title: Surgical anatomy of the diaphragm in the anterolateral approach to the spine: a cadaveric study.
abstract: METHODS
  Laboratory cadaveric study.
  
  
  OBJECTIVE
  To delineate the pertinent surgical anatomy of the diaphragm during access to the anterolateral thoracolumbar junction.
  
  
  BACKGROUND
  The general anatomy of the thoracic diaphragm is well described. The specific surgical anatomy as it pertains to the lateral and thoracoabdominal approaches to the thoracolumbar junction is not well described.
  
  
  METHODS
  Dissections were performed on adult fresh cadaveric specimens. Special attention was paid to the diaphragmatic attachments to the lower rib cage and to the spinal thoracolumbar junction.
  
  
  RESULTS
  The pertinent diaphragmatic attachments to the rib cage are at the 11th and 12th ribs. Whether the diaphragm is incised or mobilized ventrally, the pertinent spinal attachments are the lateral and medial arcuate ligaments. Identifying and sectioning these structures allows for direct access to the thoracolumbar junction, particularly the L1 vertebral body.
  
  
  CONCLUSIONS
  An understanding of the diaphragmatic-costal and diaphragmatic-spinal attachments is key for the safe and effective implementation of diaphragm mobilization during the lateral and thoracoabdominal approaches to the spine.
authors.affiliation: *Division of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ †Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Baaj
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Papadimitriou
authors.forename: Anubhav G
authors.initials: AG
authors.lastname: Amin
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Kretzer
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D000328:Adult; D002102:Cadaver; D003964:Diaphragm / Q000033:anatomy & histology* / Q000601:surgery*; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000601:surgery; D012272:Ribs / Q000601:surgery; D013131:Spine / Q000033:anatomy & histology* / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000033:anatomy & histology / Q000601:surgery