title: Can intermuscular cleavage planes provide proper transverse screw angle? Comparison of two paraspinal approaches.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  TPA ranged from about 16° at L3 to 30° at S1. TCPA through the Wiltse's and Weaver's approach ranged from about -10° and 25° at L3 to 12° and 32° 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Huangpu District, Shanghai 200003, People's Republic of China.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Cheng
authors.forename: Bin
authors.initials: B
authors.lastname: Ni
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.forename: Jinshui
authors.initials: J
authors.lastname: Chen
authors.forename: Huapeng
authors.initials: H
authors.lastname: Guan
mesh_terms: D001863:Bone Screws; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed