How does back muscle strength change after posterior lumbar interbody fusion?

Risk factors for postoperative complaints in patients following lumbar decompression and fusion: Analyses focusing on preoperative symptoms

BACKGROUND

Several patients complained of residual symptoms following lumbar decompressive surgery for lumbar degenerative disease (LDD). However, few studies analyze this dissatisfaction by focusing on preoperative patients' symptoms. This study was conduct to determine the factors that could predict the patients' postoperative complaints by focusing on their preoperative symptoms.

METHODS

Four hundred and seventeen consecutive patients who underwent lumbar decompression and fusion surgery for LDD were included. Postoperative complaint was defined by at least twice same complaint during the outpatient follow-up of 6,12, 18 and 24 months after surgery. A comparative analysis was performed between complaint group (group C, N = 168) and non-complaint group (group NC, N = 249). Demographic, operative, symptomatic, and clinical factors were compared between the groups by univariate and multivariate analyses.

RESULTS

The main preoperative chief complaints were radiating pain (318/417, 76.2%). However, most common postoperative complaint was residual radiating pain (60/168, 35.7%) followed by tingling sensation (43/168, 25.6%). The presence of psychiatric disease (adjusted odds ratio [aOR], 4.666; P = 0.017), longer pain duration (aOR, 1.021; P < 0.001), pain to below the knee (aOR, 2.326; P = 0.001), preoperative tingling sensation (aOR, 2.631; P < 0.001), preoperative sensory and motor power decrease (aOR, 2.152 and 1.678; P = 0,047 and 0.011, respectively) were significantly correlated with postoperative patients' complaints in multivariate analysis.

CONCLUSIONS

The postoperative patients' complaints could be predicted and explained in advance by checking the preoperative characteristics of patients' symptoms, including the duration and site carefully. This could be helpful to enhance the understanding of the surgical results preoperatively, which could control the anticipation of the patients.

Recovery of the Japanese orthopedic association back pain evaluation questionnaire score and walking ability following lumbar spinal stenosis surgery

PURPOSE

We investigated the recovery of the Japanese orthopedic association back pain evaluation questionnaire (JOABPEQ) scores and 6 min walk distance (6MWD) in patients after surgery for lumbar spinal stenosis and identified the items among 25 questions of JOABPEQ that showed recovery.

METHODS

A total of 227 patients (average age 71.5 years; SD: 7.5; 121 men) were included from a single center. The outcome measures were JOABPEQ, visual analog scale (VAS), and 6MWD and obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Mixed-model repeated measures were used to compare the variables at each time point between the surgery groups.

RESULTS

The JOABPEQ, VAS, and 6MWD scores generally improved at 1 month postoperatively compared with those obtained preoperatively, and some parameters further improved at 3 months. However, improvement in the lumbar spine dysfunction item of JOABPEQ was delayed, showing improvement at 3 months postoperatively for decompression surgery (average score: pre, 64.6; 3 months, 78.5) and 6 months postoperatively for fusion surgery (average score: Pre, 64.3; 6 months, 77.1). Responses to the individual JOABPEQ questions generally improved after surgery. No significant changes in lumbar spine dysfunction occurred in the fusion group.

CONCLUSION

Our results demonstrated the early postoperative recovery course of JOABPEQ and 6MWD. In the fusion group, significant changes in lumbar spine dysfunction started at 6 months postoperatively. These findings could help medical staff explain postoperative recovery to patients after lumbar spinal stenosis surgery and in their decision making regarding surgery.

Changes in psoas and posterior paraspinal muscle morphology after standalone lateral lumbar interbody fusion: a quantitative MRI-based analysis

PURPOSE

Standalone lateral lumbar interbody fusion (SA-LLIF) without posterior instrumentation can be an alternative to 360° fusion in selected cases. This study aimed to investigate quantitative changes in psoas and paraspinal muscle morphology that occur on index levels after SA-LLIF.

