Comparative study between Wiltse approach and conventional posterior open approach in patients with lumbar fractures without neurological injury

Background and aim
Thoracolumbar traumatic fractures are common in clinical practice. It is mainly treated with internal fixation, but the technique has many drawbacks. The Wiltse approach can manage these fractures with little drawbacks. This study was designed to compare the outcome of both Wiltse and conventional posterior approaches.
Patients and methods
A total of 30 neurological deficit-free patients of thoracolumbar fractures were enrolled in a prospective study between May 2017 and May 2018. Those patients were divided into equal groups based on the type of approach used for fixation; group I patients were treated using the conventional technique and group II were operated using the Wiltse technique. Baseline data, operative time, blood loss, degree of Cobb's angle, functional evaluation with the Oswestry disability index, pain assessment with visual analog scale, and muscle degeneration were compared in both groups.
Results
Both groups had insignificant differences as regards age and sex. There was male predominance in both groups. Blood loss was significantly more in the conventional posterior approach (372.66 ± 82.58) compared with that of the Wiltse approach (214.66 ± 55.01 ml). Cobb's angle in both conventional and Wiltse groups improved from (16.46 ± 4.25 and 19.40 ± 4.28) preoperatively to (8.13 ± 1.68 and 9.40 ± 3.42) postoperatively, respectively. There was no significant loss of correction in both groups comparing early and late follow-up. Visual analog scale score of low back pain was significantly better with the Wiltse approach (4.89 ± 0.98) than that of the conventional one (6.43 ± 1.11) at the time of discharge. The degree of muscle degeneration and fatty infiltration measured by MRI was more frequent with the conventional approach.
Conclusion
Management of thoracolumbar fracture with the Wiltse technique has the advantages of less tissue trauma.