J Korean Soc Spine Surg.  2011 Dec;18(4):208-216. 10.4184/jkss.2011.18.4.208.

Comparative Study of the Clinical Outcomes of Unilateral Transforaminal Lumbar Interbody Fusion(TLIF) with Bilateral TLIF using Wiltse Approach and Conventional Approach

• Kim KT
• Suk KS
• Lee SH
• Lee JH
• Park KJ
• Son ES
• Kwack YH
• Hong SH

• KMID: 1447998
• DOI: http://doi.org/10.4184/jkss.2011.18.4.208

Abstract

STUDY DESIGN: Comparative study.
OBJECTIVES
To compare the outcomes of unilateral TLIF, bilateral TLIF using Wiltse approach and bilateral TLIF using conventional midline approach. SUMMARY OF LITERATURE REVIEW: There are many studies about outcomes of Unilateral TLIF, but few have compared the 3 different fusion procedures.
MATERIALS AND METHODS
60 patients were divided into 3 groups. Each group has enrolled 20 patients (Study group: unilateral TLIF, Control group 1: bilateral TLIF using Wiltse approach, Control group 2: bilateral TLIF using conventional midline approach). For clinical outcomes, we compared operative time, blood loss, time for ambulation and discharge, VAS for back pain and leg pain and ODI among three groups. For radiologic evaluation, disc height and segmental lordosis were examined.
RESULTS
The mean operative time was 147 minutes in study group(SG), 172 minutes in control group 1(CG1), 167 minutes in control group 2(CG2). The mean total blood loss was 466ml in SG, 569ml in CG1, 1140ml in CG2 respectively. VAS for back pain at the third postoperative day significantly decreased in SG and CG1 compared with CG2. There was no significant difference in ODI, disc height and segmental lordosis among the groups.
CONCLUSION
Using Wiltse approach, there were several advantages in decreasing blood loss, immediate postoperative back pain, hospital stay and early ambulation. Clinical and radiological results of unilateral TLIF were comparable with bilateral TLIF.

Keyword

Minimally invasive surgery; Wiltse; Transforaminal lumbar interbody fusion

MeSH Terms

Animals
Back Pain
Early Ambulation
Humans
Leg
Length of Stay
Lordosis
Operative Time
Walking

Figure

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  Fig. 1. Schematic illustrations show the three different fusion procedures. (A) Unilateral TLIF (B) Bilateral TLIF using Wiltse's approach (C) Bilateral TLIF using conventional midline approach

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  Fig. 2. These photographs show the unilateral TLIF procedures.(A) Conventional approach at symptomatic side (B) Unilateral disc preparation and cage insertion (C) Decompression of contralateral side (D) Wiltse approach at contralateral side (E) Pedicle screw insertion through Wiltse approach

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  Fig. 3. Radiographic measurement of anterior (A2/A1, original magnification x 100) and posterior disc heights. (P2/P1, original magnification x 100)

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  Fig. 4. These radiographs are taken from the patient who underwent unilateral TLIF at 2 years follow up. Suspicious nonunion is observed in these radiographs. (A, B) X-ray shows radiolucent area around the cage. (C, D) CT scan shows discontinuity of bridging bone in interbody space.

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