Posterior Approach to the Lumbar Spine

Published on 02/04/2015 by admin

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Last modified 02/04/2015

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Chapter 28 Posterior Approach to the Lumbar Spine

MUSCULAR STRUCTURES FOR POSTERIOR APPROACH IN L-SPINE

The muscle groups on the dorsal side of the lumbar spine are covered with thoracolumbar fascia. This fascia is the extension of the latissimus dorsi (LD) muscle (Fig. 28-1). Under the LD muscle fascia, the erector spinae muscle groups are located. They are longitudinally arranged with medial, middle, and lateral components (Fig. 28-2). At the upper lumbar level, the serratus posterior inferior muscle is arrayed from the horizontal direction.

Medial component of erector spinae muscle group is multifidus muscle, middle component longissimus muscle and lateral component iliocostalis muscle:

There are cleavage planes between these three groups of muscles. The dissection can be performed more easily between the multifidus muscle and the longissimus muscle than between the longissimus muscle and the iliocostalis muscle (Fig. 28-3).

DEVELOPING THE PLANE DURING MUSCLE DISSECTION

A natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle is present in most of the operated cases. There is a fibrous separation between the two muscular parts. The mean distance between the level of the cleavage plane and the midline was 4 cm (2.4–5.5 cm).1 Small arteries and veins were present, precisely at the level of the cleavage plane. For the dissection between multifidus and longissimus, first, the superficial muscular fascia is opened near the midline, exposing the posterior aspect of the sacrospinalis muscle. Next, the location of the muscular cleft can be found by identifying the perforating vessels leaving the anatomical intermuscular space. The muscular plane can be confirmed with fat tissue. Further dissection leads to the pedicle. The multifidus muscle volume becomes wider from the upper lumbar level to the lumbosacral junction (Figs. 28-4 and 28-5).