Advertisement

European Spine Journal

, Volume 19, Issue 2, pp 316–324 | Cite as

Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach

  • ShunWu Fan
  • ZhiJun Hu
  • FengDong Zhao
  • Xing Zhao
  • Yue Huang
  • Xiangqian FangEmail author
Original Article

Abstract

We set out to determine whether a minimally invasive approach for one-level instrumented posterior lumbar interbody fusion reduced undesirable changes in the multifidus muscle, compared to a conventional open approach. We also investigated associations between muscle injury during surgery (creatinine kinase levels), clinical outcome and changes in the multifidus at follow-up. We studied 59 patients treated by one team of surgeons at a single institution (minimally invasive approach in 28 and conventional open approach in 31, voluntarily chosen by patients). More than 1 year postoperatively, all the patients were followed up with the visual analogue scale (VAS) and Oswestry disability index (ODI), and 16 patients from each group were evaluated using MRI. This enabled the cross-sectional area (CSA) of lean multifidus muscle, and the T2 signal intensity ratio of multifidus to psoas muscle, to be compared at the operative and adjacent levels. The minimally invasive group had less postoperative back pain (P < 0.001) and lower postoperative ODI scores (P = 0.001). Multifidus atrophy was less in the minimally invasive group (P < 0.001), with mean reductions in CSA of 12.2% at the operative and 8.5% at the adjacent levels, compared to 36.8% and 29.3% in the conventional open group. The increase in the multifidus:psoas T2 signal intensity ratio was similarly less marked in the minimally invasive group where values increased by 10.6% at the operative and 8.3% at the adjacent levels, compared to 34.4 and 22.7% in the conventional open group (P < 0.001). These changes in multifidus CSA and T2 signal intensity ratio were significantly correlated with postoperative creatinine kinase levels, VAS scores and ODI scores (P < 0.01). The minimally invasive approach caused less change in multifidus, less postoperative back pain and functional disability than conventional open approach. Muscle damage during surgery was significantly correlated with long-term multifidus muscle atrophy and fatty infiltration. Furthermore these degenerative changes of multifidus were also significantly correlated with long-term clinical outcome.

Keywords

Minimally invasive Lumbar spine Multifidus muscle Interbody fusion 

Notes

Acknowledgments

Sponsored by Zhejiang Provincial Program for the cultivation of High-level Innovative Health talents. The Institutional ethical board of this university has reviewed this study and approved this report contributed to the Eur Spine J.

References

  1. 1.
    Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ (2000) CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 9:266–272CrossRefPubMedGoogle Scholar
  2. 2.
    Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25(22):2940–2952 discussion 2952CrossRefPubMedGoogle Scholar
  3. 3.
    Fitzpatrick JM, Wickham JE (1990) Minimal invasive surgery. Br J Surg 77:721–722CrossRefPubMedGoogle Scholar
  4. 4.
    Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 28(Suppl 15):S26–S35CrossRefPubMedGoogle Scholar
  5. 5.
    Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H (1997) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24:1023–1028CrossRefGoogle Scholar
  6. 6.
    Hides JA, Richardson CA, Jull GA (1996) Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 21(23):2763–2769CrossRefPubMedGoogle Scholar
  7. 7.
    Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH (1994) Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 19(2):165–172PubMedCrossRefGoogle Scholar
  8. 8.
    Isaacs RE, Podichetty VK, Santiago P, Sandhu FA, Spears J, Kelly K et al (2005) Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine 3:98–105CrossRefPubMedGoogle Scholar
  9. 9.
    Kawaguchi Y, Matsui H, Tsuji H (1996) Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine 21(8):941–944CrossRefPubMedGoogle Scholar
  10. 10.
    Kawaguchi Y, Matsui H, Tsuji H (1997) Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine 22(9):1018–1023CrossRefPubMedGoogle Scholar
  11. 11.
    Khoo LT, Palmer S, Laich DT, Fessler RG (2002) Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery 51:S166-1PubMedGoogle Scholar
  12. 12.
    Kim DY, Lee SH, Chung SK, Lee HY (2005) Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine 30:123–129CrossRefPubMedGoogle Scholar
  13. 13.
    Kim KT, Lee SH, Suk KS, Bae SC (2006) The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine 31:712–716CrossRefPubMedGoogle Scholar
  14. 14.
    Leu HF, Hauser RK (1996) Percutaneous endoscopic lumbar spine fusion. Neurosurg Clin North Am 7(1):107–117Google Scholar
  15. 15.
    Mayer HM (2000) The ALIF concept. Eur Spine J 9(Suppl):35–43CrossRefGoogle Scholar
  16. 16.
    Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L (1989) Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine 14(1):33–36CrossRefPubMedGoogle Scholar
  17. 17.
    Nanji AA (1983) Serum creatine kinase isoenzymes: a review. Muscle Nerve 6:83–90CrossRefPubMedGoogle Scholar
  18. 18.
    Onesti ST (2004) Failed back syndrome. Neurologist 10(5):259–264CrossRefPubMedGoogle Scholar
  19. 19.
    Panjabi MM (1992) The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 5(4):383–389CrossRefPubMedGoogle Scholar
  20. 20.
    Park Y, Ha JW (2007) Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine 32(5):537–543CrossRefPubMedGoogle Scholar
  21. 21.
    Quint U, Wilke HJ, Shirazi-Adl A, Parnianpour M, Löer F, Claes LE (1998) Importance of the intersegmental trunk muscles for the stability of the lumbar spine: a biomechanical study in vitro. Spine 23(18):1937–1945CrossRefPubMedGoogle Scholar
  22. 22.
    Schwender JD, Holly LT, Rouben DP, Foley KT (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18(Suppl):S1–S6CrossRefPubMedGoogle Scholar
  23. 23.
    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428CrossRefPubMedGoogle Scholar
  24. 24.
    Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581CrossRefPubMedGoogle Scholar
  25. 25.
    Stevens KJ, Spenciner DB, Griffiths KL, Kim KD, Zwienenberg-Lee M, Alamin T et al (2006) Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech 19:77–86CrossRefPubMedGoogle Scholar
  26. 26.
    Suwa H, Hanakita J, Ohshita N, Gotoh K, Matsuoka N, Morizane A (2000) Postoperative changes in paraspinal muscle thickness after various lumbar back surgery procedures. Neurol Med Chir (Tokyo) 40(3):151–154 discussion 154–155CrossRefGoogle Scholar
  27. 27.
    Taylor H, McGregor AH, Medhi-Zadeh S, Richards S, Kahn N, Zadeh JA et al (2002) The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine 27:2758–2762CrossRefPubMedGoogle Scholar
  28. 28.
    Waddell G (1987) A new clinical model for the treatment of low-back pain. Spine 12:632–644CrossRefPubMedGoogle Scholar
  29. 29.
    Wilke HJ, Wolf S, Claes LE, Arand M, Wiesend A (1995) Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine 20:192–198PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • ShunWu Fan
    • 1
  • ZhiJun Hu
    • 1
  • FengDong Zhao
    • 1
  • Xing Zhao
    • 1
  • Yue Huang
    • 1
  • Xiangqian Fang
    • 1
    Email author
  1. 1.Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-invasive Surgery of Zhejiang UniversityZhejiang UniversityHangzhouPeople’s Republic of China

Personalised recommendations