1
|
Suo M, Zhang J, Sun T, Wang J, Liu X, Huang H, Li Z. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med 2023; 55:2258922. [PMID: 37722876 PMCID: PMC10512810 DOI: 10.1080/07853890.2023.2258922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration. OBJECTIVES The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research. METHODS We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions. RESULTS The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice. CONCLUSION The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.
Collapse
Affiliation(s)
- Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| |
Collapse
|
2
|
Wang L, Li C, Han K, Chen Y, Qi L, Liu X. Comparison of Clinical Outcomes and Muscle Invasiveness between Unilateral Biportal Endoscopic Discectomy and Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation at L5/S1 Level. Orthop Surg 2023; 15:695-703. [PMID: 36597673 PMCID: PMC9977580 DOI: 10.1111/os.13627] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Both unilateral biportal endoscopic discectomy (UBED) and percutaneous endoscopic interlaminar discectomy (PEID) could achieve favorable outcomes for lumbar disc herniation (LDH). There are limited studies comparing the two different methods of endoscopic discectomy. The objective was to comprehensively compare the clinical outcome and muscle invasiveness of UBED and PEID for the treatment of LDH at L5/S1 level with at least 1-year follow-up. METHODS The retrospective cohort study enrolled 106 LDH patients of L5/S1 level from January 2018 to December 2020. There were 51 patients who underwent UBED (22 males and 29 females, 43.8 ± 14.2 years old) and 55 patients underwent PEID (28 males and 27 females, 42.3 ± 13.8 years old). Clinical outcomes and surgical invasiveness were compared between the two groups for at least 1 year follow-up. Clinical outcomes included visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), complications, recurrence of LDH, intraoperative anesthesia time, operative time, number of intraoperative fluoroscopies, and postoperative length of stay. Surgical invasiveness was evaluated with serum CPK level and change rate of lean multifidus cross-sectional area (LMCSA). Independent-sample t test and paired sample t test were used to compare continuous data. Chi-square test and Fisher's precision probability tests were used to analyze the categorical data. RESULTS Both groups achieved favorable clinical outcomes at the last follow-up, including VAS and ODI (all Ps <0.05). The intraoperative anesthesia time for UBED was longer, but with no difference of operative time. As for intraoperative fluoroscopy times (2.5 vs 2.4), postoperative length of stay (2.1 vs 2.0 days), postoperative complications (5.9% vs 3.6%), there were also no significant difference. The serum CPK level and change rate of LMCSA for UBED was higher than PEID at postoperative 1st day. At the last follow-up, there was no significant difference in the change rate of LMCSA between the two groups (P = 0.096). CONCLUSIONS Both UBED and PEID could achieve favorable clinical outcomes for the treatment of L5/S1 LDH. Despite UBED is more invasive, the radiological manifestation of paraspinal muscle invasiveness was equal at last follow-up with at least 1 year. UBED is a safe and innovative alternative choice for treatment of LDH at L5/S1 level.
