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.

Resumo

Introdução Os desenvolvimentos técnicos na cirurgia da coluna vertebral têm proporcionado a redução das incisões cirúrgicas e da duração do procedimento.

Objetivo Descrever marcos topográficos, anatômicos e características do acesso de Wiltse, uma abordagem da coluna vertebral lombar.

Métodos A revisão bibliográfica foi realizada utilizando como banco de dados: PubMed, Embase, Science Direct, banco de dados Cochran e Google Scholar. Foram encontrados 22 trabalhos que atenderam aos critérios de inclusão, todos publicados entre 1959 e 2016.

Discussão A abordagem de Wiltse é realizada pela incisão cutânea mediana com dissecção muscular lateral entre o músculo multifidus e o músculo longissimus, na via natural. Esta abordagem permite o acesso aos pedículos e ao recesso lateral, e a realização de fusão posterior e descompressão de fratura da coluna vertebral e técnicas de discectomia minimamente invasivas. Este acesso é menos traumático do que a abordagem mediana, e é ideal para níveis mais baixos, como L4–5 e L5-S1.

Conclusão Os autores recomendam esta abordagem, pois acreditam que os benefícios desta técnica, quando bem indicada, superam as desvantagens e complicações por ser esta menos invasiva.

Keywords

Wiltse access - lumbar spine - paraspinal approach - spine surgery

Palavras-chaves

acesso de Wiltse - coluna lombar - abordagem paraespinhal - cirurgia da coluna vertebral

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