APPLIED ANATOMICAL STUDY ON APPROACH NEXT TO ERECTOR SPINAE FOR SPINAL CANAL DECOMPRESSION THROUGH INTERVERTEBRAL FORAMEN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Xiyan , YAN Zhengjian , HUANG Fan , QIU Beiming , DENG Zhongliang.

Department of Orthopaedics, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China. Corresponding author: DENG Zhongliang, E-mail: deng7586@gmail.com;

Corresponding author：

Keywords：

Spine Erector spinae; Spinal canal decompression; Applied anatomy

DOI：

10.7507/1002-1892.20130096

Video：

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Objective To observe and measure the approach next to the erector spinae in the thoracic and lumbar segments of the spine and adjacent anatomical structures by the topographic method, to clarify the positioning method and safe range so as to provide the anatomical basis of the approach for spinal canal decompression. Methods Twelve formaldehyde-treated adult cadaver specimens were selected, including 6 males and 6 females with an average age of 43 years (range, 27-52 years) and with an average height of 166 cm (range, 154-177 cm). The related data of the approach at T1-S1 levels were respectively measured: the distance between the lateral edge of the erector spinae and the spinous process, the length of the approach, the angle between the approach and the horizontal plane, the size of intervertebral foramen, and the vertical distance between the segmental artery and the upper edge of the vertebrae. Results The distance between the lateral edge of the erector spinae and the spinous process ranged from (41.75 ± 3.29) mm to (74.54 ± 7.08) mm. The length of the approach ranged from (66.75 ± 10.81) mm to (97.13 ± 13.35) mm. The angle between the approach and the horizontal plane ranged from (38.38 ± 6.16)° to (53.67 ± 4.40)°. The vertical distance between the segmental artery and the upper edge of the vertebrae ranged from (9.50 ± 0.60) mm to (18.30 ± 1.56) mm. The size of foraminal was also measured. The spinal canal could reach when iliocostalis lateral edge was used as the starting point in the lumbar segments, and longissimus lateral edge as the starting point in the thoracic segments. It was confirmed that there was enough safe space for the spinal decompression without the resection of the articular process. Conclusion The approach next to the erector spinae can reach spinal canal to achieve the purpose of decompression through the intervertebral foramen. The minimally invasive approach is feasible and safe. It has the value of the operative application.

Citation： XU Xiyan,YAN Zhengjian,HUANG Fan,QIU Beiming,DENG Zhongliang.. APPLIED ANATOMICAL STUDY ON APPROACH NEXT TO ERECTOR SPINAE FOR SPINAL CANAL DECOMPRESSION THROUGH INTERVERTEBRAL FORAMEN. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(4): 409-413. doi: 10.7507/1002-1892.20130096 Copy

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13.	卓祥龙, 胡建中, 李兵, 等. 经椎间孔腰椎间融合术治疗复发性腰椎间盘突出症的临床研究. 中国矫形外科杂志, 2009, 17(21): 1667-1669.
14.	康辉, 蔡贤华, 徐峰, 等. 双侧肌间隙入路Quadrant系统下行腰椎翻修术. 中国脊柱脊髓杂志, 2011, 21(12): 1001-1005.
15.	Park Y, Ha JW, Lee YT, et al. Surgical outcomes of minimally invasive transforaminal lumbar interbody fusion for the treatment of spondylolisthesis and degenerative segmental instability. Asian Spine J, 2011, 5(4): 228-236.
16.	梁博伟, 殷国前, 赵劲民, 等. 微创经椎间孔椎间融合术治疗退变性腰椎失稳. 中国修复重建外科杂志, 2011, 25(12): 1449-1454.
17.	马凯, 姜长明, 杨群, 等. 保留脊柱后方韧带复合体腰椎管扩大术的基础研究与临床应用. 中国修复重建外科杂志, 2008, 22(8): 918-922.
18.	Jiang XZ, Tian W, Liu B, et al. Comparison of a paraspinal approach with a percutaneous approach in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury: a prospective randomized controlled trial. J Int Med Res, 2012, 40(4): 1343-1356.
19.	Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine. A preliminary report. Clin Orthop Relat Res, 1983, (174): 127-132.
20.	Park KD, Lee J, Jee H, et al. Kambin triangle versus the supraneural approach for the treatment of lumbar radicular pain. Am J Phys Med Rehabil, 2012, 91(12): 1039-1050.

