Tandon Rushama, Kiyawat Vivek, Kumar Neeraj
Department of Orthopedic Surgery, Northern Railway Central Hospital, New Delhi, India.
Asian Spine J. 2018 Jun;12(3):518-523. doi: 10.4184/asj.2018.12.3.518. Epub 2018 Jun 4.
Single-surgeon, single-center prospective study with prospective data collection.
To clinically evaluate muscle damage after open lumbar surgery and its relationship to functional activity and to validatethe improvement in function as indicated by improved Oswestry Disability Index (ODI) score despite muscle damage.
Few studies have analyzed the functional loss and recovery pattern of muscles after open lumbar surgery.
The study included 30 patients who underwent open lumbar spine fusion surgery at our institution between August 2013 and May 2015. Preoperatively and at 6 months postoperatively, the patients were subjected to functional, biochemical, electrophysiological, and radiological assessments as outpatients, and the results were compared.
Mean preoperative and 6-month postoperative values were as follows: creatine phosphokinase levels, 133.07±17.57 and 139±17.7 U/L ( <0.001); Visual Analog Scale scores for backache, 6.73±0.88 and 3.27±0.96 ( <0.001); and ODI scores, 41.6±5.51 and 22.4±4.48 ( <0.001), respectively. Preoperatively, electrophysiological studies showed that 20% of the patients had a polyphasic configuration whereas at 6 months postoperatively, all patients had polyphasic configuration ( <0.001). The mean cross-sectional area of the multifidus observed using magnetic resonance imaging (MRI) decreased from 742.67±76.62 mm preoperatively to 598.27±66.38 mm 6 months postoperatively ( <0.001), with all the patients exhibiting grade 2 atrophy.
Open lumbar fusion surgery resulted in significant damage to the lumbar paraspinal muscles, as indicated by a reduction in the cross-sectional area of the multifidus by MRI and denervation of the multifidus demonstrated using electromyography. Nevertheless, the patients reported reduced back pain and improved quality of life, which may have been due to increased stability of the previously unstable lumbar spinal segment after the surgery.
单术者、单中心前瞻性研究，前瞻性收集数据。
临床评估开放性腰椎手术后的肌肉损伤及其与功能活动的关系，并验证尽管存在肌肉损伤，但Oswestry功能障碍指数（ODI）评分改善所表明的功能改善情况。
很少有研究分析开放性腰椎手术后肌肉的功能丧失和恢复模式。
本研究纳入了2013年8月至2015年5月期间在我院接受开放性腰椎融合手术的30例患者。术前及术后6个月，患者作为门诊患者接受功能、生化、电生理和影像学评估，并比较结果。
术前及术后6个月的平均数值如下：肌酸磷酸激酶水平分别为133.07±17.57和139±17.7 U/L（<0.001）；背痛视觉模拟量表评分分别为6.73±0.88和3.27±0.96（<0.001）；ODI评分分别为41.6±5.51和22.4±4.48（<0.001）。术前，电生理研究显示20%的患者有多相波形态，而术后6个月，所有患者均有多相波形态（<0.001）。使用磁共振成像（MRI）观察到的多裂肌平均横截面积从术前的742.67±76.62 mm²降至术后6个月的598.27±66.38 mm²（<0.001），所有患者均表现为2级萎缩。
MRI显示多裂肌横截面积减小以及肌电图显示多裂肌去神经支配，表明开放性腰椎融合手术导致腰椎旁肌肉严重损伤。然而，患者报告背痛减轻且生活质量改善，这可能是由于手术后背椎先前不稳定节段的稳定性增加所致。
