Posterior Approach to the Thoracic & Lumbar Spines for Scoliosis

Axial drawing of the open posterior approach for scoliosis fusion, with a midline incision and bilateral detachment of the paraspinal muscle
Axial drawing of the open posterior approach for scoliosis fusion, with a midline incision and bilateral detachment of the paraspinal muscles from the posterior elements (A). Panel B shows a paramedian transmuscular corridor aligned with the facet joints and pedicle screw paths. Image from Ropelato MD, Vitale J, Mannion AF, Schömig F, Puhakka J, Loibl M, Galbusera F, Jeszenszky D, Fekete TF. Outcomes of posterior spinal fusion in AIS, A minimally invasive vs. open technique analysis. Brain Spine. 2026, 6, 106029. CC BY 4.0.

Indications

Thoracic Posterolateral Costotransversectomy Approach, lateral view of a thoracic vertebra, from gray’s anatomy
Lateral view of a thoracic vertebra, from Gray’s Anatomy. Image by The original uploader was Tarek at English Wikipedia., Wikimedia Commons, Public domain.
  • Scoliosis surgery
  • Posterior spine fusions
  • Removal of tumours of posterior aspect of vertebrae
  • Open biopsy
  • Stabilisation 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
      • Emptying 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

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.