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European Spine Journal

, Volume 14, Issue 4, pp 366–371 | Cite as

Anatomical study of the paraspinal approach to the lumbar spine

  • Raphaël VialleEmail author
  • C. Court
  • N. Khouri
  • E. Olivier
  • L. Miladi
  • J. L. Tassin
  • T. Defives
  • J. Dubousset
Original Article

Abstract

The original description of the paraspinal posterior approach to the lumbar spine was for spinal fusion, especially regarding lumbosacral spondylolisthesis treatment. In spite of the technical details described by Wiltse, exact location of the area where the sacrospinalis muscle has to be split remains somewhat unclear. The goal of this study was to provide topographic landmarks to facilitate this surgical approach. Thirty cadavers were dissected in order to precisely describe the anatomy of the trans-muscular paraspinal approach. The level of the natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle was noted and measurements were done between this level and the midline at the level of the spinous process of L4. A natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle was present in all cases. There was a fibrous separation between the two muscular parts in 55 out of 60 cases. The mean distance between the level of the cleavage plane and the midline was 4 cm (2.4–5.5 cm). In all cases, small arteries and veins were present, precisely at the level of the cleavage plane. We found it possible to easily localize the anatomical cleavage plane between the multifidus part and the longissimus part of the sacrospinalis muscle. First the superficial muscular fascia is opened near the midline, exposing the posterior aspect of the sacrospinalis muscle. Then, the location of the muscular cleft can be found by identifying the perforating vessels leaving the anatomical inter-muscular space.

Keywords

Paraspinal approach Lumbar spine Lumbosacral spondylolisthesis Sacrospinalis muscle Minimally invasive approach 

Notes

This study benefited from the financial support of the Société Française de Chirurgie Orthopédique et Traumatologique and the Fondation pour la Recherche Médicale

References

  1. 1.
    Dubousset J (1997) Treatment of spondylolysis and spondylolisthesis in children and adolescents. Clin Orthop 77–85Google Scholar
  2. 2.
    Ray CD (1987) The paralateral approach to decompression for lateral stenosis and far lateral lesions of the lumbar spine. In: Watkins, Collis (eds) Lumbar discectomy and laminectomy. Aspen pp 217–227Google Scholar
  3. 3.
    Watkins MB (1959) Posterolateral bonegrafting for fusion of the lumbar and lumbosacral spine. J Bone Joint Surg Am 41:388–396Google Scholar
  4. 4.
    Watkins MB (1964) Posterolateral fusion in pseudarthrosis and posterior element defects of the lumbosacral spine. Clin Orthop 35:80–85PubMedGoogle Scholar
  5. 5.
    Wiltse LL, Hutchinson RH (1964) Surgical treatment of spondylolisthesis. Clin Orthop 35:116–135PubMedGoogle Scholar
  6. 6.
    Wiltse LL (1973) The paraspinal sacrospinalis-splitting approach to the lumbar spine. Clin Orthop 91:48–57PubMedGoogle Scholar
  7. 7.
    Wiltse LL (1977) Surgery for intervertebral disk disease of the lumbar spine. Clin Orthop 22–45Google Scholar
  8. 8.
    Wiltse LL, Spencer CW (1988) New uses and refinements of the paraspinal approach to the lumbar spine. Spine 13:696–706PubMedGoogle Scholar
  9. 9.
    Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE (1968) The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 50:919–926PubMedGoogle Scholar
  10. 10.
    Wiltse LL, Guyer RD, Spencer CW, Glenn WV, Porter IS (1984) Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. Spine 9:31–41PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Raphaël Vialle
    • 1
    • 2
    • 7
    Email author
  • C. Court
    • 3
  • N. Khouri
    • 2
  • E. Olivier
    • 4
  • L. Miladi
    • 5
  • J. L. Tassin
    • 6
  • T. Defives
    • 4
  • J. Dubousset
    • 5
  1. 1.Ecole de Chirurgie de l’Assistance Publique des Hopitaux de ParisParisFrance
  2. 2.Service de Chirurgie Orthopédique et PédiatriqueFondation Hôpital Saint JosephParis Cedex 14France
  3. 3.Service de Chirurgie OrthopédiqueKremlin-Bicêtre HôpitalLe Kremlin-BicêtreFrance
  4. 4.Service de Chirurgie OrthopédiqueCentre Hospitalier UniversitaireRouenFrance
  5. 5.Service de Chirurgie Orthopédique PédiatriqueSaint-Vincent de Paul HospitalParisFrance
  6. 6.Hôpital Belle-Isle. 2 r Belle IsleMetzFrance
  7. 7.Boulogne BillancourtFrance

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