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Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients

  • Clinical Article - Spine
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Abstract

Background

Different studies have shown that atrophy of paraspinal muscles arises after open dorsal lumbar fusion, and the reasons for this atrophy are still not yet fully clarified. This prospective study investigates the extent of atrophy of the lumbar paraspinal muscles after open lumbar interbody fusion, its possible causes, and their association with clinical outcome measures.

Methods

Thirty consecutive patients were prospectively included (13 male, 17 female, median age 60.5 years, range 33–80 years). Mono or bisegmental, posterior lumbar interbody fusion and instrumentation was performed applying a conventional, open lumbar midline approach. Clinical outcome was assessed by the Short Form (36) Health Survey (SF-36) questionnaire and visual analogue scale. Needle electromyography of paraspinal muscles was performed preoperatively, at 6 and 12 months. Serum values of creatine kinase, lactate dehydrogenase and myoglobin were determined preoperatively, at day 2 after surgery and at discharge. Paraspinal muscle volume was determined by volumetric analysis of thin-slice computed tomography scans preoperatively and 1 year after surgery.

Results

There was a significant increase of electromyographic denervation activity (p =0.024) and reduced recruitment of motor units (p = 0.001) after 1 year. Laboratory studies showed a significant increase of CK (p < 0.001) and myoglobin (p < 0.001) serum levels at day 2 after surgery. The paraspinal muscle volume decreased from 67.8 to 60.4 % (p < 0.001) after 1 year. Correlation analyses revealed a significant negative correlation between denervation and muscle volume (K = -0.219, p = 0.002). Paraspinal muscle volume is significantly correlated with physical outcome (K = 0.169, p = 0.020), mental outcome (K = 0.214, p = 0.003), and pain (K = 0.382, p < 0.001) after 1 year.

Conclusions

Atrophy of paraspinal muscles after open, posterior lumbar interbody fusion seems to be associated with denervation, as well as direct muscle trauma during surgery. While muscle atrophy is also correlated with a worse clinical outcome, it seems to be a determining factor for successful lumbar spine surgery.

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References

  1. 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 30:123–129

    Article  PubMed  Google Scholar 

  2. Kim K, Isu T, Sugawara A, Matsumoto R, Isobe M (2008) Comparison of the effect of 3 different approaches to the lumbar spinal canal on postoperative paraspinal muscle damage. Surg Neurol 69:109–113, discussion 113

    Article  PubMed  Google Scholar 

  3. Stevens KJ, Spenciner DB, Griffiths KL, Kim KD, Zwienenberg-Lee M, Alamin T, Bammer R (2006) Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech 19:77–86

    Article  PubMed  Google Scholar 

  4. Hodges P, Holm AK, Hansson T, Holm S (2006) Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine 31:2926–2933

    Article  PubMed  Google Scholar 

  5. Kumbhare D, Parkinson W, Dunlop B (2008) Validity of serum creatine kinase as a measure of muscle injury produced by lumbar surgery. J Spinal Disord Tech 21:49–54

    Article  PubMed  Google Scholar 

  6. Haig AJ, Moffroid M, Henry S, Haugh L, Pope M (1991) A technique for needle localization in paraspinal muscles with cadaveric confirmation. Muscle Nerve 14:521–526

    Article  CAS  PubMed  Google Scholar 

  7. Bogduk N, Wilson AS, Tynan W (1982) The human lumbar dorsal rami. J Anat 134:383–397

    CAS  PubMed  Google Scholar 

  8. Haig AJ, LeBreck DB, Powley SG (1995) Paraspinal mapping. Quantified needle electromyography of the paraspinal muscles in persons without low back pain. Spine 20:715–721

    Article  CAS  PubMed  Google Scholar 

  9. Haig AJ, Talley C, Grobler LJ, LeBreck DB (1993) Paraspinal mapping: quantified needle electromyography in lumbar radiculopathy. Muscle Nerve 16:477–484

    Article  CAS  PubMed  Google Scholar 

  10. Gille O, Jolivet E, Dousset V, Degrise C, Obeid I, Vital JM, Skalli W (2007) Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach. Spine 32:1236–1241

