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The original description of the paraspinal posterior approach to the lumbar spine was for spinal fusion, especially regarding lumbosacral spondylolisthesis treatment. In spite of the technical details described by Wiltse, exact location of the area where the sacrospinalis muscle has to be split remains somewhat unclear. The goal of this study was to provide topographic landmarks to facilitate this surgical approach. Thirty cadavers were dissected in order to precisely describe the anatomy of the trans-muscular paraspinal approach. The level of the natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle was noted and measurements were done between this level and the midline at the level of the spinous process of L4. A natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle was present in all cases. There was a fibrous separation between the two muscular parts in 55 out of 60 cases. The mean distance between the level of the cleavage plane and the midline was 4 cm (2.4–5.5 cm). In all cases, small arteries and veins were present, precisely at the level of the cleavage plane. We found it possible to easily localize the anatomical cleavage plane between the multifidus part and the longissimus part of the sacrospinalis muscle. First the superficial muscular fascia is opened near the midline, exposing the posterior aspect of the sacrospinalis muscle. Then, the location of the muscular cleft can be found by identifying the perforating vessels leaving the anatomical inter-muscular space.

1. Eighty-seven patients treated with lateral (intertransverse) fusion for several lumbar disease at Tamatsukuri Koseinenkin Hospital from 1968 through 1977 were followed up.2. Total estimation of results is “nearly good” on Kono's Evaluation.3. Most of operation were performed with using of Hasting's frame, midline incision and lateral approach to transverse process by splitting sacrospinalis muscle and without operating intervertebular joints.

The purpose of this study was to determine if there is any significant difference in electromyographic activity in normal lumbar sacrospinalis musculature during static pelvic traction between the supine and prone positions. Electromyographic activity was monitored on 17 normal participants. Each participant received static pelvic traction in prone and in supine for 15 minutes. The analysis of variance for a repeated measures design found significantly less lumbar sacrospinalis muscle activity during traction in the prone position than during traction in the supine position (p0.05). An analysis of covariance determined that the difference between muscle activity during traction in the prone and supine positions was not significantly affected by differences in sex, age, height, weight, treatment order, time of treatment, electrical noise levels prior to treatment, and electrical noise levels after treatment. Implications for treatment are discussed. J Orthop Sports Phys Ther 1987;8(8):382-390.

There is still a distinct place for the use of thoracoplasty in the treatment of tuberculosis and the occasional use of thoracoplasty in the poor risk type of patient can be very effective when supplemented by adequate anti-tuberculosis drugs. The method described is that of a classical thoracoplasty initiated by Alexander, and done in a single stage. Control of paradoxical respiration is easily accomplished by placing anchoring sutures from the sacrospinalis muscle to the pectoralis major, as indicated in Figure. From four to 11 ribs have been removed, including the transverse processes in 35 patients, with one death. The results of the surgery have been gratifying.