1. Chan CW, Peng P. Failed back surgery syndrome. Pain Med, 2011, 12(4): 577-606.
2. Kat’uch V, Pataky F, Kat’uchová J, et al. Surgical management of the failed back surgery syndrome (FBSS) using posterior lumbar interbody fusion (PLIF) with posterior transpedicular stabilization. Rozhl Chir, 2010, 89(7): 450-458.
3. 邵诗泽, 张恩忠, 付松, 等. 腰骶段多裂肌的形态特点及功能意义. 中国临床解剖学杂志, 2010, 29(1): 17-19.
4. 钟世镇, 丁自海, 王增涛. 脊柱外科临床解剖学. 济南: 山东科学技术出版社, 2008: 237, 340-341.
5. 郑江, 李开南, 刘莉, 等. 腰椎后路经皮微创与传统开放手术影响竖脊肌形态学改变的比较. 中国组织工程研究与临床康复, 2010, 14(39): 7307-7310.
6. Ozgur BM, Aryan HE, Pimenta L, et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J, 2006, 6(4): 435-443.
7. Rodgers WB, Cox CS, Gerber EJ. Early complications of extreme lateral interbody fusion in the obese. J Spinal Disord Tech, 2010, 23(6): 393-397.
8. Oliveira L, Marchi L, Coutinho E, et al. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S331-337.
9. Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976), 2011, 36(1): 26-32.
10. Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am), 1968, 50(5): 919-926.
11. Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine (Phila Pa 1976), 1988, 13(6): 696-706.
12. 黎庆初, 尹刚辉, 张忠民, 等. 微创Wiltse入路与传统后正中入路手术治疗双节段腰椎管狭窄症的疗效比较. 中国脊柱脊髓杂志, 2012, 22(9): 812-818.
13. 卓祥龙, 胡建中, 李兵, 等. 经椎间孔腰椎间融合术治疗复发性腰椎间盘突出症的临床研究. 中国矫形外科杂志, 2009, 17(21): 1667-1669.
14. 康辉, 蔡贤华, 徐峰, 等. 双侧肌间隙入路Quadrant系统下行腰椎翻修术. 中国脊柱脊髓杂志, 2011, 21(12): 1001-1005.
15. Park Y, Ha JW, Lee YT, et al. Surgical outcomes of minimally invasive transforaminal lumbar interbody fusion for the treatment of spondylolisthesis and degenerative segmental instability. Asian Spine J, 2011, 5(4): 228-236.
16. 梁博伟, 殷国前, 赵劲民, 等. 微创经椎间孔椎间融合术治疗退变性腰椎失稳. 中国修复重建外科杂志, 2011, 25(12): 1449-1454.
17. 马凯, 姜长明, 杨群, 等. 保留脊柱后方韧带复合体腰椎管扩大术的基础研究与临床应用. 中国修复重建外科杂志, 2008, 22(8): 918-922.
18. Jiang XZ, Tian W, Liu B, et al. Comparison of a paraspinal approach with a percutaneous approach in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury: a prospective randomized controlled trial. J Int Med Res, 2012, 40(4): 1343-1356.
19. Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine. A preliminary report. Clin Orthop Relat Res, 1983, (174): 127-132.
20. Park KD, Lee J, Jee H, et al. Kambin triangle versus the supraneural approach for the treatment of lumbar radicular pain. Am J Phys Med Rehabil, 2012, 91(12): 1039-1050.

Chinese Journal of Reparative and Reconstructive Surgery

APPLIED ANATOMICAL STUDY ON APPROACH NEXT TO ERECTOR SPINAE FOR SPINAL CANAL DECOMPRESSION THROUGH INTERVERTEBRAL FORAMEN

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