Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures
Introduction: Thoracolumbar fractures account for approximately 20% of fractures of the spinal column, the majority of which are unstable. In terms of management the aims proposed are to prevent further neurological injury, decompress the spinal canal in the presence of canal stenosis, and stabilize...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-03-01
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| Series: | Interdisciplinary Neurosurgery |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751920305673 |
| _version_ | 1828947000510382080 |
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| author | Muhammad Siddique Hamid Adrian Kelly Aftab Younus Muhammad Hanif Mian Muhammad Tariq Sohail |
| author_facet | Muhammad Siddique Hamid Adrian Kelly Aftab Younus Muhammad Hanif Mian Muhammad Tariq Sohail |
| author_sort | Muhammad Siddique Hamid |
| collection | DOAJ |
| description | Introduction: Thoracolumbar fractures account for approximately 20% of fractures of the spinal column, the majority of which are unstable. In terms of management the aims proposed are to prevent further neurological injury, decompress the spinal canal in the presence of canal stenosis, and stabilize the spine. Materials and methods: We performed a prospective cohort study of 32-patients who presented to the Department of Orthopaedics, Lahore General Hospital, in Pakistan, from the 01 April 2018–31 March 2019, with unstable thoracolumbar fractures that were operatively stabilized. Sixteen subjects underwent a mini-open muscle splitting Wiltse approach (Cohort A), and 16-subjects underwent a traditional open midline approach (Cohort B). The data captured and analysed in this study included subject age; gender; type of surgical approach performed; length of operative procedure; volume of intra-operative blood loss; and amount of post-operative thoracolumbar pain assessed by the Visual Analogue Pain Scale Score. Results: The mean age of subjects in Cohort A was 36 ± 9.7 years, and the mean age of subjects in Cohort B was 36 ± 8.0 years. The male to female ratio was 1.7:1 in Cohort A, and 2.2:1 in Cohort B. Considering duration of surgery, a significant difference was demonstrated between Cohort A and Cohort B, favouring a shorter duration of surgery in Cohort A (p < 0.05). considering intra-operative blood loss, a significant difference was demonstrated between Cohort A and Cohort B, favouring less intra-operative blood loss in Cohort A (p < 0.05). At 8-weeks post-operatively, a significant difference was demonstrated between the amount of thoracolumbar pain between Cohort A and Cohort B, favouring less pain in Cohort A (p = 0.03). Conclusion: Due to the results of our study, we recommend the mini-open Wiltse approach be used, in select patients without significant spinal stenosis, to treat unstable single level thoracolumbar fractures. |
| first_indexed | 2024-12-14T05:20:17Z |
| format | Article |
| id | doaj.art-8eeb4b8231ba4262bf973d427958eb3b |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-14T05:20:17Z |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-8eeb4b8231ba4262bf973d427958eb3b2022-12-21T23:15:41ZengElsevierInterdisciplinary Neurosurgery2214-75192021-03-0123101006Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fracturesMuhammad Siddique Hamid0Adrian Kelly1Aftab Younus2Muhammad Hanif Mian3Muhammad Tariq Sohail4Lahore General Hospital, University Of Health Sciences, Lahore, PakistanDepartment of Neurosurgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, P.O Box Medunsa, Pretoria, South Africa; Corresponding author.Department of Orthopedics, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South AfricaLahore General Hospital, University Of Health Sciences, Lahore, PakistanDoctor Hospital and Medical Centre, University of Health Sciences, Lahore, PakistanIntroduction: Thoracolumbar fractures account for approximately 20% of fractures of the spinal column, the majority of which are unstable. In terms of management the aims proposed are to prevent further neurological injury, decompress the spinal canal in the presence of canal stenosis, and stabilize the spine. Materials and methods: We performed a prospective cohort study of 32-patients who presented to the Department of Orthopaedics, Lahore General Hospital, in Pakistan, from the 01 April 2018–31 March 2019, with unstable thoracolumbar fractures that were operatively stabilized. Sixteen subjects underwent a mini-open muscle splitting Wiltse approach (Cohort A), and 16-subjects underwent a traditional open midline approach (Cohort B). The data captured and analysed in this study included subject age; gender; type of surgical approach performed; length of operative procedure; volume of intra-operative blood loss; and amount of post-operative thoracolumbar pain assessed by the Visual Analogue Pain Scale Score. Results: The mean age of subjects in Cohort A was 36 ± 9.7 years, and the mean age of subjects in Cohort B was 36 ± 8.0 years. The male to female ratio was 1.7:1 in Cohort A, and 2.2:1 in Cohort B. Considering duration of surgery, a significant difference was demonstrated between Cohort A and Cohort B, favouring a shorter duration of surgery in Cohort A (p < 0.05). considering intra-operative blood loss, a significant difference was demonstrated between Cohort A and Cohort B, favouring less intra-operative blood loss in Cohort A (p < 0.05). At 8-weeks post-operatively, a significant difference was demonstrated between the amount of thoracolumbar pain between Cohort A and Cohort B, favouring less pain in Cohort A (p = 0.03). Conclusion: Due to the results of our study, we recommend the mini-open Wiltse approach be used, in select patients without significant spinal stenosis, to treat unstable single level thoracolumbar fractures.http://www.sciencedirect.com/science/article/pii/S2214751920305673Unstable single level thoracolumbar fracturesMini-open wiltse approachTraditional open midline approach |
| spellingShingle | Muhammad Siddique Hamid Adrian Kelly Aftab Younus Muhammad Hanif Mian Muhammad Tariq Sohail Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures Interdisciplinary Neurosurgery Unstable single level thoracolumbar fractures Mini-open wiltse approach Traditional open midline approach |
| title | Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures |
| title_full | Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures |
| title_fullStr | Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures |
| title_full_unstemmed | Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures |
| title_short | Evaluating the muscle splitting Wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures |
| title_sort | evaluating the muscle splitting wiltse approach versus standard open midline approach for stabilization of unstable thoracolumbar fractures |
| topic | Unstable single level thoracolumbar fractures Mini-open wiltse approach Traditional open midline approach |
| url | http://www.sciencedirect.com/science/article/pii/S2214751920305673 |
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