Wiltse describes a bilateral paraspinal approach to the lumbar spine in which the sacrospinalis muscle is split rather than undermined. The technique provides direct access to the transverse processes and lateral masses for posterolateral fusion and nerve root decompression. This 1968 landmark paper established the anatomical and technical foundation for what is now universally called the Wiltse approach.
The Wiltse approach solves a specific problem: how do you reach the transverse processes and lateral masses for posterolateral fusion without stripping the midline musculature and sacrificing the posterior tension band?
When you're planning a single-level posterolateral fusion for isthmic spondylolisthesis — especially in a young patient where muscle preservation matters. This is the anatomic corridor to use. The intermuscular plane between the longissimus and iliocostalis is the same interval modern tubular retractor systems and percutaneous pedicle screw corridors exploit.
Two clinical rules from this paper are still in daily use: keep your iliac crest harvest within a hand's breadth of the posterior spine (cluneal nerves), and never denude the spinous processes if you want the posterior ligament complex intact.
This paper is also why L5 radiculopathy that mimics an L4-5 disc herniation should raise spondylolisthesis of L5 on your differential. It is the L5 nerve root, not L4, that is compressed at that level.
Wiltse describes a bilateral paraspinal approach to the lumbar spine in which the sacrospinalis muscle is split rather than undermined. The technique provides direct access to the transverse processes and lateral masses for posterolateral fusion and nerve root decompression. This 1968 landmark paper established the anatomical and technical foundation for what is now universally called the Wiltse approach.
The Wiltse approach solves a specific problem: how do you reach the transverse processes and lateral masses for posterolateral fusion without stripping the midline musculature and sacrificing the posterior tension band?
When you're planning a single-level posterolateral fusion for isthmic spondylolisthesis — especially in a young patient where muscle preservation matters. This is the anatomic corridor to use. The intermuscular plane between the longissimus and iliocostalis is the same interval modern tubular retractor systems and percutaneous pedicle screw corridors exploit.
Two clinical rules from this paper are still in daily use: keep your iliac crest harvest within a hand's breadth of the posterior spine (cluneal nerves), and never denude the spinous processes if you want the posterior ligament complex intact.
This paper is also why L5 radiculopathy that mimics an L4-5 disc herniation should raise spondylolisthesis of L5 on your differential. It is the L5 nerve root, not L4, that is compressed at that level.