Applied Anatomical And Clinical Application Of Witlse Approach For Lumbar Posterior Intervertebral Fusion

Applied Anatomical and Clinical Application of Witlse Approach for Posterior Lumbar Fusion.Partâ… :Applied Anatomy of the Wiltse Approach To the Lumbar Spine.1.Objectives: To study the relevant surgical anatomy for the Wiltse approach to the lumbar spine.2. Methods: 10 adult cadaver speciments were applied in the anatomy study, incising the thoracolumbar skin along the posterior median line,exposing the musculus multifidus , observing the superspinal and interspinal multifidus.3. Results: The mean distance between the level of the cleavage plane and the midline was 2.5-3.0cm.Multifidus is profundal to thoracolumbar fascia ,enthesis is from doral sacrum and mastoif of L5-L1and transvers process to bilateral tuber of spinous process ,part of tendor connected with interspinal ligment. Musculus multifidus mainly keep lumbarsacral spine arcustion and afford lumbar dynamics,which is an important factor in keeping spine stability .Measuring follow : L3-L4,L4-L5,L5-S1 intervertebral-gap points and the outer edge of a small facet, the most outer edge of the multifidus muscle and multifidus to the confluence with the lamina after the midline distance ,fluctuations in the value of the three 2.5-3.0cm.4. Conclusions: Special anatomical structure of Multifidus and Longissimus makes the smooth muscle gap blunt dissection which can be exposed to facet and transverse process. The mean distance between the level of the cleavage plane and the midline is about 2.5-3.0 cm. Knowing well about the anatomical feature of multifidus muscle bundles and the neurovascular bundle could reduce injury multifidus during posterior lumbar fusion process .Partâ…¡: Clinical Application of minimally invasive Witlse Approach for Lumbar Posterior Intervertebral Fusion1.Objectives: To comparison the technique for PLIF by Wilitse approach and the traditional midline approach the clinical outcomes.2. Methods: According to inclusion and exclusion criteria,we reviewed 20pations who umderwent PIF. 12 patients ,8 male and 4 female with ages from 32 to 61(average 48.8),underwent Wiltse approach.10patients randomly choosed in the control group .They were 8 male and 2 female with ages from 39 to 58(average 50.5).The operative duration and blood loss were evaluated. More than 1year all the patients were followed up with VAS scores and Oswestry disability questionnaire. All the patients accepted MRI evaluation by comparison the cross section area at the operative level pre-operation with post operation.3. Results: There was less operative time,blood loss,lower index of serum level of crestinine kinase in Wiltse approach.Nearly all the patients in traditional group had the complication of back pain,there were no or only little pain in Wiltse approach group.There was significant decrease in the cross sectional area of multifidus muscle in the traditional group.In contrast,the results in the Wiltse approach group showed no statistical difference between preoperative results and that of the follow-up MRI.4. Conclusions: Wiltse approach caused less paraspinal muscle damdge than traditional approach, and had positive efforts on less back pain. Wiltse approach learning curve is short, with a simple micro-hooks and other minimally invasive surgical instruments relative to the expansion chamber is more easily replicable.