Collapse
Affiliation(s)
- Liang Wang
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina,Cheeloo College of MedicineShandong UniversityJinanShandongChina
| | - Chao Li
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| | - Kaifei Han
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| | - Yongqin Chen
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| | - Lei Qi
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| | - Xinyu Liu
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| |
Collapse
|
3
|
Pang D, Yang J, Hai Y, Fan Z, Gao H, Yin P. Changes in paraspinal muscles and facet joints after percutaneous endoscopic transforaminal lumbar interbody fusion for the treatment of lumbar spinal stenosis: A 3-year follow-up. Front Surg 2022; 9:1041105. [PMID: 36386532 PMCID: PMC9649894 DOI: 10.3389/fsurg.2022.1041105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study investigates the changes in the paraspinal muscles of lumbar spinal stenosis patients after percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF). METHODS Thirty-three patients from Beijing Chaoyang Hospital who had L4/5 segment lumbar spinal stenosis between January, 2017 and January, 2019were included in this study. Patient-reported outcomes including the visual analog scale scores for back pain and leg pain (VAS-BP and VAS-LP, respectively) and the Oswestry disability index (ODI) scores at pre-operation and 1-week, 3-month, 12-month, and (at least) 3-year follow-up (the final follow-up) were evaluated. Computed tomography (CT) was performed at the 12-month follow-up, 24-month follow-up, and the final follow-up after surgery. Multifidus (MF) muscle functional cross-sectional area (FCSA) and fat infiltration (FI) were evaluated, and the degree of adjacent facet joint degeneration was evaluated using Pathria scores. RESULTS All patients underwent at least a 3-year follow-up period. The VAS-BP, VAS-LP, and ODI were significantly lower at 1-week, 3-month, 12-month, and 3-year follow-up than at pre-operation (P < 0.05). At the 3-year follow-up, no differences were found in FCSA and FI for any patient's MF muscle at the lower third of the vertebral body (L3) above the operation level (P > 0.05), and there was no statistical difference in the central plane of the L3/4 and L5/S1 vertebral facet joints at pre-operation, 12-month, 24-month, and 3-month follow-up (P > 0.05). CONCLUSIONS PE-TLIF can provide satisfactory clinical outcomes for patients with lumbar spinal stenosis. Furthermore, the technique may also reduce the injury on the paravertebral muscles, especially the MF muscle, as well as on adjacent facet joints.
Collapse
Affiliation(s)
| | | | | | | | | | - Peng Yin
- Correspondence: Jincai Yang Peng Yin
| |
Collapse
|
4
|
Hellinger S, Telfeian AE, Lewandrowski KU. Magnetic Resonance Imaging Documentation of Approach Trauma With Lumbar Endoscopic Interlaminar, Translaminar, Compared to Open Microsurgical Discectomy. Int J Spine Surg 2022; 16:343-352. [PMID: 35444042 PMCID: PMC9930667 DOI: 10.14444/8226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Endoscopic spine surgery is associated with less approach trauma than conventional open translaminar surgery. However, objective evidence to corroborate this empiric observation is scarce. Preservation of the anatomic attachment and sensory function of multifidus muscles have been stipulated to be critical to maintaining the normal function of the lumbar spinal motion segment. The authors were interested in comparing the postoperative approach trauma between traditional open translaminar microsurgical and interlaminar endoscopic discectomy. METHODS The approach trauma to the paraspinal muscles due to interlaminar or open microsurgical discectomy was evaluated on T2-weighted axial magnetic resonance imaging (MRI) images of 39 consecutive patients who underwent lumbar disc surgery. Postoperative MRI images taken at 4 days and within 1 year after surgery were analyzed. Eleven patients underwent conventional open translaminar microdiscectomy surgery. Endoscopic discectomy was performed on 17 patients via the interlaminar and on another 11 patients via the transforaminal approach. The immediate surgical approach trauma was estimated as the defect zone by measuring the normalized relative cross-sectional area (rCSA) of muscle disruption in the