Bilateral Paraspinous Lumbosacral Approach

Abstract

The most commonly used approaches to this area are the direct paraspinous muscle-splitting incision and the more lateral approach, which elevates and dissects under the lumbosacral muscle (Fig. 49.1). The muscle-splitting incision affords not only alar transverse exposure for fusions but also excellent exposure for laminectomy.^1,2 The more lateral approach removes a bicortical portion of the posterior superior iliac spine, attempts to preserve muscle and fascial integrity, and allows excellent exposure of the tips of the transverse processes to the facet joints.^3,4 There is probably no great advantage to preserving the denervated muscle with the more lateral approach. We recommend the more lateral approach for alar transverse fusion and the muscle-splitting incision when laminectomy and root exploration are needed in addition to fusion.