Study On The Effect Of Wiltse Approach And Posterior Median Approach On Paraspinal Muscles In The Treatment Of Lumbar Spinal Stenosis

Objective: To explore the effect of Wiltse approach and posterior median approach on paravertebral muscles in the treatment of patients with lumbar spinal stenosis.Methods: From January 2021 to November 2022,A total of 58 patients with lumbar spinal stenosis were selected and divided into two groups: posterior median approach lumbar interbody fusion group(TOPA group)(n=35 cases)and Wiltse approach lumbar interbody fusion group(Wiltse group)(n=23 cases).At the time of preoperative and the first and third months after surgery,the pain degree of the lumbar spine(VAS-LBP)and the leg(VAS-LP)were evaluated by visual analogue scale(VAS),and the recovery of lumbar spine function was evaluated by the modified Oswestry dysfunction index(ODI).In addition,surface electromyography(s EMG)was used to detect the patient ’s paravertebral muscles before and 3months after surgery.The root mean square(RMS)and median frequency(MF)values on the surface electromyography were recorded to analyze the patient ’s muscle function during activity.Serum creatine kinase(CK)and C-reactive protein(CRP)were measured before and on the 1st,3rd and 7th day after surgery,so as to objectively and quantitatively evaluate the injury of muscle tissue caused by operation.Perioperative data such as operation time and hospitalization days were statistically analyzed.Results: 53 patients were followed up(32 patients in TOPA group and 21 patients in Wiltse group),and 5patients did not complete the follow-up(the rate of lost visits was 8.62%).The basic data of age,gender,mean body mass index(BMI),surgical responsibility segment and stenosis degree were basically the same between the two groups(P>0.05).After statistical analysis,The VAS-LBP,VAS-LP and modified ODI scores of all patients after surgery were significantly lower than those before surgery(P<0.05),The VAS-LBP and modified ODI scores measured after operation in Wiltse group were significantly lower than those in TOPA group(P<0.05),the VAS-LP scores of the two groups at 1 and 3 months after surgery were similar and there was no difference(P>0.05).During the s EMG test,1.The patients were standing still,and the preoperative RMS value of paravertebral muscles was basically the same between the two groups(P>0.05);The RMS value of TOPA after operation was significantly higher than that of Wiltse group(P<0.05).2.In the process of lifting and stretching,the RMS value of Wiltse group after surgery is much higher than that of TOPA group(P<0.05).3.The MF value of Wiltse group was significantly higher than that of TOPA group at 3 months after operation(P<0.05).The serum CK levels of the two groups on the first and third days after surgery were significantly higher than those before surgery(P<0.05);However,On the 7th day after operation,the serum CK levels of all patients decreased to the preoperative level(P>0.05),The serum CK levels of the Wiltse group on the 1st and 3rd day after operation were significantly lower than those of the TOPA group(P<0.05).In addition,on the 1 st,3 rd and 7 th day after operation,the CRP concentration levels of all patients were higher than those before surgery(P<0.05);Compared with of CRP in TOPA group was higher than that in Wiltse group at each time point after surgery(P<0.05).In the analysis of perioperative indicators,the amount of blood drained during surgery,the amount of blood drained after surgery and the time spent in hospital in TOPA group were much higher than those in Wiltse group(P<0.05),the operation duration between TOPA group and Wiltse group was basically the same(P>0.05).Conclusion: Both the Wiltse approach and the posterior median approach can provide satisfactory therapeutic effects.The Wiltse approach has the characteristics of reducing the injury of paravertebral muscles during operation,while the post-median approach is the opposite.The Wiltse approach retains the innervation of the paravertebral muscles and significantly reduces the degree of postoperative low back pain.The muscle contractility in the lifting test was significantly stronger than that in the TOPA group,and the fatigue resistance was significantly improved,thus significantly improving the pain symptoms and postoperative quality of life.In addition,s EMG technology is simple,non-invasive,and can dynamically monitor paravertebral muscle function,which is worthy of clinical application.