A modification of the standard midline posterior approach to the intertransverse area of the lumbar spine

Abstract

A midline approach to the lumbar region is most frequently used for posterior lumbar spine surgery. The exposure of the deeper layer of muscles, however, is imprecise and can entail substantial tissue damage and blood loss. During 10 years of operative surgical experience, we have developed an improved and less traumatic technique for exposure of the lumbar transverse processes and intertransverse region in which the tendons of multifidus and longissimus muscles are isolated at every level and divided laterally to the facet joints. This method eases identification and accurate cauterisation of the subjacent arteries, thereby reducing tissue damage and blood loss. It takes no more time and clarifies the exposure of the lumbar transverse processes and intertransverse region. Cadaveric dissection confirms the muscular and arterial anatomy of the region. We recommend use of this modified approach to improve standard practice.