Modified Wiltse approach versus conventional posterior approach for treating single-segment spinal tuberculosis and infections: a retrospective study of 102 cases in Guangxi Province, China.

Abstract

Study design: Retrospective study.

Purpose: To compare the modified Wiltse with the conventional posterior approach for single-segment spinal tuberculosis/infections.

Overview of literature: 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.

Methods: 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.

Results: 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.

Conclusions: 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.