Posterior Paramedian Approach—A Simple Technique to Obtain a Lateral Viewing Angle for Spinal Lesions

Abstract

A wide lateral viewing angle is often necessary for spinal surgery. However, the skin and paraspinal muscles limit this angle in the traditional posterior midline approach. This article describes a simple, less-invasive approach that provides good lateral viewing angles to spinal lesions. The approach consisted of (1) a horizontal skin incision, (2) unilateral dissection and exposure of the laminae, (3) a horizontal fascial incision, and (4) application of retractors in the longitudinal direction with a minimal incision on the multifidus muscle. We successfully used this approach on 24 patients with various spinal diseases. The pathology of the lesions included nine schwannomas, five meningiomas, four ossification of ligamentum flavum (OLF), three malignant tumors, and three others. There were nine cervical, twelve thoracic, two lumbar, and one sacral lesions. We could achieve gross total removal in most cases without significant complications. The approach provided an excellent surgical field for removing ventrally located tumors with minimal cord retraction. This simple technique will be a valuable addition to the armamentarium of spine surgeons.