Moro Abu, Liao ShiAn, Fan Yue, Wang Yihan, Gu Wenfei, Zhan Xinli, Yang JinSong
Department of Spine and Osteopathic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Spine and Osteopathic Surgery, First People's Hospital of QinZhou, QinZhou, China.
Asian Spine J. 2025 Aug;19(4):571-582. doi: 10.31616/asj.2024.0440. Epub 2025 May 30.
Retrospective study.
To compare the modified Wiltse with the conventional posterior approach for single-segment spinal tuberculosis/infections.
Spinal infections (such as spondylitis, discitis, and spondylodiscitis) are therapeutically challenging owing to their pathophysiological complexities and delayed diagnosis, particularly in developing countries. Despite treatment advancements, challenges persist, which include multidrug resistance and surgery-related complications.
A retrospective analysis of 102 patients who underwent single-segment spinal tuberculosis surgery was conducted to compare patients who underwent surgery using the conventional posterior with those using the modified Wiltse approach. The key parameters analyzed included surgical duration, blood loss, complication rates, intensive care unit stay, deformity correction, and neurological improvement.
The modified Wiltse group exhibited lower intraoperative hemorrhage (184.72 mL vs. 365.91 mL, p<0.05) without significant differences in surgery duration and other tested outcomes. Both groups demonstrated significant improvement in thoracic kyphosis over time (p<0.01) and between the groups, with pairwise comparisons showing significant improvement from preoperative to postoperative and from preoperative to follow-up (p<0.01) but not from postoperative to follow-up, demonstrating postoperative kyphotic stability. Significant improvements in lumbar lordosis (p=0.047) and within the groups (p=0.002) were observed over time; however, pairwise comparisons did not reveal significant differences (p >0.05), demonstrating surgical intervention that focused on lordotic stability rather than correction in both groups. Significant neurological improvements were also observed, with the modified Wiltse group demonstrating superior recovery to the conventional posterior group from baseline.
The modified Wiltse approach offers a promising alternative to conventional techniques by reducing intraoperative blood loss while maintaining efficacy in deformity correction and neurological recovery. It is a viable option for patients who require reduced invasiveness and blood loss.
回顾性研究。
比较改良Wiltse入路与传统后路入路治疗单节段脊柱结核/感染的效果。
脊柱感染（如脊柱炎、椎间盘炎和脊椎椎间盘炎）因其病理生理复杂性和诊断延迟，在治疗上具有挑战性，尤其是在发展中国家。尽管治疗取得了进展，但挑战依然存在，包括多药耐药和手术相关并发症。
对102例行单节段脊柱结核手术的患者进行回顾性分析，比较采用传统后路手术的患者和采用改良Wiltse入路手术的患者。分析的关键参数包括手术时间、失血量、并发症发生率、重症监护病房停留时间、畸形矫正和神经功能改善情况。
改良Wiltse组术中出血较少（184.72 mL对365.91 mL，p<0.05），手术时间和其他测试结果无显著差异。两组患者随着时间的推移胸段后凸畸形均有显著改善（p<0.01），且组间比较也有显著改善，两两比较显示术前至术后以及术前至随访均有显著改善（p<0.01），但术后至随访无显著改善，表明术后后凸畸形稳定。随着时间的推移，腰椎前凸有显著改善（p=0.047）且组内也有显著改善（p=0.002）；然而，两两比较未发现显著差异（p>0.05），表明两组手术均侧重于前凸稳定性而非矫正。神经功能也有显著改善，改良Wiltse组从基线开始的恢复情况优于传统后路组。
改良Wiltse入路通过减少术中失血，同时保持畸形矫正和神经功能恢复的疗效，为传统技术提供了一种有前景的替代方法。对于需要减少侵袭性和失血量的患者来说，这是一个可行的选择。
