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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2018 | Technical note

Comparison of Wiltse’s paraspinal approach and open book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures: a randomized controlled trial

Authors: Zhi-da Chen, Jin Wu, Xiao-tao Yao, Tao-yi Cai, Wen-rong Zeng, Bin Lin

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

Posterior short-segment pedicle screw fixation is used to treat thoracolumbar burst fractures. However, no randomized controlled studies have compared the efficacy of the two approaches––the Wiltse’s paraspinal approach and open book laminectomy in the treatment of thoracolumbar burst fractures with greenstick lamina fractures.

Materials and methods

Patients with burst fractures of the thoracolumbar spine without neurological deficit were randomized to receive either the Wiltse’s paraspinal approach (group A, 24 patients) or open book laminectomy (group B, 23 patients). Patients were followed postoperatively for average of 27.4 months. Clinical and radiographic data of the two approaches were collected and compared.

Results

Our results showed the anterior segmental height, kyphotic angle, visual analog scale (VAS) score, and Smiley-Webster Scale (SWS) score significantly improved postoperatively in both groups, indicating that both the Wiltse’s paraspinal approach and open book laminectomy can effectively treat thoracolumbar burst fractures with greenstick lamina fractures. The Wiltse’s paraspinal approach was found to have significantly shorter operating time, less blood loss, and shorter length of hospital stay compared to open book laminectomy. However, there were two (2/24) patients in group A that had neurological deficits postoperatively and required a second exploratory operation. Dural tears and/or cauda equina entrapment were subsequently found in four patients in group B and all two patients of neurological deficits in group A during operation. No screw loosening, plate breakage, or other internal fixation failures were found at final follow-up.

Conclusions

The results demonstrated that either of the two surgical approaches can achieve satisfactory results in treating thoracolumbar burst fractures in patients with greenstick lamina fractures. However, if there is any clinical or radiographic suspicion of a dural tear and/or cauda equina entrapment pre-operation, patients should receive an open book laminectomy to avoid a second exploratory operation. More research is still needed to optimize clinical decision-making regarding surgical approach.

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Title: Comparison of Wiltse’s paraspinal approach and open book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures: a randomized controlled trial
Authors: Zhi-da Chen
Jin Wu
Xiao-tao Yao
Tao-yi Cai
Wen-rong Zeng
Bin Lin
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-0743-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of Wiltse’s paraspinal approach and open book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures: a randomized controlled trial

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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