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BACKGROUND

Traditional midline microdiscectomy risks paraspinal muscle devascularization/denervation, particularly of the multifidus. We evaluated a standardized lateral-to-spinous Wiltse-interval tubular microdiscectomy (ULTRA, fixed 10-mm tube) designed to minimize muscle injury while maintaining microscopic control. We report 30-day safety and early functional outcomes from an 8-year, single-surgeon series.

METHODS

We performed a retrospective analysis of a prospectively maintained, single-center registry of consecutive single-level lumbar discectomies (L2-L3 to L5-S1) undertaken from January 2017 to May 2024 using a fixed 10-mm tubular retractor through the lateral-to-spinous Wiltse corridor under microscopy. Primary endpoints were 30-day complications, readmissions, and reoperations; secondary endpoints included operative time, length of stay, same-day discharge, and change in Oswestry Disability Index (ODI). The study was Institutional Review Board approved, and consent was waived.

RESULTS

A total of 973 procedures were analyzed (mean age 49 ± 12 years; 54.5% men; body mass index ≥30 kg/m² in 24.2%; 29.6% smokers; 6.8% diabetes). Mean operative time was 18 ± 5 minutes; 96.3% finished in <30 minutes. Same-day discharge occurred in 99.8% (971/973). Intraoperative dural tear occurred in 7.3% (71/973) and was primarily repaired; postoperative cerebrospinal fluid fistula occurred in 0.7% (7/973). No surgical site infections or epidural hematomas were observed. The 30-day readmission rate was 0.7% (7/973), and reoperation for recurrent herniation was 0.3% (3/973). Mean ODI improved from 74 ± 9 preoperatively to 18 ± 7 at 30 days (Δ56, P < 0.001). Unadjusted ODI at 30 days did not differ between patients with or without complications (P = 0.709); in adjusted models, any complication was associated with a modestly smaller ΔODI (P = 0.033).

CONCLUSIONS

A 10-mm lateral-to-spinous (Wiltse) tubular approach enables rapid decompression with low early morbidity and large early functional gains. Properly repaired intraoperative dural tears did not worsen short-term outcomes.

CLINICAL RELEVANCE: Findings support routine outpatient use of a 10-mm Wiltse corridor for lumbar disc herniation and provide benchmark 30-day rates for counseling and quality assurance.