How to perform the Wiltse posterolateral spinal approach: Technical note

Area of Science:

• Spine surgery
• Minimally Invasive Surgery (MIS)

Background:

• The Wiltse approach, also known as the paraspinal or posterolateral approach, is a long-standing technique that aligns with minimally invasive surgery (MIS) principles.
• This study aims to detail the Wiltse paraspinal approach using existing literature and analyze its advantages and limitations.

Purpose of the Study:

• To provide a comprehensive, step-by-step description of the Wiltse paraspinal approach for lumbar spine surgery.
• To analyze the primary benefits and drawbacks of this muscle-sparing surgical technique.

Main Methods:

• A literature review was conducted using PubMed and Lilacs.
• Search terms included "Wiltse approach," "paraspinal approach," "muscle sparing approach," and "lumbar spine."
• Ten relevant papers were synthesized to detail the surgical steps from preparation to closure.

Main Results:

• The Wiltse approach is predominantly characterized by its minimally invasive nature.
• Key advantages identified include minimal intraoperative bleeding, reduced hospital length of stay, and a low rate of surgical site infections.

Conclusions:

• The Wiltse approach is fundamentally a minimally invasive technique that preserves muscle planes and soft tissues.
• It facilitates extensive far lateral lumbar decompression, discectomy, and fusion with a low overall complication rate.