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https://upload.orthobullets.com/topic/12070/images/wiltse.jpg
Introduction
  • Indications
    • far lateral disc herniation
    • pars defect
Internervous Plane
  • Intermuscular plane between
    • multifidus
    • longissimus
Postition & Preparation
  • Position
    • prone on Wilson or Jackson table
  • Imaging
    • must confirm level with AP/lateral radiograph
Approach
  • Incision
    • incision make 3 cm from midline
  • Superficial dissection
    • find plane between multifidus and longissimus and develop with blunt dissection
  • Deep dissection
    • manually palpate transverse process
    • place clamp on transverse process and confirm level with radiograph
    • dissect transverse process above and below
    • identify pars medially
Dangers
  • Dorsal root ganglion
 

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