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| WANG Shidong,DENG Xuefei,YIN Zongsheng.The anatomical and radiological observation of the paraspinal intermuscular space for paramedian approach to the lumbar spine[J].Chinese Journal of Spine and Spinal Cord,2013,(3):257-262. |
| The anatomical and radiological observation of the paraspinal intermuscular space for paramedian approach to the lumbar spine |
| Received:June 14, 2012 Revised:August 01, 2012 |
| English Keywords:Paramedian muscle-splitting approach Intermuscular space Anatomy MRI CT |
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| English Abstract: |
| 【Abstract】 Objectives: To clarify the anatomic and radiographic features of the intermuscular space for paramedian approach to the lumbar spine and to provide the option and morphological basis for surgery. Methods: A total of 18 spine specimens of adult was used in this study. The anatomical description of the paraspinal muscles and adjacent elements were verified by dissecting on one side of lower back, while the other side was used by simulated diverse paramedical approach to the lumbar spine. MRI and CT scan of intermuscular space was determined on serial horizontal views of 30 healthy volunteers. Results: The Wiltse space without blood vessel or nerve distribution was noted between the multifidus and longissimus, and natural surgical access to zygapophysial joints and transverse process could be viewed. In volunteers, this space could be detected in 75% of the cases on CT and 93.3% of the cases on MRI. LIMP space existed between longissimus and iliocostalis muscle, with a thin fascia interposed, and witness ramus posterior nervorum spinalium could be seen cross this space in 69.4% of the cases. Intervertebral foramina and pedicle of vertebral arch could be easily reached via LIMP space. In volunteers, 41.6% cases on CT and 56.6% cases on MRI could be seen respectively. Watkins space was sandwiched between the sacrospinalis and quadratus lumborum formed by middle layer of thoracolumbar fascia, without blood vessel or nerve distribution in 75% cases. LIMP space could access to the intervertebral foramina and lateral border of vertebral body, and it could be seen in 63.3% and 86.6% cases on CT and MRI respectively in healthy subjects. Conclusions: The intermuscular space in the lumbar spine and its well defined features on CT and MRI can facilitate the surgical approach. |
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