METHODS

Patients undergoing single- or multi-level SA-LLIF at L2/3 to L4/5 who had preoperative and postoperative lumbar MRI scans, the latter performed between 3 and 18 months after surgery for any reason, were retrospectively included. Muscle measurements were performed of the psoas and posterior paraspinal muscles (PPM; erector spinae and multifidus) on index levels using manual segmentation and an automated pixel intensity threshold method to differentiate muscle from fat signal. Changes in the total cross-sectional area (TCSA), the functional cross-sectional area (FCSA), and the percentage of fat infiltration (FI) of these muscles were assessed.

RESULTS

A total of 67 patients (55.2% female, age 64.3 ± 10.6 years, BMI 26.9 ± 5.0 kg/m2) with 125 operated levels were included. Follow-up MRI scans were performed after an average of 8.7 ± 4.6 months, primarily for low back pain. Psoas muscle parameters did not change significantly, irrespective of the approach side. Among PPM parameters, the mean TCSA at L4/5 (+ 4.8 ± 12.4%; p = 0.013), and mean FI at L3/4 (+ 3.1 ± 6.5%; p = 0.002) and L4/5 (+ 3.0 ± 7.0%; p = 0.002) significantly increased.

CONCLUSION

Our study demonstrated that SA-LLIF did not alter psoas muscle morphology, underlining its minimally invasive nature. However, FI of PPM significantly increased over time despite the lack of direct tissue damage to posterior structures, suggesting a pain-mediated response and/or the result of segmental immobilization.

Comparison of multifidus degeneration between scoliosis and lumbar disc herniation

Objective

To assess and compare the pathological and radiological outcomes of multifidus degeneration in scoliosis and lumbar disc herniation patients.

Methods

We performed a retrospective review on 24 patients with scoliosis and 26 patients with lumbar disc herniation (LDH) in the Third Hospital of Hebei Medical University from January 2017 to March2021. The patients were divided into scoliosis group and LDH group according to the treatment. The MRI fatty infiltration rate (FIR) of multifidus and strength of back muscle were calculated to evaluate muscle condition. Multifidus biopsy samples were obtained during surgery in the affected side at L4 or L5 segment in LDH group and on the concavity side of apical vertebrae in scoliosis group. The biopsy fatty infiltration degree (FID) and FIR in two groups, the FIR of affected and unaffected side in LDH group, and the FIR of concavity and convexity side in scoliosis group were compared. The correlation between concavity-convexity FIR difference and cobb angle in scoliosis group, back muscle strength and FIR in LDH group, FID and FIR in both groups was calculated respectively.

Results

The FIR was higher in scoliosis group than in LDH group, higher in concavity side than convexity side in scoliosis group (both P < 0.05). The FID was higher in scoliosis group than in LDH group (P < 0.05). No significant difference was found between affected and unaffected side in LDH group (P > 0.05). There was a positive correlation between concavity-convexity FIR difference and cobb angle, FIR and FID (both P < 0.01). There was a negative correlation between back muscle strength and FIR (P < 0.01). The biopsy staining results showed that both two groups were found the existence of rimmed vacuoles, nuclear aggregation, and abnormal enzyme activity, indicating that the scoliosis and LDH may be associated with myogenic diseases.

Conclusion

The scoliosis patients showed more serious fatty infiltration than LDH patients and rare pathological findings were found in both diseases.

Correlations between paraspinal extensor muscle endurance and clinical outcomes in preoperative LSS patients and clinical value of an endurance classification

Background

Few study has investigated how paraspinal muscle endurance deteriorates in lumbar spinal stenosis (LSS) patients. In addition, little information is available on the relationship between clinical outcomes and the endurance of paraspinal muscles.

Objective

To explore the correlation between paraspinal extensor muscle endurance, quality of life (QOL) and sagittal spinopelvic alignment. Besides, we attempted to propose a paraspinal extensor muscle endurance test (PEMET) classification for identifying the severity of clinical symptoms and sagittal imbalance in LSS patients.

Methods

171 hospitalized LSS patients and 100 healthy controls from the community were prospectively enrolled in this study. The paraspinal extensor endurance test was performed at baseline according to Ito test. The LSS patients were stratified into three groups based on the performance time of endurance test: grade I (<10s); grade II (10–60s); and grade III (>60s). Clinical measures of QOL included the visual analog scale scores (VAS) for back pain and leg pain and the Oswestry Disability Index (ODI). Sagittal alignment was analysed by standing posteroanterior and lateral whole spine X-ray in LSS patients.

