Modified Muscle-Sparing Paraspinal Approach for Stabilization and Interlaminar Decompression: A Minimally Invasive Technique for Pedicle Screw-Based Posterior Nonfusion Stabilization

INTRODUCTION: Though Wiltse developed the paraspinal muscle-splitting approach to the spine, the exact location of where and how to split the paraspinal musculature when performing this approach remains unclear. This type of approach may be particularly useful for posterior nonfusion stabilization as significantly less damage occurs with this approach than with a muscle-stripping approach. METHODS: We use the term “modified muscle-sparing approach” to describe our technique for following the natural cleavage plane between the multifidus and longissimus muscles to access the spine. We review the rationale behind this methodology and describe technical aspects of this approach and also demonstrate the technique on video. RESULTS: We use this technique routinely for our posterior nonfusion pedicle screw stabilization approach. CONCLUSIONS: The modified muscle-sparing approach is a useful approach for insertion of pedicle screw-based posterior nonfusion stabilization. The approach can be readily performed with little blood loss and with little muscle damage. Decompression can also be performed through the same incision if needed.