Objective To explore the anatomical basis of Wiltse approach in lumbar operation and to improve reliability and manipuility of the lumbar Wiltse approach．Methods Twenty embalmed cadavers were used to observe the anatomical characteristics as follows: the relationship between sacrospinalis aponeurosis and multifidus muscle, the relationship between sacrospinalis aponeurosis and longissimus muscle, whether the interspace between multifidus muscle and longissimus muscle was clear, whether there were stable anatomic signs to identify, and whether there was other structure in the surface or inferior part of sacrospinalis aponeurosis could be the anatomic signs of the interspace between multifidus muscle and longissimus muscle. Results Multifidus muscle could be seen as an independent part from sacrospinalis aponeurosis though it had few fibers. Longissimus muscle formed a starting point from sacrospinalis aponeurosis in the lumbar regions. The starting point extended from central-superfacial to inferior-lateral and formed fascia stretching to facet joints and accessory process that made up the native interspace between multifidus muscle and longissimus muscle. The fascia was taken as an anatomical sign, successful blunt dissection were made to expose facet joints directly in all 20 cadavers. There were no other special anatomical signs in the surface or in the inferior part of sacrospinalis aponeurosis to locate the interspace between multifidus muscle and longissimus muscle. In the interspace, segmental nerve and concomitant blood vessel can be seen definitely inside the longissimus muscle. Conclusions The Wiltse approach requires a comprehensive understanding of lumbar fascia, based on which ,the operation could be safe and feasible.
Key words
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Wiltse approach /
Multifidus muscle /
Longissimus muscle /
Anatomy
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