surgical corridor 4 days postoperatively. The long-term effect of surgical approach trauma was assessed by measuring the area of the paraspinal muscles that had been replaced by fatty tissue 1 year postoperatively. RESULTS The rCSA data showed diminished approach trauma with a smaller surgical defect zone in the interlaminar endoscopy group (17.6%) was smaller than in the microsurgical group 4 days postoperatively (41.2%). At 1 year postoperatively, the mean fatty replacement of the paraspinal muscles was 23.6% after microsurgery and 2.1% after the interlaminar endoscopy. Muscle recovery was substantially reduced in the interlaminar endoscopic group, with the muscle zone reducing from 20.3% to 2.1% when analyzed 1 year postoperatively. In the microsurgery group, the muscle damage by atrophy increased from 41.2% to 62.9% at 1 year postoperatively (P < 0.001). Fatty replacement of the multifidus muscle was seen on the ipsilateral and contralateral approach side. There was a negligible change in the muscle zone with the transforaminal approach. CONCLUSIONS Tissue trauma was significantly reduced with endoscopic surgery techniques compared with the traditional translaminar microdiscectomy approach. There was a minor postoperative tissue trauma and hardly any long-term replacement of the multifidus and paraspinal muscles by fatty tissue 1 year postoperatively with the endoscopic technique. The transforaminal approach has the least effect on the paraspinal muscles of the surgical motion segment. Further study is needed to investigate whether these findings translate into decreased postoperative instability or low back pain following endoscopic discectomy surgery. CLINICAL RELEVANCE MRI analysis of multifidus atrophy following various lumbar translaminar and transforaminal decompression techniques. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- Stefan Hellinger
- Department of Orthopedic Surgery, Arabella Klinik, Munich, Germany
| | - Albert E. Telfeian
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA,Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, AZ, USA .,Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, DC, Colombia.,Department of Orthopaedic Surgery, UNIRIO, Rio de Janeiro, Brazil
| |
Collapse
|
5
|
Tsai CY, Su YF, Kuo KL, Ko HJ, Su HY, Wu CH, Chou YL, Lin CL, Tsai TH. Minimally Invasive Transforaminal Lumbar Interbody Fusion for 2-Level Degenerative Lumbar Disease in Patients With Osteoporosis: Long-Term Clinical and Radiographic Outcomes. Oper Neurosurg (Hagerstown) 2021; 20:535-540. [PMID: 33550407 DOI: 10.1093/ons/opab009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Spine fusion surgery in osteoporosis remains controversial because it is related to a high incidence of osteoporosis-related complications, such as cage nonfusion, pedicle screw loosening, and new vertebral compression fractures (VCFs). OBJECTIVE To treat 2-level degenerative lumbar disease in osteoporosis patients as an effective and safe surgical treatment for long-term results using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS We retrospectively assessed 12 patients with osteoporosis who underwent MIS-TLIF on L4 and L5 between 2011 and 2012 to assess the clinical and radiographic results for 2-level lumbar degenerative spine disease. All patients were followed-up for at least 2 yr after surgery and assessed by using X-ray. Basic patient data and clinical and radiological outcomes were collected and analyzed. RESULTS Of all 12 patients, 11/12 (91.6%) and 1/12 (8.3%) demonstrated cage fusion and cage subsidence, respectively. Pedicle screw loosening was found in 1/12 (8.3%) patients. The P-values calculated using the F-test for changes in the vertebral body height pre- and postoperation in L3, L4, and L5 were .69, .87, and .39, respectively. The data revealed no significant variants of new VCFs. CONCLUSION MIS-TLIF provided a high cage fusion rate and low pedicle screw loosening rate in patients with osteoporosis with 2-level degenerative spine disease. Furthermore, no new VCFs were found in long-term follow-up. The clinical outcomes also demonstrated no significant difference compared with traditional open spine fusion surgery. Therefore, MIS-TLIF could be considered an effective and safe surgical treatment modality for 2-level degenerative spine disease in osteoporosis.
