Komplikationen dorsaler Zugänge zur Lendenwirbelsäule und deren Verhütung: Der submuskuläre Zugang

Abstract

The median posterior approach to the lumbar spine is likely to cause significant injury to the erector spinae muscle (ESM). This injury can be minimized by using the approach recommended by Ray. We have extended this approach to allow access to the disc space. The lumbar spine is exposed between the ESM and the deep lumbar fascia; the point of insertion for a pedicle screw is then exposed by simply lifting the ESM. The intervertebral foramen and posterior anulus fibrosus are then exposed, after which the foramen/ lateral recess are decompressed or an intervertebral implant (EPLIF) inserted from outside the foramen. There is less injury to the ESM with this method, and none of the posterior vertebral elements is destroyed, but it does need two approaches. 12 patients were treated with EPLIF at L3–S1, and 2 with dynamic pedicle fixation without EPLIF. After 1–2 years, results in all the patients treated by implantation of an EPLIF were very good to satisfactory, while those treated with dynamic pedicle fixation had unsatisfactory results. Complications caused by the stabilizing implants were pseudarthrosis (1 case) and radicular lesions/irritation (2 cases). Injury to the ESM can thus be minimized and posterior vertebral elements preserved by using this approach, giving it decisive advantages over the standard median approach, and it can therefore be recommended for certain indications.