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Comparison of pedicle fixation by the Wiltse approach and the conventional posterior open approach for thoracolumbar fractures, using MRI, histological and electrophysiological analyses of the multifidus muscle

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Abstract

Purpose

To use imaging, histology and electrophysiological assessment to compare the Wiltse approach to pedicle fixation with the conventional posterior open approach for thoracolumbar fractures.

Methods

We analyzed clinical and histopathological information of consecutive patients with thoracolumbar fractures who underwent short-segment pedicle fixation using either the Wiltse approach or the posterior open approach. Seventy-five patients were enrolled between June 2010 and August 2014 (Wiltse group 35 cases; posterior open group 40 cases). The two groups were compared for MRI appearance, histological and electrophysiological changes in multifidus muscle.

Results

On MRI, multifidus cross-sectional area (CSA) in the Wiltse group decreased by only 7.6% between pre-op and the last follow-up, compared to 35.4% in the posterior open group, and less fatty infiltration was found in the Wiltse group. Histologically, post-op (removal of internal fixation) tissue from the posterior open group showed disordered myofibrils, with diameter and CSA decreased by 11.6 and 24.3%, respectively; also, the myofibril gap became larger with fat deposition and scar formation. The Wiltse group had no such significant changes. Electrophysiologically, in the posterior open group, median frequency slope (MFs) significantly increased by 67.6% with average amplitude (AA) significantly decreased by 17.5% between pre-op and 12 months post-op. No significant changes were found in the Wiltse group. At 12 months post-op, AA was significantly lower and MFs was higher in the posterior open group than the Wiltse group.

Conclusion

The Wiltse approach showed a lower incidence of multifidus atrophy and denervation, and less fatty infiltration. It is an effective and minimally invasive approach for thoracolumbar fractures.

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Acknowledgements

The authors wish to express their gratitude to Prof. Michael Adams and Dr. Patricia Dolan for help with the manuscript.

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    Authors and Affiliations

    1. Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, People’s Republic of China

      Liu Junhui, Xu Wenbin, Hao Lu, Li Shengyun, Fan Shunwu & Zhao Fengdong

    2. Department of Orthopaedics, County People’s Hospital of Tiantai, Taizhou, People’s Republic of China

      Pang Zhengbao

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    1. Liu Junhui
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    2. Pang Zhengbao
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    3. Xu Wenbin
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    Correspondence to Zhao Fengdong.

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    The authors declare that they have no conflict of interest.

    Funding

    National Natural Science Foundation of China (project number: 31270997); Zhejiang Medical and Health Science and Technology project: (project number: 2016136915, 2013KYA2334).

    Additional information

    L. Junhui, P. Zhengbao and X. Wenbin contributed equally to this paper and should be considered co-first authors.

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    Junhui, L., Zhengbao, P., Wenbin, X. et al. Comparison of pedicle fixation by the Wiltse approach and the conventional posterior open approach for thoracolumbar fractures, using MRI, histological and electrophysiological analyses of the multifidus muscle. Eur Spine J 26, 1506–1514 (2017). https://doi.org/10.1007/s00586-017-5010-1

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    • DOI: https://doi.org/10.1007/s00586-017-5010-1

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