The Mercedes-Benz incision for posterior exposure of the lumbosacral junction: An institutional review.

Authors

Venugopal K Menon, Rejo Varghese Jacob, Salman Sulfeeker, Pallai Divya Radhakrishna, Evani Anirudh Sarma, Mantu Jain

Published in

Journal of clinical orthopaedics and trauma. Volume 80. Pages 103530. Epub Jun 09, 2026.

Abstract

Posterior exposure of the lumbosacral junction (LSJ) is frequently required for diverse spinal pathologies but is associated with significant soft-tissue morbidity and wound tension. The Mercedes-Benz incision (MBI), a tri-radiate posterior incision with a midline cranial limb and two oblique limbs directed toward the posterior superior iliac spines, was designed as an anatomical alternative to improve exposure while minimizing wound complications. Evidence evaluating its clinical outcomes remains limited. The present study evaluates early wound outcomes after use of the MBI for posterior exposure of the LSJ.
A retrospective cohort study was conducted of patients who underwent LSJ surgery using the MBI between January 2017 and December 2023. Data were extracted from institutional records with ethics approval. Included patients had complete documentation and at least a 6-month follow-up. Variables assessed included surgical indications, operative parameters, and early postoperative wound outcomes. Descriptive statistics were used.
Eighty-five patients (53 males, 32 females; mean age 50.05 years) comprising 81 primary and 4 revision cases. Indications spanned degenerative, infectious, traumatic, deformity, and selected tumor conditions. Fusion constructs primarily involved the lumbosacral or spinopelvic region and ranged from L5-S1/L4-S1 to T4-ilium; a small subset ended at L5. Wound-related complications occurred in 7 of 85 patients (8.25%). Skin necrosis occurred in 2 patients (1 requiring debridement,1 flap coverage). Four patients developed SSI requiring debridement and antibiotics. One case of apical necrosis resolved conservatively. 2 patients required reconstructive procedures. Revision surgery unrelated to wound complications occurred in two patients, and one patient died within six months.
MBI provides extensile, anatomically aligned exposure of the LSJ while maintaining low wound complication rates across a range of pathologies. Larger multi-center studies are needed to validate its safety and effectiveness relative to traditional approaches.

PMID:
42359264
Bibliographic data and abstract were imported from PubMed on 26 Jun 2026.

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