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Xu X, Pu S, Wang H, Wang A. The real world of the dorsal segmental distribution of the spinal nerves: the information from cutaneous rash in patients with herpes zoster. Minerva Anestesiol 2023; 89:109-111. [PMID: 36745122 DOI: 10.23736/s0375-9393.22.16831-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Xiaotao Xu
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shaofeng Pu
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haiyan Wang
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Aizhong Wang
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China -
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Steinke H, Saito T, Kuehner J, Reibetanz U, Heyde CE, Itoh M, Voelker A. Sacroiliac innervation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2831-2843. [PMID: 36029360 DOI: 10.1007/s00586-022-07353-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate the innervation pattern of the sacroiliac region, especially with regard to the sacroiliac joint (SIJ). Dorsal SIJ innervation was analyzed and described. Our main hypothesis was that nerves reach the SIJ dorsally, passing ligamental compartments, as this would explain dorsal SIJ pain. METHODS To examine sacroiliac innervation, we followed the nerves in over 50 specimens over several years. Plastinated slices were evaluated, nerves in the region were stained histologically, and the data were summarized as 3D models. RESULTS The Rami communicans and posterior branches of the spinal nerves and their branches that form a dorsal sacral plexus and communicating branches, together with corresponding vessels, were observed to form neurovascular bundles embedded by tiny fatty connectives in gaps and tunnels. Branches of L5-S1 pass the inner sacroiliac ligaments (the interosseous sacroiliac ligament and axial interosseous ligament). The outer sacroiliac ligaments (posterior sacroiliac ligaments, long posterior sacroiliac ligament, sacrotuberal ligament, thoracolumbar fascia) are passed by the S1-S4 branches. However, although the paths of these nerves are in the direction of the SIJ, they do not reach it. It is possible that impingement of the neurovascular bundles may result in pain. Moreover, the gaps and tunnels connect to the open dorsal SIJ. CONCLUSION Our findings suggest that Bogduk's term "sacroiliac pain" correlates to "sacroiliac innervation", which consists of "inner-" and "outer sacroiliac ligament innervation", and to ventral "SIJ pain". The watery gaps and tunnels observed could play a significant role in innervation and thus in the origins of SIJ pain. LEVEL OF EVIDENCE Individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Hanno Steinke
- Department of Anatomy, University Leipzig, Liebigstr. 13, 04103, Leipzig, Germany.
| | - Toshiyuki Saito
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Janne Kuehner
- Department of Anatomy, University Leipzig, Liebigstr. 13, 04103, Leipzig, Germany
| | - Uta Reibetanz
- Department of Biophysics, University Leipzig, Härtelstr. 16-18, 04107, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopeadics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Anna Voelker
- Department of Orthopeadics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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OUP accepted manuscript. PAIN MEDICINE 2022; 23:1863-1868. [DOI: 10.1093/pm/pnac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/20/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
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A Study on the Anatomical Relationship of the Lumbar Extrapedicular Puncture Approach with the Spinal Nerve and its Branches. Spine (Phila Pa 1976) 2021; 46:E611-E617. [PMID: 33428360 DOI: 10.1097/brs.0000000000003947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The anatomical relationship of the extrapedicular approach with the spinal nerve and its branches was researched in cadavers. Three types of extrapedicular paths were simulated: puncture inside the medial branch (MB), puncture outside the MB, and puncture outside the lateral branch (LB). At L1-L3, puncture outside the LB could avoid damage to these nerves.
