Objective: The Wiltse approach ligamentotaxis (WALT) is a combination of paravertebral muscle natural gap access and posterior longitudinal ligament tension, which can achieve good fracture repositioning and indirect spinal canal decompression, thus avoiding the disadvantages of traditional posterior direct decompression approach. This paper provides a detailed explanation and analysis of WALT through clinical cases. Methods: 103 patients with thoracolumbar vertebral fractures classified as

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... surgically treated with the spinal screw bar system from 2017.01 to 2020.06 were included, of whom 52 were performed with indirect decompression and repositioning of the spinal canal by the WALT method (hereafter referred to as the Wiltse group) and 51 were performed with direct decompression and repositioning of the spinal canal by traditional posterior direct decompression approach (hereafter referred to as the traditional group), and the results were compared by operating time, bleeding, incision length, preoperative and postoperative changes in relative vertebral body height and Cobb angle, preoperative and postoperative Visual analogue scores (VAS) and Frankel scores, postoperative Oswestry disability index (ODI), postoperative drainage flow, postoperative time to remove drainage devices, and postoperative hospitalization days to compare the surgical results of fractures in the two groups. Results: The Wiltse group had an operative time of 76.5(65-110) min, bleeding volume of 90(50-180) ml, incision length of 9.4(7.8-11.3) cm, postoperative drainage of 97.4 ± 34.7 ml, postoperative drainage removal time of 2(1-4) days, postoperative hospitalization of 4(3-6) days, VAS score of 0(0-1) for 1 year postoperatively and ODI score 5(2-8) for 1 year postoperatively. In the traditional approach group, the operative time was 120(90-145) min, bleeding volume was 190(140-300) ml, incision length was 16.5(14.0-18.5) cm, postoperative drainage flow was 181.7 ± 41.0 ml, postoperative drainage removal time was 4(2-6) days, and postoperative hospital stay was 6(3-8) days. days, VAS score 1(1-2) 1 year postoperatively, ODI score 6(3-10) 1 year postoperatively. The differences were significant in both groups (P < 0.05). There were no statistically significant differences in changes of vertebral height, Cobb Angle and Frankel score 1 year postoperatively (P > 0.05). Conclusion: The Wiltse approach reveals the vertebral pedicle and vertebral body through the paravertebral muscle gap separation without stripping the paravertebral muscle from the lamina and without removing and destroying bony structures such as the lamina, thus reducing the operative time and bleeding and avoiding the medically induced injuries caused by traditional surgery. This approach combined with the ligament tension repositioning method for indirect decompression and repositioning of the spinal screw bar system can achieve the same effectiveness as traditional surgery, which is a minimally invasive surgical method that can replace most traditional surgeries and is worth studying and promoting.