Results

The LSS group had a significantly shorter performance time of the endurance test than the control group. The paraspinal muscle endurance significantly correlated with VAS-back, VAS-leg, ODI, pelvic tilt, lumbar lordosis and sagittal vertical axis (SVA; all p < 0.05). In binary logistic regression, the performance time of the endurance test was an independent factor of both poor functional status (ODI >40; p = 0.005, OR = 0.985) and global sagittal imbalance (SVA >50 mm; p = 0.019, OR = 0.985). Based on PEMET classification, moving from the grade III group to the grade I group, there was progressive worsening in VAS-back and ODI (all adjusted p < 0.05). Moreover, the grade I group had significantly greater VAS- leg, less LL and greater SVA than the other two groups (all adjusted p < 0.05).

Conclusion

Paraspinal muscle endurance was associated with QOL and sagittal spinopelvic alignment in LSS patients. A PEMET classification system has been constructed and has shown a correlation with QOL and sagittal imbalance.

Translational potential statement

The PEMET classification system proposed in this study could be available for identifying the severity of clinical symptoms and sagittal imbalance during preoperative evaluation in LSS patients.

Can fat infiltration in the multifidus muscle be a predictor of postoperative symptoms and complications in patients undergoing lumbar fusion for degenerative lumbar spinal stenosis? A case-control study

Purpose

This study aimed to explore whether 25% as the cutoff value of fat infiltration (FI) in multifidus (MF) could be a predictor of clinical outcomes of lumbar spinal stenosis (LSS) patients.

Methods

A total of 461 patients undergoing posterior lumbar interbody fusion for LSS with 1-year follow-up were identified. After sex- and age-match, 160 pairs of patients were divided into a FI < 25% group and a FI ≥ 25% group according to FI of MF at L4 on preoperative magnetic resonance imaging. Patient-reported outcomes including the visual analog scale scores (VAS) for back pain and leg pain and the Oswestry disability index (ODI) scores were evaluated. Bone nonunion and screw loosening were evaluated by dynamic X-ray.

Results

After matching, there was no significant difference in age, sex, body mass index, fusion to S1, number of fusion levels, osteoporosis, spondylolisthesis, smoking and diabetes. FI ≥ 25% group had significantly higher VAS for back pain, VAS for leg pain and ODI than FI < 25% group at 1-year follow-up. However, there was no significant difference in the change of them from baseline to 1-year follow-up between the two groups. In light of complications, FI ≥ 25% group had a significantly higher rate of bone nonunion than FI < 25% group, whereas there was no significant difference of screw loosening rates between the two groups.

Conclusion

MF FI might be a pragmatic cutoff value to predict bone nonunion in LSS patients, but it has little predictive value on screw loosening and postoperative improvement of symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-022-03186-2.

Bone-Mounted Robotic System in Minimally Invasive Spinal Surgery for Osteoporosis Patients: Clinical and Radiological Outcomes

Purpose

Severe complications, including screw loosening events and low fusion rates, in spinal fusion surgery using the traditional open method are problematic. This retrospective study aimed to evaluate the rate of screw loosening and the clinical outcomes of bone-mounted miniature robot-assisted pedicle screw placement in patients treated for degenerative spinal disease.

Patients and Methods

Data were collected from the medical records of 118 patients (mean age, 69 years). Differences in clinical outcomes, including the Oswestry disability index, visual analog scale score, screw loosening rate, cage fusion rate, and complications, were evaluated among different bone mineral densities.

Results

The screw loosening and cage fusion rates for all patients, normal bone mineral density, osteopenia, and osteoporosis groups were 12%, 8.6%, 13.1%, and 14%, respectively, and 85.3%, 93%, 82.5%, and 81.4%, respectively. There was a higher screw loosening rate and a lower cage fusion rate in the osteopenia and osteoporosis groups than in the normal bone density group. The accuracy of the screw placement was 97.3%. There were no statistically significant differences in the Oswestry disability index and visual analog scale scores, and no major complications for dural tear or vascular or visceral injury.