    Article  PubMed  Google Scholar 

  11. Lu WW, Hu Y, Luk KD, Cheung KM, Leong JC (2002) Paraspinal muscle activities of patients with scoliosis after spine fusion: an electromyographic study. Spine 27:1180–1185

    Article  PubMed  Google Scholar 

  12. Kawaguchi Y, Matsui H, Tsuji H (1994) Back muscle injury after posterior lumbar spine surgery. Part 1: Histologic and histochemical analyses in rats. Spine 19:2590–2597

    Article  CAS  PubMed  Google Scholar 

  13. Kawaguchi Y, Matsui H, Tsuji H (1994) Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans. Spine 19:2598–2602

    Article  CAS  PubMed  Google Scholar 

  14. Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24:1023–1028

    Article  CAS  PubMed  Google Scholar 

  15. Kawaguchi Y, Yabuki S, Styf J, Olmarker K, Rydevik B, Matsui H, Tsuji H (1996) Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine 21:2683–2688

    Article  CAS  PubMed  Google Scholar 

  16. Kim KT, Lee SH, Suk KS, Bae SC (2006) The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine 31:712–716

    Article  PubMed  Google Scholar 

  17. Lenke LG, Bridwell KH, Jaffe AS (1994) Increase in creatine kinase MB isoenzyme levels after spinal surgery. J Spinal Disord 7:70–76

    Article  CAS  PubMed  Google Scholar 

  18. Liu X, Wang Y, Wu X, Zheng Y, Jia L, Li J, Zhang K, Wei B (2010) Impact of surgical approaches on the lumbar multifidus muscle: an experimental study using sheep as models. J Neurosurg Spine 12:570–576

    Article  PubMed  Google Scholar 

  19. Hartwig T, Streitparth F, Gross C, Muller M, Perka C, Putzier M, Strube P (2011) Digital 3-dimensional analysis of the paravertebral lumbar muscles after circumferential single-level fusion. J Spinal Disord Tech 24:451–454

    Article  PubMed  Google Scholar 

  20. Hayashi N, Tamaki T, Yamada H (1992) Experimental study of denervated muscle atrophy following severance of posterior rami of the lumbar spinal nerves. Spine 17:1361–1367

    Article  CAS  PubMed  Google Scholar 

  21. Hyun SJ, Kim YB, Kim YS, Park SW, Nam TK, Hong HJ, Kwon JT (2007) Postoperative changes in paraspinal muscle volume: comparison between paramedian interfascial and midline approaches for lumbar fusion. J Korean Med Sci 22:646–651

    Article  PubMed Central  PubMed  Google Scholar 

  22. Ren G, Eiskjaer S, Kaspersen J, Christensen FB, Rasmussen S (2009) Microdialysis of paraspinal muscle in healthy volunteers and patients underwent posterior lumbar fusion surgery. Eur Spine J 18:1604–1609

    Article  PubMed Central  PubMed  Google Scholar 

  23. Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581

    Article  CAS  PubMed  Google Scholar 

  24. Tsutsumimoto T, Shimogata M, Ohta H, Misawa H (2009) Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine 34:1923–1928

    Article  PubMed  Google Scholar 

  25. Watanabe K, Hosoya T, Shiraishi T, Matsumoto M, Chiba K, Toyama Y (2005) Lumbar spinous process-splitting laminectomy for lumbar canal stenosis. Technical note. J Neurosurg Spine 3:405–408

    Article  PubMed  Google Scholar 

  26. Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X (2010) Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J 19:316–324

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Albrecht Waschke, Christin Hartmann, Jan Walter, Pedro Dünisch, Falko Wahnschaff, Rolf Kalff & Christian Ewald

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  1. Albrecht Waschke
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  2. Christin Hartmann
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  3. Jan Walter
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  4. Pedro Dünisch
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  5. Falko Wahnschaff
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  6. Rolf Kalff
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  7. Christian Ewald
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Correspondence to Albrecht Waschke.

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Waschke, A., Hartmann, C., Walter, J. et al. Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients. Acta Neurochir 156, 235–244 (2014). https://doi.org/10.1007/s00701-013-1981-9

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  • DOI: https://doi.org/10.1007/s00701-013-1981-9

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