Outcome of Modified Wiltse Paramedian Approach For Fusion Of Single Level Lower Lumbar Spinal Instability
In one way, conventional open posterior midline approach for pedicle screws fixation for lower lumbar pathology is usually associated with significant para spinal muscle damage and mobility and in other way , recently used minimally invasive percutaneous pedicle screw fixation techniques have higher radiation exposure . Thus in midway between two Modified Wiltse paramedian approach may still provide the muscle sparing with minimal morbidity and radiation safety. We retrospectively evaluated the outcome of 12 patients of single level of lumbar instability at L4-L5 or at L5-S1 which included 2 patients with L5 vertebral body burst fracture, 6 patients with L4L5 ishthmic spondylolisthesis and 4 patients with L5S1 Ishthmic spondylolisthesis. There were 4 male patients and 8 female patients with age range from 16 years to 45 years ( mean age of 34.6 years). The procedure was completed with less than 150 ml estimated blood loss. The average C arm exposure was 10.5.The average length of post operative stay was 3.5 days. There was no intraoperative neurological complications. Stitches were removed at 14th postoperative day and followed monthly for three months and 3 monthly upto 1 year . The mean preoperative VAS score ( 8.3) improved to the mean postoperative VAS score (3.2) in 3rd post op day and 1.2 by 1 year with no use of analgesic medications.
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