Paraspinal Lumbar Spine Approach - Wiltse Access

Abstract

Introduction Technical developments in spinal surgery have reduced the number of surgical incisions and of the length of time for the procedure. Objective Describe topographical landmarks, anatomy and characteristics of the Wiltse access, a paraspinal approach to the lumbar spine. Methods A review of the literature was performed using as databases: PubMed, Embase, Science Direct, the Cochran Database and Google Scholar. Total 22 papers met the inclusion criteria, and they were all published between 1959 and 2016. Discussion The Wiltse approach is performed by median skin incision with lateral muscle dissection between the multifidus and the longissimus muscles, in a natural pathway. This approach allows access to the pedicles and to the lateral recess, enabling the performance of posterior spinal fusion and decompression and minimally invasive discectomy techniques. This access is less traumatic than the median approach, and it is ideal for lower levels, like L4–5 and L5-S1. Conclusion The authors strongly encourage this approach because they believe that, when well-indicated, the benefits outweigh the disadvantages and complications due to the fact that it is a less invasive procedure.

Use of Wiltse approach in lumbar plexus schwannoma: A technical note

“…[ 9 ] The Wiltse approach is mainly used for classical herniated disc extraforaminal and lateral recess channels, being also useful in interbody fusion surgeries. [ 5 ] It reduces intraoperative damage due to natural access roads, reduced length of surgery time, less postoperative pain due to undamaged supra and interspinous ligaments,[ 5 ] and reduces the risk of wound breakdown and infection. [ 4 , 5 , 11 ] Some disadvantages such as poor visability, tendency to lateralization of the point of entrance,[ 5 ] and difficulty in localization of the plane of access when closer to the sacral level[ 2 ] require familiarity with this surgical approach.…”

“…[ 5 ] It reduces intraoperative damage due to natural access roads, reduced length of surgery time, less postoperative pain due to undamaged supra and interspinous ligaments,[ 5 ] and reduces the risk of wound breakdown and infection. [ 4 , 5 , 11 ] Some disadvantages such as poor visability, tendency to lateralization of the point of entrance,[ 5 ] and difficulty in localization of the plane of access when closer to the sacral level[ 2 ] require familiarity with this surgical approach. Our choice for the Wiltse approach was due to its natural cleavage plane between the multifidus and the longissimus muscles, providing a better access to the tumor while reducing intraoperatory damage and bleeding.…”