| Background:Minimal invasive approach is the surgical approachachieving the best surgical effect but lead to minimal trauma of the spine.Patients can acquire the fastest recovery of motor function, the biggestdifference is the minimal injury to the surrounding tissues of the lesion, whichbrings smaller interference to the internal environment and have smallerincision, better clinical outcomes, quicker recovery and better Psychologicaleffect. Surgery especially of the spine are the treatments at the cost of traumaand risk, and are not the preferred treatments to some kind of diseases, thus theminimal invasive techniques and skills should be stressed. Due to theapplication and wide-use of the advanced facilities such as C-Arm, CT, MRI,PET, DSA, and UR in the resent20years, the minimal invasive spinal surgeryhad step in to a new era. The surgeons can analysis and choose the approachesmore objectively and more comprehensively by using of the coronal, axial andsagittal images.Lumbar midline approach is one of the most commonly used approachesin the treatments of lumbar diseases and vertebral fractures. As the realizationof the importance of the posterior column of the spine, flat back deformity andobstinate low back pain following ischemic, atrophy and denervation of theparaspinal muscle due to the over extensive stripping and traction in thetraditional midline approach were rejected, which gave birth to series ofminimal invasive approaches of the lumbar spine. Surgery of the spine from thepost-lateral approach between sacrospinalis muscle and lumbar quadratemuscle was performed by Wiltse in1959, and was successfully applied in thepost-lateral lumbosacral fusion. Based on it, the paraspianl approach (Wilts approach) were put forward by Wiltse in1968, and was used in the surgicaltreatment of the extreme-lateral lumbar disc herniation through the space ofmultifidus muscle and longest muscle. Later, gave thought to the cosmeticproblems and reducing the difficulty of re-operation, Wilts recommendedstripping to the bilateral muscle pace through a single midline incision in1988.All the exposure were carried out between the inter-muscle gaps in theparaspinal muscle space approach, the attachment points of the paraspinalmuscle and the intact of the multifidus muscle were retained. which brings littleinterference to the function and earlier exercise of the back muscles, shorterbed-stay time. Precise striping between the muscles ensured the operation wascarried out on the non-vascular interface, which reduce the amount of bleedingtremendously. Mean while, the articular process can be exposed directly in thisapproach, which brings convenience to the posterior pedicle fixation of thespine and shortened the operation time tremendously and had been recognizedby more and more spine surgeons.Objective: To define the exact location of the gap between multifidusmuscle and longest muscle of each segment of the lumbar spine by analysis andmeasurement of the distance between paraspinal muscle gap and midline overthe cross section of the disc from L1to S1, and provide references for thesurgical approach.Method:200Patients collected randomly who were suffering fromlumbar spinal diseases were included, of which100are male, the other100arefemale. Retrospective study were performed to their MRI scan. Distance fromthe gap of multifidus muscle and longest muscle to the midline over the crosssection of the disc from L1to S1were measured bilaterally. Age, gender,weight and height of the200patients were recorded and analysed statisticallywith the location of the gap to find out if there was any correlation betweenthem. Results: Huge deference were found among the results of the distancefrom the gap of multifidus muscle and longest muscle to the midline due todifferent cross section of discs (P<0.05). The mean distance from the musclegap to the midline at the level of L5-S1was33.56±3.97mm, and L4-529.85±3.45mm, L3–424.97±2.96mm, L2–319.91±2.38mm, L1–216.17±1.87mm respectively.Conclusion: There was significant difference among the distancesbetween the muscle gap and midline of different lumbar spinal segments. Thedistances increased gradually from L1to S1. At each segment of L1-2, L2-3,L3-4, distance of the male patients had an everage of1mm more than that ofthe female patients, but it was not obvious at the segments of L4-5, L5-S1. Norelationship was found between the distance and age, weight and height. Thestudy provided valuable references to the precise usage of paraspinal approachfor spine surgeons in the lumbar spine surgery. |
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