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Guven AE, Evangelisti G, Burkhard MD, Köhli P, Hambrecht J, Zhu J, Chiapparelli E, Kelly M, Tsuchiya K, Amoroso K, Zadeh A, Shue J, Tan ET, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Asymmetrical atrophy of the paraspinal muscles in patients undergoing unilateral lumbar medial branch radiofrequency neurotomy. Pain 2024:00006396-990000000-00557. [PMID: 38635483 DOI: 10.1097/j.pain.0000000000003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/31/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Lumbar medial branch radiofrequency neurotomy (RFN), a common treatment for chronic low back pain due to facet joint osteoarthritis (FJOA), may amplify paraspinal muscle atrophy due to denervation. This study aimed to investigate the asymmetry of paraspinal muscle morphology change in patients undergoing unilateral lumbar medial branch RFN. Data from patients who underwent RFN between March 2016 and October 2021 were retrospectively analyzed. Lumbar foramina stenosis (LFS), FJOA, and fatty infiltration (FI) functional cross-sectional area (fCSA) of the paraspinal muscles were assessed on preinterventional and minimum 2-year postinterventional MRI. Wilcoxon signed-rank tests compared measurements between sides. A total of 51 levels of 24 patients were included in the analysis, with 102 sides compared. Baseline MRI measurements did not differ significantly between the RFN side and the contralateral side. The RFN side had a higher increase in multifidus FI (+4.2% [0.3-7.8] vs +2.0% [-2.2 to 6.2], P = 0.005) and a higher decrease in multifidus fCSA (-60.9 mm2 [-116.0 to 10.8] vs -19.6 mm2 [-80.3 to 44.8], P = 0.003) compared with the contralateral side. The change in erector spinae FI and fCSA did not differ between sides. The RFN side had a higher increase in multifidus muscle atrophy compared with the contralateral side. The absence of significant preinterventional degenerative asymmetry and the specificity of the effect to the multifidus muscle suggest a link to RFN. These findings highlight the importance of considering the long-term effects of lumbar medial branch RFN on paraspinal muscle health.
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Affiliation(s)
- Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Gisberto Evangelisti
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco D Burkhard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Paul Köhli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Hambrecht
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, United States
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Michael Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Koki Tsuchiya
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Arman Zadeh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
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