Clinical Impact of Muscle-Sparing Wiltse Transforaminal Lumbar Interbody and Fusion

The Wiltse incision represents a significant advancement in minimally invasive spine surgery. This muscle-sparing paramedian approach was first described in 1968 and allows pathologies traditionally treated with open lumbar fusion or decompression to be addressed in a manner that minimizes iatrogenic tissue damage and instability. When compared to open techniques, adoption of the Wiltse approach has led to several improvements in clinical outcomes. Patients may experience reduced postoperative pain, decreased narcotic use, shorter length of stay (LOS), and lower rates of surgical site infection (SSI) and adjacent segment disease. Economic analyses also suggest greater cost savings with this approach. However, the learning curve associated with this incision has been linked to potentially increased risk of iatrogenic complications and prolonged surgical duration. The foundational principles established by Dr. Wiltse helped lay the groundwork for minimally invasive spinal surgery and have been associated with numerous benefits for patients, surgeons, and hospitals.