Conclusion

Our study demonstrated an acceptable screw loosening rate in patients with osteoporosis compared to that in patients with normal bone mineral density. The robotic system resulted in accurate screw placement in patients with osteoporosis.

Evaluation of the efficacy of OLIF combined posterior internal fixation for single-segment lumbar tuberculosis: a single-center retrospective cohort study

Objective

To evaluate the clinical efficacy of oblique lateral interbody fusion (OLIF) combined posterior fixation for single-segment lumbar tuberculosis (TB).

Methods

The medical records of spinal TB patients who were admitted to our department from January 2016 to December 2018 were retrospectively reviewed, and those meeting the inclusion criteria were finally included for analysis. The operative time, operative blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), Cobb angle of surgical segment, bone graft fusion rate, erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), neurological function (ASIA grade) and complications of the included patients were all recorded and analyzed.

Results

Thirty-nine patients with lumbar TB were finally included. The mean operative time, operative blood loss, and hospital stay were 135.8 ± 19.2 min, 239.4 ± 84.7 ml, and 9.5 ± 2.7 days, respectively. The mean follow-up time was 26.3 ± 7.5 months. During the follow-up, both VAS score and ODI were significantly improved at 1 month, 3 months, 6 months, 1 year postoperative, and the last follow-up, compared with preoperative (P < 0.001). Cobb angle was significantly corrected at 1 month postoperatively (P < 0.001), however, from 3 months postoperative to the last follow-up, Cobb angle was getting lost (P < 0.01). Bone graft fusion rate at 3 months, 6 months, 1 year postoperative, and last follow-up were 66.67%, 87.18%, 94.88%, and 100%, respectively. Compared with preoperative, ESR and CRP were both showed significant decrease at 1 and 6 months postoperative, and the last follow-up (P < 0.001). At the last follow-up, all patients had improvement in ASIA grade compared with preoperative (P < 0.001). Six patients were found with postoperative complications, and all were cured after active treatment.

Conclusions

OLIF combined posterior internal fixation is safe and effective in the treatment of single-segment lumbar TB, with satisfactory pain relief, improvement of lumbar and neurological function, and deformity correction.

Change in the dimensions of the lumbar area muscles after surgery: MRI analysis

OBJECTIVE:

This study aims to assess the change in the dimensions of the lumbar muscles in patients with chronic lower back pain using Magnetic Resonance Imaging (MRI) and to determine pre/post effects of surgery.

METHODS:

We enrolled 28 individuals (13F/15M; age: 45.39±11.56 years) whose L2–S1 muscle measurements were obtained using MRI, before and at follow-up 6–12 months after surgery. The control group comprising 37 individuals (18F/19M; age: 34.41±10.72 years) who had no lumbar pathology but for whom retrospective archive images were available. In the axial MRI analysis, the cross-sections of m.multifidus, mm.erector spinae and m.psoas major on both sides were measured with the ‘closed polygon’ technique.

RESULTS:

The L2–3 and L4–5 levels of the m.multifidus on the right side, the L2–3, L4–5 and L5–S1 levels of the m.multifidus and the L5–S1 levels of the mm. erector spinae on the left side cross-sectional areas were significantly lower than the control group (p<0.05). The right-side m.multifidus and the left-side mm.erector spinae sectional areas were significantly lower than the pre-surgery values at the L5–S1 levels (p<0.05).

CONCLUSION:

This study demonstrated that chronic lower back pain causes atrophy in the lumbar muscles and established the existence and continuity of atrophy after surgery.

