Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA 92354, USA.
Spine (Phila Pa 1976). 2011 Jul 15;36(16):1263-7. doi: 10.1097/BRS.0b013e3181f520e8.
Retrospective magnetic resonance imaging (MRI)-based study.
Our goal was to develop Wiltse's paraspinal surgical approach by determining the precise anatomic locations of the intermuscular cleavage planes formed by the multifidus and longissimus muscles. The primary objective was to measure the distances between the midline and the intermuscular planes, bilaterally, on MRI scans at each of the five disc levels between L1 and S1. Secondary objectives included identifying the existence of any correlations between patient demographics and the measured outcomes.
In 1968, Wiltse described an approach to the spine using the natural cleavage plane of the multifidus and longissimus muscles as an entry to the posterior spinal elements. The small direct incisions lessened bleeding, tissue violation, and muscle retraction, which popularized Wiltse's approach among surgeons. A detailed description of the locations of the intermuscular cleavage planes at each lumbar disc level, however, is not available.
MRI scans of 200 patients taken during routine care (2007-2009) were retrospectively reviewed to gather measurements of the distances from the intermuscular cleavage planes to the midline, bilaterally, at each disc level from L1 to S1. Age, sex, and BMI (body mass index) were obtained to determine correlations.
Mean measurements significantly differed between all disc levels. At L5-S1, the mean distance was 37.8 mm; at L4-L5, 28.4 mm; at L3-L4, 16.2 mm; at L2-L3, 10.4 mm; and at L1-L2, 7.9 mm. The mean female distances were significantly greater than males (2 mm) on both sides of L5-S1 only. No correlation was discovered between BMI, age, height (N = 50), or weight (N = 50) with respect to measured distances.
In the absence of any significant clinical correlation between patient demographics and the entry site in Wiltse's approach, the spine surgeon may use distances described in this paper to apply to a broad base of spine patients regardless of BMI, sex, or age.
回顾性磁共振成像（MRI）研究。
我们的目标是通过确定多裂肌和最长肌之间形成的肌间裂隙平面的精确解剖位置来发展 Wiltse 的椎旁手术入路。主要目标是测量 MRI 扫描中 L1 至 S1 每个椎间盘水平双侧中线与肌间平面之间的距离。次要目标包括确定患者人口统计学特征与测量结果之间是否存在任何相关性。
1968 年，Wiltse 描述了一种使用多裂肌和最长肌的自然裂隙平面作为进入脊柱后元素的入路。较小的直接切口减少了出血、组织损伤和肌肉回缩，这使得 Wiltse 的方法在外科医生中流行起来。然而，每个腰椎间盘水平的肌间裂隙平面的位置并没有详细的描述。
回顾性分析 2007 年至 2009 年期间常规护理中 200 名患者的 MRI 扫描，以测量从 L1 至 S1 每个椎间盘水平双侧中线至肌间裂隙平面的距离。获取年龄、性别和 BMI（体重指数）以确定相关性。
所有椎间盘水平的平均测量值差异均有统计学意义。在 L5-S1 水平，平均距离为 37.8mm；在 L4-L5 水平，平均距离为 28.4mm；在 L3-L4 水平，平均距离为 16.2mm；在 L2-L3 水平，平均距离为 10.4mm；在 L1-L2 水平，平均距离为 7.9mm。仅在 L5-S1 的双侧，女性的平均距离明显大于男性（2mm）。未发现 BMI、年龄、身高（N=50）或体重（N=50）与测量距离之间存在相关性。
在患者人口统计学特征与 Wiltse 入路的入路部位之间没有任何显著的临床相关性的情况下，脊柱外科医生可以使用本文中描述的距离来应用于广泛的脊柱患者，无论 BMI、性别或年龄如何。
