Wang Ting-Yun, Pao Jwo-Luen, Yang Rong-Sen, Jang Jyh-Shing Roger, Hsu Wei-Li
School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Division of Minimally Invasive Spine Surgery & Orthopedic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.
Hum Mov Sci. 2015 Apr;40:284-97. doi: 10.1016/j.humov.2015.01.002. Epub 2015 Jan 24.
Limited back motion and damage of paraspinal muscles after spinal fusion surgery may lead to abnormal compensatory movements of the body. Whether neuromuscular control changes after surgery remains unclear. The purpose of the study was to identify the muscle activation patterns employed before and after lumbar spinal fusion. Nineteen patients having low back pain and undergoing minimally invasive lumbar spinal fusion were evaluated at 1 day before and 1 month after fusion surgery. Nineteen matched healthy participants were recruited as controls. Patients' pain severity and daily activity functioning were recorded. All participants were instructed to perform forward reaching, and the muscle activities were monitored using surface electromyography (EMG) with sensors placed on both sides of their trunk and lower limbs. The muscle activation patterns were identified using the principal component analysis (PCA). All patients had significant improvements in pain intensity and daily activity functioning after surgery, but exhibited an adaptive muscle activation pattern during forward reaching movement compared with the controls. Significant loading coefficients in the dominant movement pattern (reflected in the first principal component) were observed in back muscles for controls whereas in leg muscles for patients, both pre- and postoperatively. Despite substantial improvements in pain intensity and daily activity functioning after surgery, the patients exhibited decreased paraspinal muscle activities and adaptive muscle coordination patterns during forward reaching. They appeared to rely mainly on their leg muscles to compensate for their insufficient paraspinal muscle function. Early intervention focusing on training paraspinal muscles should be considered after spinal fusion surgery.
脊柱融合手术后脊柱活动受限和椎旁肌肉损伤可能导致身体出现异常代偿性运动。术后神经肌肉控制是否发生变化尚不清楚。本研究的目的是确定腰椎融合术前和术后所采用的肌肉激活模式。对19例患有腰痛并接受微创腰椎融合术的患者在融合手术前1天和术后1个月进行了评估。招募了19名匹配的健康参与者作为对照。记录患者的疼痛严重程度和日常活动功能。所有参与者均被要求进行前伸动作，并使用表面肌电图（EMG）监测肌肉活动，传感器放置在他们的躯干和下肢两侧。使用主成分分析（PCA）确定肌肉激活模式。所有患者术后疼痛强度和日常活动功能均有显著改善，但与对照组相比，在前伸动作过程中表现出适应性肌肉激活模式。对照组在主导运动模式（反映在第一主成分中）中，背部肌肉观察到显著的负荷系数，而患者术前和术后均在腿部肌肉中观察到。尽管术后疼痛强度和日常活动功能有实质性改善，但患者在前伸过程中椎旁肌肉活动减少，肌肉协调模式具有适应性。他们似乎主要依靠腿部肌肉来补偿椎旁肌肉功能的不足。脊柱融合手术后应考虑针对椎旁肌肉训练的早期干预。
