Publication Title
Cureus
Document Type
Article
Publication Date
12-12-2019
Abstract
The posterior midline approach to the lumbar spine requires significant manipulation of the paraspinal muscles. Muscle detachment and retraction results in iatrogenic damage such as crush injury, devascularization, and denervation, all of which have been associated with postoperative pain. The muscle most directly affected by the posterior approach is the lumbar multifidus (LM), the largest and most medial of the deep lumbar paraspinal muscles. The effects of the posterior approach on the integrity of the LM is concerning, as multiple studies have demonstrated that intraoperative injuries sustained by the LM lead to postoperative muscle atrophy and potentially worsening low back pain. Given the inevitability of intraoperative paraspinal muscle manipulation when using the posterior approach, this technical note describes methods by which surgeons may minimize LM tissue disruption and restore the anatomical position of the LM to ultimately expedite recovery, minimize postoperative pain, and improve patient satisfaction.
Clinical Institute
Neurosciences (Brain & Spine)
Specialty/Research Institute
Neurosciences
Specialty/Research Institute
Surgery