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Bu L, Jiao Z, Wang A. Combination thoracic paravertebral blockade with caudal blockade provides complete anesthesia and analgesia in the percutaneous nephroscopic lithotomy. J Clin Anesth 2021; 71:110250. [PMID: 33744794 DOI: 10.1016/j.jclinane.2021.110250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Lina Bu
- Departments of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhihua Jiao
- Departments of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Aizhong Wang
- Departments of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
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Yu Y, Wang M, Ying H, Ding J, Wang H, Wang Y. The Analgesic Efficacy of Erector Spinae Plane Blocks in Patients Undergoing Posterior Lumbar Spinal Surgery for Lumbar Fracture. World Neurosurg 2020; 147:e1-e7. [PMID: 33340727 DOI: 10.1016/j.wneu.2020.10.175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the postoperative analgesic efficacy of ultrasound-guided lumbar erector spinae plane (ESP) blocks in patients undergoing posterior lumbar spinal surgery for lumbar spinal fractures. METHODS A total of 80 patients who were scheduled for posterior internal fixation for lumbar spinal fractures were divided into a patient-controlled analgesia (PCA) group or a combined ESP-PCA group. Numeric rating scale at rest and during movement, postoperative sufentanil consumption, and accumulative and effective bolus presses of PCA were recorded at 6, 12, 24, and 48 hours postoperatively. Numeric rating scale at rest and during movement was the primary outcome. Incidence of postoperative nausea and vomiting during the first 24-48 hours, pruritus and chronic postoperative pain, and dose of pethidine for rescue analgesia were also recorded. RESULTS Numeric rating scale at rest and during movement at 6, 12, and 24 hours was lower in the ESP-PCA group (P < 0.001, P < 0.001, P = 0.0016 at rest; all P < 0.001 during movement). Lumbar ESP blocks diminished accumulative bolus presses and effective bolus presses of PCA at 6, 12, 24, and 48 hours postoperatively. Besides, patients in the ESP-PCA group had fewer demands for sufentanil and pethidine. The incidence of postoperative nausea and vomiting in the ESP-PCA group was lower than that in PCA group. CONCLUSIONS PCA combined with lumbar ESP blocks provided superior postoperative analgesia for patients with lumbar spinal fractures treated with posterior internal fixation. Lumbar ESP blocks decreased postoperative opioid consumption and incidence of postoperative nausea and vomiting, thereby enhancing postoperative recovery.
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Affiliation(s)
- Yulong Yu
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Mingcang Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Haifeng Ying
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Jinfeng Ding
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Hongzhu Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Yu Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China.
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He W, He D, Sun Y, Xing Y, Liu M, Wen J, Wang W, Xi Y, Tian W, Ye X. Quantitative analysis of paraspinal muscle atrophy after oblique lateral interbody fusion alone vs. combined with percutaneous pedicle screw fixation in patients with spondylolisthesis. BMC Musculoskelet Disord 2020; 21:30. [PMID: 31937277 PMCID: PMC6961348 DOI: 10.1186/s12891-020-3051-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is no available literature for comparison on muscle atrophy between the "stand-alone" oblique lateral interbody fusion (OLIF) and regular OLIF (i.e., combined with percutaneous pedicle screws fixation (PPSF) in patients with spondylolisthesis). This study aimed to identify changes in back muscle atrophy between the two surgeries. METHODS This was a retrospective cohort study of patients who underwent OLIF or OLIF+PPSF at Beijing Jishuitan Hospital and Shanghai ChangZheng Hospital between 07/2014 and 10/2017. Computed tomography (CT) was used to measure functional cross-sectional area (FCSA) and fat infiltration percentage (FIP) of the multifidus and erector spinae before and 24 months after surgery. RESULT There were no differences in FCSA and FIP between OLIF (n = 32) and OLIF+PPSF (n = 41) groups before surgery. In the OLIF group, the multifidus and erector spinae FCSA and FIP did not change at 24 months (FCSA: multifidus: from 8.59 ± 1.76 to 9.39 ± 1.74 cm2, P = 0.072; erector spinae: from 13.32 ± 1.59 to 13.55 ± 1.31 cm2, P = 0.533) (FIP: multifidus: from 15.91 ± 5.30% to 14.38 ± 3.21%, P = 0.721; erector spinae: from 11.63 ± 3.05% to 11.22 ± 3.12%, P = 0.578). In the OLIF+PPSF group, the multifidus and erector spinae FCSA decreased (multifidus: from 7.72 ± 2.69 to 5.67 ± 1.71 cm2, P < 0.001; erector spinae: from 12.60 ± 2.04 to 10.15 ± 1.82 cm2, P < 0.001), while the FIP increased (multifidus: from 16.13 ± 7.01% to 49.38 ± 20.54%, P < 0.001; erector spinae: from 11.93 ± 3.22% to 22.60 ± 4.99%, P < 0.001). The differences of FCSA and FIP between the two groups at 24 months were significant (all P < 0.001). The patients in the standalone OLIF group had better VAS back pain, and JOA scores than the patients in the OLIF combined group (all P < 0.05) at 1 week and 3 months after surgery. There were two cases (4.9%) of adjacent segment degeneration in the OLIF combined group, while there was no case in the OLIF alone group. CONCLUSIONS Standalone OLIF had better clinical outcomes at 1 week and 3 months than OLIF+PPSF in patients with spondylolisthesis. OLIF may not result in paraspinal muscle atrophy at 24 months after surgery.
