score, VAS for LBP or leg pain and ODI score between the two groups (P > 0.05). The incision length, blood loss and time to achieving exposure were better in the Wiltse approach than the traditional approach group (P < 0.05). The VAS for LBP and muscle atrophy MRI scores were significantly lower in the Wiltse approach than the traditional approach group on Days 1 and 14 and at 1 year follow-up (P < 0.05). The VAS for leg pain, JOA recovery rate and JOA and ODI scores tended to be lower in the Wiltse approach than the traditional approach group at 1 year follow-up examinations (no differences statistically significant, P > 0.05). The interbody fusion rate was not significantly different between the groups (P > 0.05). There were no complications of internal fixation in either group.

Conclusion: TLIF via both approaches has satisfactory clinical efficacy. TLIF through the Wiltse approach significantly reduces the damage of multifidus and postoperative incidence of chronic LBP.