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POSTERIOR APPROACH TO THE LUMBAR SPINE

USES

This approach is commonly used to access the posterior elements of the lumbar spine, most frequently for excision of lumbar disk herniations. Posterior lumbar decompression with or without fusion and instrumentation, foraminotomy, and tumor resection are other applications.

ADVANTAGES

Compared to the anterior approach to the lumbar spine, the posterior approach is easier in that accessibility is less of a problem. Dissection is relatively superficial, and major structures that are encountered (e.g., peritoneum, great vessels, genitofemoral nerves) are rarely at risk here. Furthermore, a smaller, midline, and hence more cosmetic incision is usually used in this approach.

DISADVANTAGES

The disadvantage of this approach is that access to the middle or anterior columns is limited. Decompression of burst fracture fragments from the neural canal may not be adequately and safely performed from the back. Clearly, an anterior approach is superior in this situation. Also, the prone position is associated with increased anesthetic risks and potential for soft tissue pressure problems.

STRUCTURES AT RISK

If dissection is carried further lateral to the facet joints, the dorsal branch of the segmental artery as well as the posterior primary rami of the spinal nerve (which both He within the substance of the paraspinal muscles) are at risk. Careful subperiosteal dissection prevents damage to these structures. In cases where fusion or instrumentation are not planned, the facet joint capsules must be preserved as well to prevent spinal instability. Within the spinal canal, the dura as well as the exiting and traversing nerve roots are encountered, and should be protected with nerve root retractors. If a diskectomy is performed, care must be taken to prevent perforation of the anterior annulus and anterior longitudinal ligament by the instrument, as this may also injure the aorta on the other side of the spine.

TECHNIQUE

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Paronychium Approach Anterior Approach Anterolateral (Internervous) Approach Posterior Approach Anterior Approach to the Cervical Spine

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