A comparison of hidden blood loss between the Wiltse approach with pedicle screw fixation and the percutaneous pedicle screw fixation for neurologically intact thoracolumbar fractures
Ding Hu1
, Yu He1, Yin-xiao Peng2, Shanchuan Wei3
1Department of Spine Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
2Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, China
3Department of Joint and Traumatology, People’s Hospital of ChangShou, Chongqing, China
Keywords: Hidden blood loss, minimally invasive surgery, percutaneous pedicle screw fixation, thoracolumbar fractures. Wiltse approach.
Abstract
Objectives: This study aims to quantify hidden blood loss (HBL) associated with minimally invasive pedicle screw placement and to compare HBL between the Wiltse approach and percutaneous pedicle screw techniques.
Patients and methods: Between January 2020 and December 2022, a total of 126 neurologically intact patients (63 males, 63 females; mean age: 43.0±11.5 years; range, 18 to 65 years) with single-segment traumatic thoracolumbar fractures who underwent surgery were retrospectively analyzed. The patients were categorized into two groups based on surgical technique: the study group (Wiltse approach) and control group (percutaneous pedicle screw). Demographic and clinical data were collected. Perioperative laboratory values were recorded, and HBL was calculated using a combination of the Nadler, Gross, and Sehat formulas.
Results: The Wiltse approach group demonstrated a significantly shorter surgical time and fewer intraoperative fluoroscopy uses compared to the percutaneous group (p<0.001 for both). Although intraoperative visible blood loss (VBL) was higher in the Wiltse group (p<0.001), this group showed a smaller postoperative hemoglobin loss (p=0.025) and significantly less HBL in absolute volume (p=0.031).
Conclusion: In minimally invasive surgery for single-segment thoracolumbar fractures, perioperative HBL considerably exceeds VBL. Compared to the Wiltse approach, percutaneous pedicle screw fixation is associated with longer operation time, greater radiation exposure, and higher HBL. Therefore, spine surgeons should emphasize close monitoring of postoperative hemoglobin and appropriate management of anemia in patients undergoing percutaneous instrumentation.
Citation: Hu D, He Y, Peng YX, Wei S. A comparison of hidden blood loss between the Wiltse approach with pedicle screw fixation and the percutaneous pedicle screw fixation for neurologically intact thoracolumbar fractures. Jt Dis Relat Surg 2026;37(x):i-viii. doi: 10.52312/jdrs.2026.2556.