Anatomical study of the paraspinal approach to the lumbar spine

被引:85
作者
Vialle, R
Court, C
Khouri, N
Olivier, E
Miladi, L
Tassin, JL
Defives, T
Dubousset, J
机构
[1] Assistance Publ Hop Paris, Ecole Chirurg, F-75005 Paris, France
[2] Fdn Hop St Joseph, Serv Chirurg Orthoped & Pediat, F-75647 Paris, France
[3] Kremlin Bicetre Hop, Serv Chirurg Orthoped, F-94275 Le Kremlin Bicetre, France
[4] Ctr Hosp Univ, Serv Chirurg Orthoped, F-76000 Rouen, France
[5] Hop St Vincent de Paul, Serv Chirurg Orthoped Pediat, F-75014 Paris, France
[6] Hop Belle Isle, F-57000 Metz, France
关键词
paraspinal approach; lumbar spine; lumbosacral spondylolisthesis; sacrospinalis muscle; minimally invasive approach;
D O I
10.1007/s00586-004-0802-5
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:366 / 371
页数:6
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