Collapse
Affiliation(s)
- Cheng-Yu Tsai
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, National Health Research Institutes, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Su
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Keng-Liang Kuo
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Huey-Jiun Ko
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Yuan Su
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chieh-Hsin Wu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Lin Chou
- Division of Spine Surgery, Chi Hsien Spine Hospital, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Hsin Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
6
|
Khalooeifard R, Shariatpanahi ZAHRAVAHDAT, Ahani A, Keykhaee M, Oraee-Yazdani M, Zali A, Oraee-Yazdani S. Effect of Protein Supplement on Paraspinal Muscles in Spine Fusion Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial. Int J Spine Surg 2021; 15:47-54. [PMID: 33900956 PMCID: PMC7931746 DOI: 10.14444/8005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Dysfunction and weakness due to atrophy of the paraspinal muscles is a major issue after posterior spinal fusion (PSF) surgery, resulting in pain and disability. Considering the role of protein in muscle regeneration, it seems that protein supplements after surgery may prevent muscle atrophy. To date, to our knowledge, no intervention study has investigated the effect of protein supplementation on the volume of paraspinal muscles, pain, or disability after PSF. METHODS In this randomized, double-blind, placebo-controlled clinical trial, patients were randomly assigned to a control (placebo + diet with 1.2 g/kg body weight of protein, n = 40) or a protein supplementation (36 g/day + a diet with 1.2 g/kg body weight of protein, n = 40) group, which received intervention from 48 hours before to 1 month after surgery. The cross-sectional area (CSA) of the paraspinal muscles was measured by thin-slice computed tomography, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. RESULTS After 4 weeks of protein supplementation, the CSAs of multifidus and psoas muscles on both sides were significantly higher in the supplementation group than the placebo group (P <.001). Less atrophy was seen in the right erector spinae and quadratus lumborum muscles in the group receiving protein supplements than the placebo group (P < .001). In addition, protein supplementation was significantly negatively correlated with both pain (P < .001) and disability (P < .001). CONCLUSIONS In conclusion, we demonstrated that 36 g/day protein supplementation significantly increased the CSA of muscles and reduced the atrophy, pain, and disability after PSF surgery. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
- Razieh Khalooeifard
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - ZAHRA VAHDAT Shariatpanahi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirahmad Ahani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Keykhaee
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Hofste A, Soer R, Hermens HJ, Wagner H, Oosterveld FGJ, Wolff AP, Groen GJ. Inconsistent descriptions of lumbar multifidus morphology: A scoping review. BMC Musculoskelet Disord 2020; 21:312. [PMID: 32429944 PMCID: PMC7236939 DOI: 10.1186/s12891-020-03257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
Background Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature. Methods Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system. Results In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings – particularly for levels L4–S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases. Discussion Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas. Conclusions We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology.
Collapse
Affiliation(s)
- Anke Hofste
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands. .,Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands.
| | - Remko Soer
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands.,Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.,Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
| | - Heiko Wagner
- Department of Movement Science, Institute of Sport and Exercise Sciences, Münster, Germany
| | - Frits G J Oosterveld
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - André P Wolff
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands
| | - Gerbrand J Groen
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Abstract
STUDY DESIGN Single institution retrospective clinical review. OBJECTIVE To investigate the relationship between levels fused and clinical outcomes in patients undergoing open and minimally invasive surgical (MIS) lumbar fusion. SUMMARY OF BACKGROUND DATA Minimally invasive spinal fusion aims to reduce the morbidity associated with conventional open surgery. As multilevel arthrodesis procedures are increasingly performed using MIS techniques, it is necessary to weigh the risks and benefits of multilevel MIS lumbar fusion as a function of fusion length. METHODS Patients undergoing <4 level lumbar interbody fusion were stratified by surgical technique (MIS or open), and grouped by fusion length: 1-level, 2-levels, 3+ levels. Demographics, Charlson Comorbidity Index (CCI), surgical factors, and perioperative complication rates were compared between technique groups at different fusion lengths using means comparison tests. RESULTS Included: 361 patients undergoing lumbar interbody fusion (88% transforaminal, 14% lateral; 41% MIS). Breakdown by fusion length: 63% 1-level, 22% 2-level, 15% 3+ level. Op-time did not differ between groups at 1-level (MIS: 233 min vs. Open: 227, P = 0.554), though MIS at 2-levels (332 min vs. 281) and 3+ levels (373 min vs. 323) were longer (P = 0.033 and P = 0.231, respectively). While complication rates were lower for MIS at 1-level (15% vs. 30%, P = 0.006) and 2-levels (13% vs. 27%, P = 0.147), at 3+ levels, complication rates were comparable (38% vs. 35%, P = 0.870). 3+ level MIS fusions had higher rates of ileus (13% vs. 0%, P = 0.008) and a trend of increased adverse pulmonary events (25% vs. 7%, P = 0.110). MIS was associated with less EBL at all lengths (all P < 0.01) and lower rates of anemia at 1-level (5% vs. 18%, P < 0.001) and 2-levels (7% vs. 16%, P = 0.193). At 3+ levels, however, anemia rates were similar between groups (13% vs. 15%, P = 0.877). CONCLUSION MIS lumbar interbody fusions provided diminishing clinical returns for multilevel procedures. While MIS patients had lower rates of perioperative complications for 1- and 2-level fusions, 3+ level MIS fusions had comparable complication rates to open cases, and higher rates of adverse pulmonary and ileus events. LEVEL OF EVIDENCE 3.
