Comparison of the clinical efficacy of the Wiltse paraspinal approach and O-arm navigation for the treatment of thoracolumbar fractures

Background: To evaluate the clinical efficacy of the Wiltse paraspinal approach and percutaneous pedicle screw placement under O-arm navigation for the treatment of thoracolumbar fracture.Methods: We enrolled a total of 54 patients with neurologically intact thoracolumbar fracture who received minimally invasive treatment. Among these, 28 patients were treated with pedicle screw fixation through the Wiltse paraspinal approach (WPSF), and another 26 were received percutaneous pedicle screw fixation under O-arm navigation (OPSF). Statistical methods were used to perform a detailed comparison of clinical outcomes, radiologic findings and complications between the two groups obtained preoperatively, postoperatively and at last follow-up.Results: There were no significant differences between the two groups in terms of the intraoperative bleeding, length of incision, postoperative hospitalization durations or accuracy rate of pedicle screw placement (p>0.05). Visual analog scale (VAS) scores, Oswestry disability in­dex (ODI) scores, local Cobb angle (LCA), vertebral wedge angle (VWA) and R value were notably improved after surgery, though no clear discrepancy between the groups at each time point (p>0.05). However, the OPSF group had a longer operation time and greater surgical expenditure than the WPSF group (p<0.05).Conclusions: Both WPSF and OPSF were safe and effective for the treatment of thoracolumbar fracture. Although the two groups showed favorable clinical and radiologic outcomes through the final follow-up, we recommended the minimally invasive WPSF given its lower duration of surgery and medical costs. A randomized controlled study of high-quality and with a larger sample size is required to comfirm our findings in the future.