Post-graduation Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Division of Emergency, Armed Forces Hospital, Brasília, Distrito Federal, Brazil.
Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
World Neurosurg. 2019 Sep;129:e514-e521. doi: 10.1016/j.wneu.2019.05.197. Epub 2019 May 29.
The aims of this study were to evaluate the risk factors for muscle injury in patients undergoing posterior lumbar spinal surgery and the clearance of postoperative biochemical changes following lumbar fusion and secondarily to evaluate the timing for monitoring postoperative biochemical serum levels and potential clinical correlation.
The study prospectively enrolled 39 patients with degenerative disease of the lumbar spine. Biochemical markers (creatine phosphokinase [CPK], creatinine, and hemoglobin) were analyzed in 5 predefined stages. All relevant clinical data were collected. Rhabdomyolysis (RML) was defined as a postoperative 5-fold increase of the baseline CPK value.
Patients from the lumbar fusion group had the highest postoperative CPK ratio. Overall, the rate of RML was 43.6%. CPK and creatinine activity reached their maximum on the first postoperative day in 69.2% and 87.5% of patients, respectively. Lumbar fusion (P = 0.005), surgical time >270 minutes (P = 0.028), and fall in hemoglobin levels >3 g/dL (P = 0.034) were identified as independent factors associated with higher risk of RML.
The risk of RML increases with prolonged and invasive surgery with higher bleeding potential. Knowing the clearance of postoperative biochemical changes permits a standardized strategy with measurements in precise intervals, thereby avoiding unnecessary costs. The clinical significance is still undetermined.
本研究旨在评估接受后路腰椎脊柱手术的患者发生肌肉损伤的风险因素，以及腰椎融合术后生化变化的清除情况，并进一步评估监测术后生化血清水平的时间和潜在的临床相关性。
该研究前瞻性纳入 39 例腰椎退行性疾病患者。在 5 个预设阶段分析生化标志物（肌酸磷酸激酶 [CPK]、肌酐和血红蛋白）。收集所有相关临床数据。将术后 CPK 值增加 5 倍定义为横纹肌溶解症（RML）。
腰椎融合组患者术后 CPK 比值最高。总体上，RML 发生率为 43.6%。69.2%和 87.5%的患者 CPK 和肌酐活性在术后第 1 天达到最大值。腰椎融合（P=0.005）、手术时间>270 分钟（P=0.028）和血红蛋白水平下降>3g/dL（P=0.034）是与 RML 风险增加相关的独立因素。
随着潜在出血风险较高的手术时间延长和侵袭性增加，RML 的风险增加。了解术后生化变化的清除情况可以制定标准化策略，以精确的时间间隔进行测量，从而避免不必要的费用。但临床意义仍不确定。
