Can intermuscular cleavage planes provide proper transverse screw angle? Comparison of two paraspinal approaches

The goal of this study was to determine which paraspinal approach provided a better transverse screw angle (TSA) for each vertebral level in lower lumbar surgery. Axial computed tomography (CT) images of 100 patients, from L3 to S1, were used to measure the angulation parameters, including transverse pedicle angle (TPA) and transverse cleavage plane angle (TCPA) of entry from the two approaches. The difference value between TCPA and TPA, defined as difference angle (DA), was calculated. Statistical differences of DA obtained by the two approaches and the angulation parameters between sexes, and the correlation between each angulation parameter and age or body mass index (BMI) were analyzed. TPA ranged from about 16A degrees at L3 to 30A degrees at S1. TCPA through the Wiltse's and Weaver's approach ranged from about -10A degrees and 25A degrees at L3 to 12A degrees and 32A degrees at S1, respectively. The absolute values of DA through the Weaver's approach were significantly lower than those through the Wiltse's approach at each level. The angulation parameters showed no significant difference with sex and no significant correlation with age or BMI. In the lower lumbar vertebrae (L3-L5) and S1, pedicle screw placement through the Weaver's approach may more easily yield the preferred TSA consistent with TPA than that through the Wiltse's approach. The reference values obtained in this paper may be applied regardless of sex, age or BMI and the descriptive statistical results may be used as references for applying the two paraspinal approaches.