Tonomura Hitoshi, Hatta Yoichiro, Mikami Yasuo, Ikeda Takumi, Harada Tomohisa, Nagae Masateru, Koike Hironori, Hase Hitoshi, Kubo Toshikazu
*Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine †Department of Orthopaedics, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
Clin Spine Surg. 2017 Mar;30(2):E76-E82. doi: 10.1097/BSD.0b013e31829eb9de.
This is a retrospective study.
The aim of this study was to determine the extent of damage to the paravertebral muscles after muscle-preserving interlaminar decompression (MILD) using magnetic resonance imaging to evaluate changes in the multifidus muscle (MF).
Short-term surgical outcomes of MILD for lumbar spinal canal stenosis (LSCS) are satisfactory; however, the extent of damage to the paravertebral muscles after MILD remains unclear.
Thirty-four patients (18 men/16 women; mean age: 72.6 y) who had LSCS treated with MILD were retrospectively investigated. A total of 61 decompressed disk levels [L2/3(5); L3/4(21); L4/5(30); L5/S(5)] and 34 nondecompressed levels (L1/2) were assessed. There was 1 decompressed disk level in 12 cases, 2 in 17 cases, and 3 in 5 cases. Magnetic resonance imaging scans were obtained before surgery and at 3 and 12-18 months after surgery, using the same scanner. The rate of paravertebral muscle atrophy was evaluated to compare the area of the MF in the T2-weighted axial plane (intervertebral disk level) preoperatively and postoperatively, using OsiriX Medical Imaging Software. Changes in muscle signal intensity were also recorded. Statistical analysis was performed using 3-way analysis of variance with the post hoc Fisher PSLD test.
The rate of MF atrophy was 4.0% at the decompressed levels and 2.1% at the nondecompressed levels. There were no changes of signal intensity in the MF between the preoperative and postoperative periods. In decompressed levels, muscle atrophy and signal intensity were significantly improved from 3 months to 12-18 months after surgery. The number and level of the decompressed disks did not affect the extent of muscle injury.
The extent of paravertebral muscle injury after MILD is satisfactory. The midline interlaminar approach used in this technique may prevent local denervation and irreversible damage to the paravertebral muscles. These results indicate that MILD is useful to treat LSCS less invasively.
这是一项回顾性研究。
本研究旨在通过磁共振成像评估多裂肌（MF）的变化，以确定保留肌肉的椎板间减压术（MILD）后椎旁肌的损伤程度。
MILD治疗腰椎管狭窄症（LSCS）的短期手术效果令人满意；然而，MILD后椎旁肌的损伤程度仍不清楚。
对34例接受MILD治疗的LSCS患者（18例男性/16例女性；平均年龄：72.6岁）进行回顾性研究。共评估了61个减压椎间盘节段[L2/3（5个）；L3/4（21个）；L4/5（30个）；L5/S1（5个）]和34个未减压节段（L1/2）。12例患者有1个减压椎间盘节段，17例患者有2个，5例患者有3个。术前以及术后3个月和12 - 18个月使用同一台扫描仪进行磁共振成像扫描。使用OsiriX医学成像软件，通过比较术前和术后T2加权轴向平面（椎间盘节段）上MF的面积来评估椎旁肌萎缩率。还记录了肌肉信号强度的变化。采用三因素方差分析及事后Fisher PSLD检验进行统计分析。
减压节段的MF萎缩率为4.0%，未减压节段为2.1%。术前和术后MF的信号强度没有变化。在减压节段，术后3个月至12 - 18个月肌肉萎缩和信号强度有显著改善。减压椎间盘的数量和节段不影响肌肉损伤程度。
MILD后椎旁肌损伤程度令人满意。该技术采用的中线椎板间入路可能预防局部去神经支配和椎旁肌的不可逆损伤。这些结果表明MILD对于以微创方式治疗LSCS是有用的。
