الفهرس 
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Abstract
Spondylolysis can range from a defect in the pars interarticularis to a fracture with separation and can be unilateral but is bilateral in 80% of symptomatic cases (38).
The most common location is L5 (85-95%) followed by L4 (5-15%) (23).
The pathological progression is a response usually to repetitive loads, which create a stress reaction in the pars, progressing to an incomplete stress fracture, and then a complete pars fracture. from that point, either normal healing and union will occur or there may a permanent inactive non-union filled in with fibrotic tissue. These early stages are apparent only with advanced imaging. (24).
Treatment of spondylolithesis has long been a topic of debate, as multiple modalities are currently utilized. For example, patients with a diagnosis of lumbar DS, 40% were treated with corticosteroid injections, 37% were treated with physical therapy, and only 22% were treated surgically (129).
When considering surgical treatment variations with data from the Spine Patient Outcomes Research Trial (SPORT), 7% were treated with decompression alone, 21% were treated with non-instrumented fusion, and 71% were treated with fusion surgery (71).
NASS guidelines state that surgical decompression may be considered for patients with low-grade DS and symptomatic spinal stenosis that is refractory to conservative therapies (22).
The paraspinal sacrospinalis splitting approach to the lumbar spine, first described by Leon Wiltse in 1968 (98) has become instrumental as a technique for surgery and for new innovations in spine surgery (130).
The Wiltse approach is now often used for numerous minimally invasive and open procedures such as: decompression, discectomy, resection of tumor, stabilization of fracture, and correction of deformity. Prior to the inception of the paraspinal approach, most lumbar procedures were tackled through a single midline incision. Wiltse argued instead for making two curved incisions approximately 45 mm on either side of midline and splitting the sacrospinalis muscle. These two incisions provide a more direct plane for decompression with less bleeding than a single midline incision (98,122).
Wiltse ultimately amended the indications for his approach in 1988, stating that a single midline incision is superior cosmetically and has fewer potential complications (97).
The aim of this study is to compare the clinical effects, intraoperative parameters and postoperative effects (ODI and VAS score) of Wiltse’s approach and conventional open in the treatment of single-segment lumbar degenerative disease via the prospective cohort study.
A total of 30 patients were enrolled from November 2018 to November 2019, including 15 patients in Wiltse’s approach and 15 patients in the conventional open. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores before operation, operation time, intraoperative blood loss, postoperative drainage volume, blood transfusion rates, postoperative hospital stays, intraoperative fluoroscopic time, VAS scores before operation, 3 days and 1 week after operation, and ODI and VAS scores in the last follow-up between the two groups were compared.
There were significant differences between the two groups in the operation time, intraoperative blood loss, postoperative drainage, blood transfusion rates, postoperative hospital stays and intraoperative fluoroscopic time; all indicators in Wiltse’s approach group were superior to those in conventional open group (p<0.05).