Abstract
BackgroundRecognition of the intermuscular spaces within lumbar paraspinal muscles is critically important for using the paramedian muscle-splitting approach to the lumbar spine. As such, it is important to determine the intermuscular spaces within the lumbar paraspinal muscles by utilizing modern medical imaging such as computed tomography (CT) and magnetic resonance imaging (MRI).MethodsA total of 30 adult cadavers were studied by sectional anatomic dissection, and 60 patients were examined using CT (16 slices, 3-mm thickness, 3-mm intersection gap, n = 30) and MRI (3.0T, T2-WI, 5-mm thickness, 1-mm intersection gap, n = 30). The distances between the midline and the superficial points of the intermuscular spaces at different intervertebral disc levels were measured.ResultsBased on study of our cadavers, the mean distances from the midline to the intermuscular space between multifidus and longissimus, from intervertebral disc levels L1–L2 to L5–S1, were 0.9, 1.1, 1.7, 3.0, and 3.5 cm, respectively. Compared with the upper levels (L1–L3), the superficial location at the lower level (L4–S1) is more laterally to the midline (P<0.05). The intermuscular space between sacrospinalis and quadratus lumborum, and that between longissimus and iliocostalis did not exist at L4–S1. The intermuscular spaces in patients also varied at different levels of the lumbar spine showing a low discontinuous density in CT and a high signal in MRI. There were no significant differences between the observations in cadavers and those made using CT and MRI.ConclusionThe intermuscular spaces within the paraspinal muscles vary at different intervertebral disc levels. Preoperative CT and MRI can facilitate selection of the muscle-splitting approach to the lumbar spine. This paper demonstrates the efficacy of medical imaging techniques in surgical planning.
Highlights
Contrasting to open surgery, minimally invasive posterior approaches to the lumbar spine have a major advantage of limiting iatrogenic trauma to surrounding structures, thereby reducing postoperative pain, facilitating patient recovery and shortening hospital stay
The intermuscular space between sacrospinalis and quadratus lumborum, and that between longissimus and iliocostalis did not exist at L4–S1
There were no significant differences between the observations in cadavers and those made using computed tomography (CT) and magnetic resonance imaging (MRI)
Summary
Contrasting to open surgery, minimally invasive posterior approaches to the lumbar spine have a major advantage of limiting iatrogenic trauma to surrounding structures, thereby reducing postoperative pain, facilitating patient recovery and shortening hospital stay. Paraspinal approaches allow access to the transverse processes and facets of the lumbar spine, and have been utilized in a variety of surgical procedures used in the management of various spinal pathologies. This includes discectomy for disc herniation, decompression for spinal canal stenosis, insertion of pedicle screws for fractures, lumbar interbody fusions, and treatment of intradural lesions such as tumors [1,2,3,4,5,6,7,8,9,10,11]. Recognition of the intermuscular spaces within the paraspinal muscles is critically important for the paramedian muscle-splitting approach to the lumbar spine. Recognition of the intermuscular spaces within lumbar paraspinal muscles is critically important for using the paramedian muscle-splitting approach to the lumbar spine. It is important to determine the intermuscular spaces within the lumbar paraspinal muscles by utilizing modern medical imaging such as computed tomography (CT) and magnetic resonance imaging (MRI)
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