Effectiveness of a 12-month home-based exercise program on trunk muscle strength and spine function after lumbar spine fusion surgery: a randomized controlled trial

Purpose: The effectiveness of a 12-month home-exercise program on trunk muscle strength after lumbar spine fusion surgery was evaluated. Materials and methods: Three months postoperatively, 98 patients were randomized either to the exercise group (EG), with a progressive 12-month home-based exercise program, or to usual care group (UCG), with one guidance session for light home-exercises. Maximal trunk muscle strength was measured by a strain-gauge dynamometer and trunk extensor endurance was measured by Biering-Sørensen's test at baseline and after the intervention. Results: The mean change in extension strength during the intervention was 75 N in EG and 58 N in UCG. Flexion strength improved 50 N in UCG and 45 N in EG. Trunk extension/flexion strength ratio changed from 0.90 to 1.02 in EG and from 0.98 to 1.00 in UCG. In EG, Biering-Sørensen's test improved by 17 s, and in UCG, it improved by 24 s. No statistically significant between-group differences were found in any variables. Median exercise frequency in EG decreased from 2.5×/week during the first two intervention months to 1.7×/week during the last two intervention months. Conclusions: Twelve-month progressive exercise program was equally effective as usual care in improving trunk muscle strength. Home exercise adherence decreased, which may have influenced the strength changes.Implications for rehabilitationThe 12-month home-based exercise program was equally as effective as usual care after lumbar spine fusion (LSF) in improving trunk muscle strength, however, the back-specific exercises led to better trunk muscle strength balance in exercise group only.The adherence to the home based exercise program is a challenge; therefore, different techniques could be implemented to provide purposeful support for each individual in their long-term exercising.It is important to recognize those who need more individualized rehabilitation in recovery of the spine function, while others may manage with subtle intervention after LSF.

Early Rehabilitation Program and Vitamin D Supplementation Improves Sensitivity of Balance and the Postural Control in Patients after Posterior Lumbar Interbody Fusion: A Randomized Trial

BACKGROUND

The introduction of early rehabilitation exercise is the foundation of treatment post-Posterior lumbar interbody fusion (PLIF) surgery, and the search for additional sources of reinforcement physiotherapy seems to be very important.

METHODS

The patients were randomly divided into the vitamin D3 (n = 15; D3) supplemented group and received 3200 IU per day for five weeks before surgery and the placebo group (n = 18; Pl) received vegetable oil during the same time. The patients began the supervisor rehabilitation program four weeks after surgery.

RESULTS

The limits of stability (LOS) were significantly improved in the D3 group after 5 and 14 weeks (p < 0.05), while in the Pl group, progress was only observed after 14 weeks (p < 0.05). The LOS were also higher in the D3 group than in the Pl group after five weeks of supervised rehabilitation (p < 0.05). In the postural stability (PST) test, significant progress was observed in the D3 group after 14 weeks (p < 0.02). In addition, neither rehabilitation nor supplementation had significant effects on the risk of falls (RFT).

CONCLUSIONS

Vitamin D supplementation seems to ameliorate the effects of an early postoperative rehabilitation program implemented four weeks after posterior lumbar interbody fusion. Early physiotherapy treatment after PLIF surgery combined with vitamin D supplementation appears to be a very important combination with regard to the patients' recovery process.

[Postoperative management of weight bearing and rehabilitation after lumbar spinal surgery]

BACKGROUND

Because of the growing trend of lumbar spinal surgery, it is essential for physicians and physiotherapists to develop standardized postoperative treatment. However, currently postoperative treatment after lumbar spinal surgery is controversial.

PURPOSE OF THE STUDY

The purpose of this review article is to make recommendations for the postoperative treatment of lumbar intervertebral disc surgery, lumbar decompression surgery and lumbar spinal fusion surgery regarding mobilization, weight bearing and rehabilitation. These recommendations are based on current evidence and experience in our institution.

MATERIALS AND METHODS

A selective literature research of relevant publications was conducted in Pubmed. The studies are presented in tabular form.

RESULTS

Patient training, accurate information about the postoperative course, information about limitations and stress possibilities as well as pain management seem to have an important role in the final outcome of the operation. Ideally, these procedures should be performed preoperatively or at the latest or repeatedly from the first postoperative day after lumbar spine surgery. Physiotherapy can have a positive impact on the clinical and functional outcome after lumbar disc, decompression and fusion surgery.

DISCUSSION

Due to the heterogeneity of the intensity, duration and form of physiotherapy or rehabilitation, which are listed as interventions in the various studies, it is only possible to draw limited conclusions about general instructions for action on "physiotherapy" after spinal surgery.