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Affiliation(s)
- Wei He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yuqing Sun
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yonggang Xing
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Mingming Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Jiankun Wen
- Department of Spine surgery, Shanghai ChangZheng Hospital, Shanghai, 200003, China
| | - Weiheng Wang
- Department of Spine surgery, Shanghai ChangZheng Hospital, Shanghai, 200003, China
| | - Yanhai Xi
- Department of Spine surgery, Shanghai ChangZheng Hospital, Shanghai, 200003, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Xiaojian Ye
- Department of Spine surgery, Shanghai ChangZheng Hospital, Shanghai, 200003, China.
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Saito T, Steinke H, Hammer N, Li ZL, Kawata S, Yasuda M, Wakao N, Koyasu H, Itoh M. Third primary branch of the posterior ramus of the spinal nerve at the thoracolumbar region: a cadaveric study. Surg Radiol Anat 2019; 41:951-961. [DOI: 10.1007/s00276-019-02258-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
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Ghabach MB, Mhanna NE, Abou Al Ezz MR, Mezher GN, Chammas MJ, Ghabach MM. Comparison of Effects of Hemostatic Gelatin Sponge Impregnated with Ropivacaine versus Normal Saline Applied on the Transverse Process of the Operated Vertebrae on Postoperative Pain in Patients Undergoing Spinal Instrumentation Surgery: A Randomized Clinical Trial. World Neurosurg 2019; 128:e1126-e1130. [PMID: 31121375 DOI: 10.1016/j.wneu.2019.05.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Protocols for effective postoperative pain control in patients undergoing spinal surgery are not standardized. In our study, we compared the effects of hemostatic absorbable gelatin sponge impregnated with ropivacaine versus normal saline when applied to the transverse process of the operated vertebrae on the postoperative pain following instrumentation spine surgery. METHODS A prospective double-blind randomized study was conducted on 30 patients undergoing spine surgery. At the end of surgery, the hemostatic gelatin sponge was applied by the surgeon on the transverse process of the operated vertebra containing either ropivacaine 0.5% or normal saline NaCl 0.9. Pain was assessed using the visual analog scale (VAS) every 4 hours for 48 hours postoperatively in the 2 groups (ropivacaine vs. normal saline). The total amount of postoperative opioid use was also recorded. RESULTS The VAS score was significantly lower in patients receiving hemostatic gelatin sponge impregnated with local anesthetics as compared with patients receiving gelatin sponge impregnated with normal saline 48 hours postoperatively; the mean total dose of meperidine given in the first 48 hours postoperatively was significantly lower (53.5 ± 51.0 mg) in patients receiving gelatin sponge impregnated with local anesthetics as compared with patients receiving hemostatic gelatin sponge impregnated with normal saline (140.5 ± 102 mg). CONCLUSIONS Use of intraoperative hemostatic gelatin sponge impregnated with ropivacaine applied on the transverse process of the operated vertebrae intraoperatively resulted in decreasing the postoperative pain in patients undergoing lumbar instrumentation surgery as manifested by the decrease in the VAS score and the total dose of opioids.
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Affiliation(s)
- Maroun B Ghabach
- Department of Anesthesiology, Rosary Sisters Hospital, Gemayze, Beirut, Lebanon.
