Posterolateral musculofascial approach to intervertebral discs of the lumbar spine: anatomic and topographic study

Objective: assessment of the anatomical and topographical parameters of the wound channel formed in the course of the posterolateral musculofascial approach with the purpose of identifying the possibility of its clinical use in decompressive and stabilizing surgical interventions. Materials and Methods: a posterolateral musculofascial approach to the lumbar spine was modeled using material from 20 male and female cadavers 54 – 76 years of age (median 67.5 years) who died from diseases not associated with the pathology of the spine. The study examined wound length, depth, wound depth index, and wound access zone, as well as the angle of intersection of the wound edges with the surface of surgical instruments. Results: the mean length of the surgical wound when performing the lateral musculofascial approach was 149.75±6.35 mm. The mean depth of the wound was 116.75±8.85 mm. The mean value of the surgical wound depth index with interfascial approach was 77.96±5.04. The mean area of the intervertebral disc available for removal was 71.2±2.8%. The length of the aperture in the annulus fibrosus was on average 15.8±0.78 mm. The mean angle of the intersection of the wound edge by the trajectory of transpedicular screw implantation was 3.15±1.25°. Conclusion:the assessment of the anatomical and topographical parameters of the wound channel formed during the posterolateral musculofascial approach allowed concluding that such surgical approach could be used to improve the functional outcomes of decompressive and stabilizing interventions on the lumbar spine.