Collapse
|
10
|
Zhu HF, Wang GL, Zhou ZJ, Fan SW. Prospective Study of Long-term Effect between Multifidus Muscle Bundle and Conventional Open Approach in One-level Posterior Lumbar Interbody Fusion. Orthop Surg 2018; 10:296-305. [PMID: 30402963 DOI: 10.1111/os.12402] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/07/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To compare postoperative imaging results, clinical outcomes and complications between the multifidus muscle bundle (MMB) approach and the conventional open (CO) approach in one-level posterior lumbar interbody fusion (PLIF). METHODS Based on the inclusion and exclusion criteria, 201 of 351 patients in our hospital were enrolled in this prospective study and underwent MMB-PLIF or CO-PLIF randomly: 111 patients in the MMB-PLIF group and 90 patients in the CO-PLIF group. A total of 100 patients failed to be followed up in the following 7-9 years. Therefore, in this study, 52 patients of the MMB group and 49 patients of the CO group were included. We evaluated the differences in terms of multifidus atrophy rate, intervertebral disc height and segmental lordosis restoration of the operation segment, lumbar lordosis restoration, fusion rate, visual analogue scale (VAS) for back and leg pain, Oswestry disability index (ODI), complication rates, and patient satisfaction rates between the two groups. Correlation between multifidus muscle degeneration and the incidence of complications was investigated, and we compared the multifidus muscle degeneration rate between patients with or without intractable back pain or adjacent segment degeneration. RESULTS There were no significant differences in age, sex, body mass index (BMI), diagnosis, segments distribution, and mean follow-up time between the MMB-PLIF group and the CO-PLIF group. In addition, no differences regarding sex, age, or BMI were found between the lost follow-up group and the successful follow-up group. In regard to imaging and clinical evaluation, at the final follow-up, there were significant differences in multifidus atrophy rates (27.0% ± 6.8% vs 38.7% ± 10.9%), lumbar lordosis restoration (4.6° ± 2.5° vs 3.0° ± 1.9°), postoperative VAS for back pain (1.1 ± 0.9 vs 1.8 ± 1.2), ODI (7.7 ± 5.0 vs 12.4 ± 6.7), and patient satisfaction rates (86.5% vs 61.2%) between MMB-PLIF and CO-PLIF groups. However, there were no significant differences in segmental lordosis, intervertebral height restoration, postoperative VAS for leg pain or fusion rate between the two groups. In regards to complications, there were significant differences in the incidence of adjacent segment degeneration (3.8% vs 14.3%), intractable back pain (3.8% vs 22.4%), and residual neurological symptoms (5.8% vs 20.4%) between the two groups (P < 0.05) at the final follow-up. In addition, patients with adjacent segment degeneration and intractable back pain were observed with more significant multifidus muscle atrophy than those without these two complications (31.9% ± 1.1% vs 39.6% ± 2.1% and 30.9% ± 1.1% vs 42.8% ± 2.1%). CONCLUSION Compared with CO-PLIF, MMB-PLIF had advantages in relation to protection of the multifidus muscle, better maintenance of lumbar lordosis, reduced lower back pain and ODI score, fewer complications, and a higher patient satisfaction rate. Protection of the multifidus muscle in lumbar surgery is an important aspect of minimally invasive surgery.
