Anatomical Study And Clinical Application Of The Paraspinal Approach To The Lumbar Spine

Objectives:To explore the advantages and indications of the paraspinal (Wiltse) approach by anatomical study and clinical application.Methods:Through the anatomical data and clinical practice to describe the accurate position of the muscles and surrounding tissues, as well as the results of clinical application of paraspinal approach.28cases by traditional approach, 10cases of lumbar stenosis ,18cases of thoracolumbar fracture.24 cases by Wiltse approach 8cases of lumbar stenosis ,16 cases of thoracolumbar fracture To compare with traditional approach by op time, blood loss,incision length, JOA score,radiography result(Cobb's angle,height of anterior edge of the vertebrae).Results:Completely exposure of the facet and transverse process could be easily perfomed by identifying natural cleavage plane between the multifidus and longissimus muscles. The muscular cleft was (1.9±0.7) cm lateral to the midline for female, and (2.1±0.6)cm for male at T12 level. The distance was(3.3±0.6)cm lateral to the midline for female, and (3.7±1.0)cm for male at L4 level. To compare with traditional approach, the operation time, blood loss and incision length have apparently difference in statistics (P<0.05) and the radiography result (Cobb's angle, height of anterior edge of the vatebrae) has no difference in paraspinal approach (P>0.05).Conclusions:The paraspinal approach is performed through natural cleavage plane between the multifidus and longissimus muscles. Without wide muscular disinsertions and leavingthe supraspinous and interspinous ligaments intact, the approach is easy and allows reaching the articular and transverse processes, providing a clear surgical field for the placement of pedicle screws.It can be widely used on thoracolumbar spine surgery.