| | - Nakhle E Mhanna
- Department of Orthopedic Surgery and Traumatology, Rosary Sisters Hospital, Gemayze, Beirut, Lebanon
| | - Morad R Abou Al Ezz
- Department of Orthopedic Surgery and Traumatology, Rosary Sisters Hospital, Gemayze, Beirut, Lebanon
| | - Georges N Mezher
- Department of Anesthesiology, Rosary Sisters Hospital, Gemayze, Beirut, Lebanon
| | - Monique J Chammas
- Department of Anesthesiology, Rosary Sisters Hospital, Gemayze, Beirut, Lebanon
| | - Marc M Ghabach
- American University of Beirut, Faculty of Medicine, Beirut, Lebanon
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Wang AZ, Fan K. Ultrasound-guided posterior ramus of spinal nerve block for anesthesia and analgesia in lumbar spinal surgery. J Clin Anesth 2018; 52:48-49. [PMID: 30176503 DOI: 10.1016/j.jclinane.2018.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/22/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Ai-Zhong Wang
- Departments of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Kun Fan
- Departments of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
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Comparative Study of 2 Skin Incisions for Microscopic Lumbar Discectomy. World Neurosurg 2016; 100:440-443. [PMID: 27777163 DOI: 10.1016/j.wneu.2016.10.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Microscopic lumbar discectomy is a common minimally invasive surgery. A transverse skin incision has sound theoretical cosmetic advantages compared with the classic vertical incision. We compared transverse and vertical skin incisions for microscopic discectomy regarding cosmetic outcome, postoperative pain, and the provided surgical cutaneous inlet. METHODS This prospective study enrolled 86 patients who were randomly assigned to a vertical incision group or a transverse incision group. The maximum surgical cutaneous inlet provided was measured in 2 diameters. Pain was recorded on postoperative days 1, 3, and 7 using a numeric patient rating scale from 0 to 10 with 0 indicating no pain. The cosmetic appearance of the wound was evaluated by a plastic surgeon and by the patients as excellent, very good, good, fair, and poor. RESULTS Compared with vertical incisions, transverse incisions provide similar surgical cutaneous inlets, cause higher pain scores on postoperative days 1 and 3 but a similar score on postoperative day 7, and ensure significantly better wound cosmesis. CONCLUSIONS Transverse skin incision for microscopic lumbar discectomy is an applicable alternative to classic midline or paramedian vertical incision with better esthetic results.
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Mekonen HK, Hikspoors JP, Mommen G, Eleonore KÖhler S, Lamers WH. Development of the epaxial muscles in the human embryo. Clin Anat 2016; 29:1031-1045. [DOI: 10.1002/ca.22775] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Hayelom K. Mekonen
- Department of Anatomy and Embryology; Maastricht University; Maastricht The Netherlands
| | - Jill P.J.M. Hikspoors
- Department of Anatomy and Embryology; Maastricht University; Maastricht The Netherlands
| | - Greet Mommen
- Department of Anatomy and Embryology; Maastricht University; Maastricht The Netherlands
| | - S. Eleonore KÖhler
- Department of Anatomy and Embryology; Maastricht University; Maastricht The Netherlands
| | - Wouter H. Lamers
- Department of Anatomy and Embryology; Maastricht University; Maastricht The Netherlands
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center; Amsterdam The Netherlands
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Putzier M, Hartwig T, Hoff EK, Streitparth F, Strube P. Minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF-a prospective randomized clinical trial. Spine J 2016; 16:811-9. [PMID: 26235468 DOI: 10.1016/j.spinee.2015.07.460] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/10/2015] [Accepted: 07/24/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT An overload of the paravertebral muscles after surgical intervention is suggested to be the major cause of postoperative pain. In cross-sectional area analyses, increased atrophy of the multifidus muscle (MF) after conventional open versus minimally invasive posterior lumbar interbody fusion (PLIF) has been described. The three-dimensional characteristics of the paravertebral muscles and separate evaluation of the longissimus muscle (LS) have not been addressed in analyses thus far. PURPOSE The purpose of the present study was to compare the MF and LS volume atrophy and fatty degeneration between single-level minimally invasive transforaminal lumbar interbody fusion (miTLIF) and conventional midline approach-based PLIF (coPLIF) of L4/L5 or L5/S1 at the index and superior adjacent segments. DESIGN This was a prospective, randomized, controlled, non-blinded study. PATIENT SAMPLE Fifty patients with single-level segment degeneration (Pfirrmann ≥III and Modic ≥3) of L4/L5 or L5/S1 not requiring decompression were randomly assigned to two groups. OUTCOME MEASURES Paraspinal lumbar residual muscle tissue volume, change in the relative fat content of MF and LS at the index and superior adjacent segments, and clinical parameters, including a visual analogue scale (VAS) for low back pain and the Oswestry Disability Questionnaire (ODI) were the outcome measures in this study. METHODS Twenty-five patients were treated with miTLIF, and the remaining patients were treated with coPLIF (both with transpedicular fixation). Clinical scoring was performed preoperatively and at 1 week and 12 months postoperatively, and computed tomography was performed at the latter two follow-ups. RESULTS The LS damage at the index segment was similar in both groups (3% greater fat content increase in the coPLIF vs. the miTLIF group, p=.032), whereas MF atrophy and degeneration were increased (p<.001) in the coPLIF group. At the adjacent segment, muscle atrophy and increased fatty infiltration (p<.05) were minimal in both muscles but were similar in both groups. Visual analogue scale and ODI scores improved (p<.001), without differences between the groups. CONCLUSIONS The muscle damage after miTLIF was inferior to that after coPLIF; spatially, however, the muscle sparing was predominantly attributed to the MF and, surprisingly, not to the LS.