Collapse
Affiliation(s)
- Hai-Feng Zhu
- Department of Orthopedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Gang-Liang Wang
- Department of Orthopedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Zhi-Jie Zhou
- Department of Orthopedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Shun-Wu Fan
- Department of Orthopedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| |
Collapse
|
11
|
Clinical Correlation between Muscle Damage and Oswestry Disability Index Score after Open Lumbar Surgery: Does Open Surgery Reduces Functional Ability? Asian Spine J 2018; 12:518-523. [PMID: 29879780 PMCID: PMC6002177 DOI: 10.4184/asj.2018.12.3.518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 10/02/2017] [Accepted: 10/10/2017] [Indexed: 12/12/2022] Open
Abstract
STUDY DESIGN Single-surgeon, single-center prospective study with prospective data collection. PURPOSE To clinically evaluate muscle damage after open lumbar surgery and its relationship to functional activity and to validatethe improvement in function as indicated by improved Oswestry Disability Index (ODI) score despite muscle damage. OVERVIEW OF LITERATURE Few studies have analyzed the functional loss and recovery pattern of muscles after open lumbar surgery. METHODS The study included 30 patients who underwent open lumbar spine fusion surgery at our institution between August 2013 and May 2015. Preoperatively and at 6 months postoperatively, the patients were subjected to functional, biochemical, electrophysiological, and radiological assessments as outpatients, and the results were compared. RESULTS Mean preoperative and 6-month postoperative values were as follows: creatine phosphokinase levels, 133.07±17.57 and 139±17.7 U/L (p <0.001); Visual Analog Scale scores for backache, 6.73±0.88 and 3.27±0.96 (p <0.001); and ODI scores, 41.6±5.51 and 22.4±4.48 (p <0.001), respectively. Preoperatively, electrophysiological studies showed that 20% of the patients had a polyphasic configuration whereas at 6 months postoperatively, all patients had polyphasic configuration (p <0.001). The mean cross-sectional area of the multifidus observed using magnetic resonance imaging (MRI) decreased from 742.67±76.62 mm2 preoperatively to 598.27±66.38 mm2 6 months postoperatively (p <0.001), with all the patients exhibiting grade 2 atrophy. CONCLUSIONS Open lumbar fusion surgery resulted in significant damage to the lumbar paraspinal muscles, as indicated by a reduction in the cross-sectional area of the multifidus by MRI and denervation of the multifidus demonstrated using electromyography. Nevertheless, the patients reported reduced back pain and improved quality of life, which may have been due to increased stability of the previously unstable lumbar spinal segment after the surgery.
Collapse
|
12
|
Assessment of Paraspinal Muscle Atrophy Percentage after Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Instrumentation Using a Novel Contralateral Intact Muscle-Controlled Model. Asian Spine J 2018; 12:256-262. [PMID: 29713406 PMCID: PMC5913016 DOI: 10.4184/asj.2018.12.2.256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/13/2017] [Accepted: 06/28/2017] [Indexed: 02/07/2023] Open
Abstract
Study Design Retrospective comparative clinical study. Purpose This study aimed to assess paraspinal muscle atrophy in patients who underwent minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and unilateral pedicle screw fixation using a novel contralateral intact muscle-controlled model. Overview of Literature The increased incidence of paravertebral lumbar muscle injuries after open techniques has raised the importance of implementing minimally invasive spine surgical techniques using tubular retractors and minimally invasive screw placement. The functional cross-sectional area (FCSA) represents the lean muscle mass; furthermore, FCSA is a useful marker of the contractile ability of a muscle following a spine surgery. However, the benefits of unilateral fixation and MI-TLIF on paraspinal muscles have not been defined. Methods We performed a retrospective imagenological review on eleven patients who underwent unilateral MI-TLIF and unilateral transpedicular screw lumbar placement. FCSAs of the multifidus and erector spinae were measured 1 year after surgery at adjacent levels and were compared to the contralateral intact muscles. Measurement differences between the surgical and nonsurgical sites were compared. The interobserver reliability was calculated using an intraclass correlation coefficient. Results The mean FCSA at the surgical site was 20.97±5.07 cm2 at the superior level and 8.89±2.87 cm2 at the inferior level. The mean FCSA at the contralateral nonsurgical site was 20.15±5.95 cm2 at the superior level and 9.20±2.66 cm2 at the inferior level was. The superior and inferior FCSA measurements showed no significant difference between the surgical and nonsurgical sites (p=0.5, p=0.922, respectively). Conclusions Using a mini-open tubular approach through the sulcus between the longissimus and iliocostalis, MI-TLIF and unilateral pedicle screw instrumentation produced minimal paraspinal muscle damage at the superior and inferior adjacent levels.
