The "open book" technique for preparation of the lumbar transverse process for posterolateral fusion

A new technique is reported for preparation of the recipient graft bed for posterolateral intertransverse process fusion of the lumbar spine. The dorsal surface of each transverse process is reflected open like the pages of a book. This increases the surface area of cancellous bone in the recipient bed, thereby promoting better contact with the grafted bone. This maneuver also preserves much of the periosteal blood supply to the dorsal aspect of the transverse process and much of the cortical bone that would normally be drilled away during decortication. The technical details are described.