Magnetic resonance imaging-based anatomical study of the multifidus-longissimus cleavage planes in the lumbar spine

Purpose: The Wiltse approach allows spinal surgeries to be performed with minimal soft tissue trauma. The purpose of this study was to investigate the anatomy of the natural cleavage plane between multifidus and longissimus at different levels based on MRI images. Methods: MRI cross-sectional scans from L1 to S1 were collected from 205 out patients (103 males, 102 females). Based on the images, some parameters were defined and measured to describe the locations, curvature and directions of Wiltse approach. Besides, differences of these parameters between genders and segments were compared. Results: Among the total of 2460 one-sided images, cleavage planes between multifidus and longissimus were not able to be identified in 105 images. The locations, directions and curvature of the cleavage plane differed significantly among different segments but followed some regular pattern from L1-S1. The simultaneous rotation of the plane around its deepest points to the midline from S1 to L1 and the plane seemed to be the most curved at L3 and relatively straight for L5 and S1. Conclusions: With a better understanding of the natural cleavage plane between multifidus and longissimus, performers can correctly plan the distance of skin incisions from the midline and the direction of muscle dissection at each vertebral level, thus reducing trauma in the operation.