Collapse
|
13
|
Spinal Biologics in Minimally Invasive Lumbar Surgery. Minim Invasive Surg 2018; 2018:5230350. [PMID: 29850240 PMCID: PMC5907390 DOI: 10.1155/2018/5230350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/25/2018] [Indexed: 12/28/2022] Open
Abstract
As the use of minimally invasive spine (MIS) fusion approaches continues to grow, increased scrutiny is being placed on its outcomes and efficacies against traditional open fusion surgeries. While there are many factors that contribute to the success of achieving spinal arthrodesis, selecting the optimal fusion biologic remains a top priority. With an ever-expanding market of bone graft substitutes, it is important to evaluate each of their use as it pertains to MIS techniques. This review will summarize the important characteristics and properties of various spinal biologics used in minimally invasive lumbar surgeries and compare their fusion rates via a systematic review of published literature.
Collapse
|
14
|
Kim YE, Choi HW. Does stabilization of the degenerative lumbar spine itself produce multifidus atrophy? Med Eng Phys 2017; 49:63-70. [PMID: 28774686 DOI: 10.1016/j.medengphy.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/25/2017] [Accepted: 07/17/2017] [Indexed: 11/25/2022]
Abstract
The effect of stabilization of the degenerative segment on changes in the pattern of paraspinal muscle activity was investigated using a previously developed musculoskeletal model. Muscle activity change depending on L4-L5 segment stabilization with and without taking into account the presence of multifidus atrophy according to direct invasion of the back muscle during surgery (MADIBM) was analysed in erect standing and 20° flexed postures. For the stabilization of the degenerative segment, a fusion or non-fusion stabilization with a pedicle-based dynamic stabilization system (PBDS) was applied. During erect standing, fusion generated a 12% reduction in the total multifidus muscle force, while its reduction was 6.6% with PBDS application. The presence of MADIBM produced 23.0% and 22.5% reductions in fusion and with PBDS application, respectively. During 20° flexion, 10.5% and 9.3% reductions were produced for fusion and PBDS application, respectively, and the corresponding values were 23.4% and 23.0%, respectively, in the presence of MADIBM. Increased facet joint contact forces were produced at the non-stabilized levels after stabilization while in erect standing posture. Alterations in muscle activity, which could be regarded as adaptions to altered spinal stability, may generate unexpected secondary problems in the spine.
Collapse
Affiliation(s)
- Young Eun Kim
- Department of Mechanical Engineering, Dankook University, 152, Jukjeon-ro, Suji-gu, Yongin-si, Gyeonggi-do, 16890, Republic of Korea.
| | - Hae Won Choi
- Department of Mechanical Engineering, Dankook University, 152, Jukjeon-ro, Suji-gu, Yongin-si, Gyeonggi-do, 16890, Republic of Korea
| |
Collapse
|
15
|
Multifidus Muscle Atrophy Not Observed Following Two-segment Anterior Interbody Fusion: A Rabbit Model Study With a 12-Month Follow-up. Spine (Phila Pa 1976) 2017; 42:711-717. [PMID: 27683975 DOI: 10.1097/brs.0000000000001917] [Citation(s) in RCA: 2] [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
STUDY DESIGN Experimental study evaluated magnetic resonance imaging (MRI) and histologic changes in the multifidus muscle after anterior spinal fusion. OBJECTIVE To determine the effect of spinal fusion on the multifidus muscle in an anterior rabbit model through the use of MRI and histologic evaluation. SUMMARY OF BACKGROUND DATA Retraction and splitting approach are known to be important factors in postoperative injury and atrophy of the multifidus muscle. The effect and possible mechanism of spinal fusion as an independent factor remains unknown. METHODS Thirty-six New Zealand white rabbits were divided into two groups. Animals in the fusion group underwent two-level anterior spinal fusion whereas those in the control group underwent similar surgery without spinal fusion. The status of the multifidus muscle was evaluated with MRI and histological analysis at preoperative, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. RESULTS All rabbits in the fusion group achieved solid fusion. The mean T1-weighted and T2-weighted signal intensity ratios of gross multifidus to psoas muscles were all approximately 1.0 postoperatively, with no remarkable difference between the groups. The mean lesser diameter of myofibrils in either group did not significantly differ between the preoperative and postoperative specimens. There was no significant fibrotic change or fatty degeneration for either group. Decrease in acetylcholine activity or granular degeneration of the neuromuscular junction were not observed, and normal shape and size were found in nearly all samples at all time points in both groups (P > 0.05). CONCLUSION After two-segment anterior spinal fusion, multifidus atrophy was not observed throughout a 12-month follow up. The rabbit model of anterior fusion is better suited to study the effect of fusion alone on the status of the multifidus muscle. LEVEL OF EVIDENCE 3.
