Posterior approach to the Thoracic & Lumbar Spines for Scoliosis

Indications

Scoliosis surgery
Posterior spine fusions
Removal of tumours of posterior aspect of vertebrae
Open biopsy
Stabilization of fractured vertebrae

Position

Prone
Bolster along each side down to ASIS
- Anterior chest wall clear of table
  - Allows chest expansion
- Anterior Abdominal wall clear of table
  - Empyting of nonvalvular vertebral venous plexus into vena cava
    - Reducing operative bleeding

Landmarks

gluteal cleft
C7T1 spinous processes

Incision

Straight longitudinal midline incision

Internervous Plane

Paraspinal muscles
- Segmentally innervated by posterior primary rami

Superficial Dissection

Continue dissection to middle of spinous processes
Split spinous process apophyses longitudinally & dissect them to each side with Cobb elevator

Deep Dissection

Reflect subperiosteally, the spinal muscles from spinous process & laminae towards the transverse processes

Dangers

Nerves
- Posterior primary rami
Vessels
- Segmental vessels