Research Progress on the Posterior Midline Lumbar Spinous Process-Splitting Approach

Abstract

The traditional posterior median approach laminectomy is widely used for lumbar decompression. However, the bilateral dissection of paraspinal muscles during this procedure often leads to postoperative muscle atrophy, chronic low back pain, and other complications. The posterior midline spinous process-splitting approach (SPSA) offers a significant advantage over the traditional approach by minimizing damage to the paraspinal muscles. SPSA reduces the incidence of muscle atrophy and chronic low back pain while maintaining the integrity of the posterior spinal structures. The technique involves longitudinal splitting of the spinous process, which allows for adequate access to the lamina for decompression without detaching the paraspinal muscles. As a result, it provides a clearer surgical field and facilitates muscle preservation, which reduces the risk of postoperative complications. Additionally, SPSA requires only standard surgical instruments, making it accessible in most surgical settings. This paper reviews the anatomical considerations, surgical techniques, and clinical applications of the SPSA, highlighting its effectiveness in reducing muscle atrophy and improving recovery outcomes. The paper also discusses its potential in treating conditions such as lumbar spinal stenosis, disc herniation, and spondylolisthesis. Furthermore, it emphasizes the need for future research to establish the long-term benefits of SPSA and refine surgical techniques. The results suggest that SPSA is a promising alternative to traditional approaches, with better outcomes in terms of muscle preservation and overall recovery.

Keywords: decompression; lumbar spine; posterior midline approach; spinous process.

FIGURE 1

Literature screening flowchart.

FIGURE 2

Lumbar spinous process‐splitting techniques: (A and B) Classic spinous process‐splitting technique: The spinous process is longitudinally split along the midline, with the base detached from the lamina to preserve the bilateral attachment of the paraspinal muscles. Bilateral decompression is achieved, providing access to both sides of the spinal canal and minimizing muscle disruption. (C) Half‐splitting technique: The spinous process is split longitudinally from the midline, with the decompression‐side half fractured and detached from the lamina. (D) Bilateral decompression via unilateral laminectomy.(E) Modified Marmot technique: The spinous process is longitudinally split from the midline and tilted outward while remaining attached to the lamina. (F) Ventral portions of the lamina and ligamentum flavum are resected to create sufficient space between the remaining lamina and dura mater, facilitating decompression.