Collapse
|
16
|
Kim JY, Ryu DS, Paik HK, Ahn SS, Kang MS, Kim KH, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU. Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J 2016; 16:867-75. [PMID: 26970600 DOI: 10.1016/j.spinee.2016.03.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/21/2016] [Accepted: 03/04/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adjacent segment degeneration (ASD) is one of the major complications after lumbar fusion. Several studies have evaluated the risk factors of ASD. Although the paraspinal muscles play an important role in spine stability, no study has assessed the relationship between paraspinal muscle atrophy and the incidence of ASD after lumbar fusion. PURPOSE In the present study, we aimed to verify the known risk factors of ASD, such as body mass index (BMI), preoperative adjacent facet joint degeneration, and disc degeneration, and to assess the relationship between paraspinal muscle atrophy and ASD. STUDY DESIGN This is a retrospective 1:1 pair analysis matched by age, sex, fusion level, and follow-up period. PATIENT SAMPLE To calculate the appropriate sample size for the study, we performed a pre-study analysis of the paraspinal muscle cross-sectional area (CSA), and estimated that at least 35 cases would be needed for each group. Among the 510 patients who underwent posterior lumbar fusion for degenerative lumbar disease between January 2009 and October 2009, a total of 50 patients with ASD after surgery were selected. Another group of 50 matched patients with degenerative lumbar disease without ASD after spinal fusion were selected as the control group. Each patient in the ASD group was matched with a control patient according to age, sex, fusion level, and follow-up period. OUTCOME MEASURES Radiographic measurements and demographic data were reviewed. METHODS The risk factors considered were higher BMI, preoperative adjacent segment disc and facet degeneration, and preoperative paraspinal muscle atrophy and fatty degeneration. The radiographic data were compared between the ASD and control groups to determine the predictive factors of ASD after posterior lumbar fusion by using logistic regression analysis. The study was not externally funded. The authors have no conflict of interest to declare. RESULTS Multivariate logistic regression analysis indicated that higher BMI (odds ratio [OR]: 1.353, p=.008), preoperative facet degeneration on computed tomography examination (OR: 3.075, p=.011), disc degeneration on magnetic resonance imaging (MRI) (OR: 2.783, p=.003), fatty degeneration (OR: 1.080, p=.044), and a smaller relative CSA of the paraspinal muscle preoperatively (OR: 0.083, p=.003) were significant factors for predicting the development of ASD. CONCLUSIONS The occurrence of radiological ASD is most likely multifactorial, and is associated with a higher BMI, preexisting facet and disc degeneration on preoperative examination, and a smaller preoperative relative CSA of the paraspinal muscle on MRI.
Collapse
Affiliation(s)
- Jong Yeol Kim
- Department of Neurosurgery, Gospel Hospital, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan, 49267, Republic of Korea
| | - Dal Sung Ryu
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Ho Kyu Paik
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Sang Soak Ahn
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Moo Sung Kang
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Jeong Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Dong Kyu Chin
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Keun Su Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
| |
Collapse
|