Arts Mark P, Nieborg Arjan, Brand Ronald, Peul Wilco C
Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands.
J Neurosurg Spine. 2007 Sep;7(3):282-6. doi: 10.3171/SPI-07/09/282.
Muscle injury is inevitable during surgical exposure of the spine and is quantified by the release of creatine phosphokinase (CPK). No studies have been conducted on different spinal approaches and nonspinal surgery with regard to muscle injury. The present prospective cohort study was conducted to evaluate the results of postoperative serum CPK as an indicator of muscle injury in relation to various spinal and nonspinal procedures.
The authors analyzed data in 322 consecutive patients who had undergone 257 spinal and 65 nonspinal procedures. Primary procedures were performed in 264 patients and revision surgeries in 58. Spinal procedures were subdivided according to the degree of surgical invasiveness as follows: minimally invasive (microendoscopic lumbar discectomy, unilateral transflaval discectomy, and minithoracotomy), average invasiveness (bilateral lumbar discectomy, laminectomy, and anterior cervical discectomy), and extensive surgery (instrumented single or multilevel spondylodesis of the entire spinal column). Spinal localization, number of spinal levels involved, surgical approach, duration of surgery, and body mass index (BMI) were recorded. Creatine phosphokinase was measured before surgery and 1 day after surgery, and the CPK ratio (that is, the difference within one patient) was used as the outcome measure.
There was a significant dose-response relationship between the CPK ratio and the degree of surgical invasiveness; extensively invasive surgery had the highest CPK ratio and minimally invasive surgery had the lowest. Thoracolumbar surgery had a significantly higher CPK ratio compared with those for cervical and nonspinal surgery. There was a slightly negative relationship between the number of spinal segments involved and the CPK ratio. The CPK ratio in revision surgery was significantly higher than in primary surgery. Posterior surgical approaches had a higher CPK ratio, and the ratios for unilateral compared with bilateral approaches were not significantly different. The duration of surgery and preoperative serum level of CPK significantly influenced postoperative CPK. There was also a significant association between CPK ratio and nonspinal surgery. Age, sex, and BMI were not significant factors.
Data in this study have shown a dose-response relationship between CPK and the extent of surgical invasiveness. Thoracolumbar surgery, posterior approaches, duration of surgery, revision surgery, and preoperative value of CPK were significant influencing factors for the CPK ratio. The clinical significance of the results in the present study is not known.
脊柱手术暴露过程中肌肉损伤不可避免，可通过肌酸磷酸激酶（CPK）的释放来量化。尚未有关于不同脊柱手术入路及非脊柱手术中肌肉损伤的研究。本前瞻性队列研究旨在评估术后血清CPK作为肌肉损伤指标在各种脊柱和非脊柱手术中的结果。
作者分析了连续322例接受257例脊柱手术和65例非脊柱手术患者的数据。264例患者进行了初次手术，58例进行了翻修手术。脊柱手术根据手术侵袭程度细分为：微创（显微内镜下腰椎间盘切除术、单侧经椎间孔椎间盘切除术和胸腔镜下小切口手术）、中等侵袭性（双侧腰椎间盘切除术、椎板切除术和颈椎前路椎间盘切除术）和广泛手术（整个脊柱节段的器械辅助单节段或多节段脊柱融合术）。记录脊柱定位、受累脊柱节段数、手术入路、手术时间和体重指数（BMI）。术前和术后1天测量肌酸磷酸激酶，CPK比值（即同一患者内的差值）用作结果指标。
CPK比值与手术侵袭程度之间存在显著的剂量反应关系；广泛侵袭性手术的CPK比值最高，微创性手术的CPK比值最低。胸腰椎手术的CPK比值显著高于颈椎和非脊柱手术。受累脊柱节段数与CPK比值之间存在轻微的负相关关系。翻修手术的CPK比值显著高于初次手术。后路手术入路的CPK比值较高，单侧与双侧入路的比值无显著差异。手术时间和术前血清CPK水平显著影响术后CPK。CPK比值与非脊柱手术之间也存在显著关联。年龄、性别和BMI不是显著因素。
本研究数据显示CPK与手术侵袭程度之间存在剂量反应关系。胸腰椎手术、后路入路、手术时间、翻修手术和术前CPK值是CPK比值的显著影响因素。本研究结果的临床意义尚不清楚。