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Affiliation(s)
- Michael Putzier
- Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Tony Hartwig
- Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Eike Karl Hoff
- Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Florian Streitparth
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Patrick Strube
- Klinik für Orthopädie der Friedrich-Schiller-Universität Jena, Waldkrankenhaus "Rudolf Elle" gGmbH Eisenberg, Klosterlausnitzer Strasse 81, 06706 Eisenberg, Germany.
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Umemoto K, Saito T, Naito M, Hayashi S, Yakura T, Steinke H, Nakano T. Anatomical Relationship between Bl23 and the Posterior Ramus of the L2 Spinal Nerve. Acupunct Med 2016; 34:95-100. [DOI: 10.1136/acupmed-2015-010847] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/03/2022]
Abstract
Background The acupuncture point BL23 is located in the region of the posterior ramus of the second lumbar spinal nerve (L2) and has historically been used to treat conditions such as lower back pain, pollakiuria, erectile dysfunction, dysmenorrhoea, tinnitus, and vertigo. Some of these treatment effects have been hypothesised to be mediated by the sympathetic nervous system. It was recently discovered that the posterior ramus of the spinal nerve (PRSN) at L2 forms not two but three branches. Objective To examine the relationship between the acupuncture point BL23 and the L2 PRSN in order to consider the pathways possibly affected by BL23 acupuncture. Methods Acupuncture needles were inserted through the skin at BL23 to a depth of 3 cm a total of 13 times in eight donor cadavers (seven right-sided, six left-sided). Leaving the needle in place, ventral dissection was performed to determine the PRSN anatomy between the L1 and L3 spinal segments. In four cadavers, the relationship between the L2 spinal nerve and sympathetic branches was additionally evaluated. Following dissection, three-dimensional (3D) data were acquired using a photo scanner and 3D structural images were created using 3D computer graphics software. One additional (female) cadaver was studied without insertion of an acupuncture needle (due to significant scoliosis). Results The L2 PRSN was divided into medial, intermediate and lateral branches. The needle inserted at BL23 came to lie in the region of the intermediate or lateral branches in all cases. Rami communicantes were found between the L2 spinal nerve and sympathetic trunk with fibres going on to supply the superior hypogastric plexus. Conclusions Our findings suggest that acupuncture needles inserted at BL23 come into close proximity with the intermediate or lateral branch of the L2 PRSN, which could result in stimulation of both the somatic and sympathetic nervous systems.
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Affiliation(s)
- Kanae Umemoto
- Meiji School of Oriental Medicine, Osaka, Japan
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Toshiyuki Saito
- Department of Anatomy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shogo Hayashi
- Department of Anatomy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomiko Yakura
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hanno Steinke
- Institute of Anatomy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Takashi Nakano
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
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Cooled Versus Conventional Thermal Radiofrequency Neurotomy for the Treatment of Lumbar Facet-Mediated Pain. PM R 2015; 7:1095-1101. [DOI: 10.1016/j.pmrj.2015.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 02/05/2023]
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Behringer M, Franz A, McCourt M, Mester J. Motor point map of upper body muscles. Eur J Appl Physiol 2014; 114:1605-17. [DOI: 10.1007/s00421-014-2892-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/12/2014] [Indexed: 11/30/2022]
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17
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Zhou L, Schneck CD, Shao Z. The Anatomy of Dorsal Ramus Nerves and Its Implications in Lower Back Pain. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/nm.2012.32025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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