ВACKGROUND: For the treatment of degenerative diseases of the spine, various deformities, a minimally invasive technique of lateral lumbar interbody fusion is used, which minimizes the risks of spinal cord injury. In the development of these pathologies, the most important role is assigned to the paraspinal muscles, the histological features of which are insufficiently elucidated in the relevant literature when modeling spondylodesis. АIM: To investigate the effect of lateral interbody vertebral fusion (spondylodesis) when introducing titanium implants on the histostructure of the psoas minor muscle. МATERIALS AND METHODS: Experiments were performed in 14 mongrel dogs, 3 individuals the control group (norm). The аnimals underwent discectomy at the level of L45, L56 vertebrae through the lateral approach on the right, and interbody titanium implants were installed. The lumbar spine was stabilized with an external fixator for 30 days. Paraffin muscle sections were stained with hematoxylin-eosin, according to Masson. RESULTS: During the experiment, an increased variety of myosymplast diameters, loss of polygonality of their profiles, fibrosis of the interstitial space, and sclerotization of the vascular membranes were observed in the psoas minor muscle. The volume density of endomysium in both muscles increased 1.5 times relative to the norm after 6 months Other parameters decreased: the volume of myosymplasts was 95%, that of microvessels 73% on the left, 83% on the right. On the other hand, the degree of fatty infiltration increased, amounting to 276% on the left and 394% on the right of the normal parameters. After 18 months, the bulk density of muscle fibers on the left was restored to the value in the control, on the right it was only 95%. The degree of sclerotization in the muscle on the left is 133%, on the right 161% of the norm; the index of fatty infiltration was 146% on the left and 339% on the right of the normal parameter. CONCLUSION: pathohistological changes in the psoas minor during lateral interbody fusion are more pronounced on the side of the operative approach, which necessitates minimizing trauma to the paravertebral muscles during operations in order to prevent sclerotization and fatty involution of muscle tissue.
Paravertebral muscles play an important role in the development of deformities and degenerative diseases of the spine. The impact of posterior arthrodesis of the ileosacral articulation (sacrum-iliac joint) on the morphological characteristics of the m. sacrocaudalis (coccygeus) dorsalis lateralis of mongrel dogs was studied in animal experiments. Titanium cages were used, followed by stabilization with an external fixation device for 30 days. The advantages of posterior arthrodesis include a small incision, minimal blood loss, preservation of the integrity of most ligaments, and a short immobilization period. Nevertheless, when modeling arthrodesis experimentally in animals, fibrosis of the interstitial space and fatty infiltration in the adjacent muscle were revealed at the end of the experiment, which amounted to 240% and 310% of the intact parameters, respectively. In addition, fibrosis of the vessel membranes of the arterial link was observed. When performing surgical interventions on the spine, traumatization of the muscles should be reduced in order to minimize fibrogenesis and fatty involution of the paravertebral muscles.
Проведено морфологическое исследование икроножной мышцы щенков в раннем постнатальном периоде: новорожденных, 7-, 14-, 21-, 28-суточных, n = 2 для каждого периода. Использованы методы гистологии, стереометрии, сканирующей электронной микроскопии, статистического анализа. Полутонкие срезы окрашивали по M. Ontell, изучали с помощью стереомикроскопа «AxioScope.A1» и встроенной фотокамеры «AxioCam» (Carl Zeiss MicroImaging GmbH, Германия). Цитоархитектонику исследовали посредством растрового электронного микроскопа «JSM-840» (JEOL, Япония). Криостатные срезы с выявленной активностью миозиновой АТФ-азы послужили для стереологического анализа. Рассчитывали: объемную плотность мышечных волокон, микрососудов, эндомизия; численную плотность миоцитов и микрососудов, индекс васкуляризации (видовая константа). Выявлены особенности цитоархитектоники мышцы, её стромально-паренхиматозных отношений, отмечен волнообразный характер динамики показателей микроциркуляторного русла. Определены параллели по основным стереометрическим параметрам для передней большеберцовой и икроножной мышц. У новорожденных щенков узкие мышечные волокна без поперечной исчерченности, сети тонких эластических волоконец, наибольшее содержание соединительнотканного компонента. На 7-14 сутки в миосимпластах идентифицируется поперечная исчерченность, к 21-28 суткам мышечные волокна оплетены микрососудами, в том числе в направлении, перпендикулярном ходу миоцитов, соединительнотканные прослойки минимальны. Для растущей мышцы характерны парные миобласты, группы ядер (миотубы), контрактурно измененные миоциты, в соединительнотканном компоненте эластические и коллагеновые волокна, фибробласты, фиброциты, макрофаги. Результаты могут представлять интерес при сравнительном морфологическом анализе в различных экспериментальных моделях.
Objective. To present a clinical case of a patient with spinal deformity associated with myopathy, which was initially undiagnosed and assessed as secondary myopathy after performed spinal surgeries.Material and Methods. Study design: clinical observation and review of the literature. A 51-year-old female patient has been repeatedly operated on for scoliotic deformity of the spine with progressing neurological disorders. Clinical and complex radiological assessment (spinal telemetry in sitting position, CT, MRI) of the pathology was performed. In connection with the atypical course of the disease, a pathohistological study of muscle tissue fragments was performed with their fixation in a solution of 10 % neutral formalin. After histological processing, the fragments were embedded in paraffin and stained with hematoxylin-eosin by the Masson trichromic method and by the PTAH method. The preparations were examined using the Pannoramic MIDI II BF hardware and software complex to obtain digital images using the Whole slide imaging technology in the Single layer and Extended focus modes and an AxioScope.A1 stereomicroscope with a digital camera.Results. Two patterns of distribution of nemaline rods of various density and configuration stained dark blue (by PTAH) were identified in sarcoplasm of parts of muscular tissues: diffusely throughout the myocyte and forming clusters of various sizes in transverse sections, and as filamentous structures – in longitudinal ones. Extensive fields of fatty degeneration, transformation of fibers into lipocytes, contracturely changed fibers, pictures of myophaga and areas of fibrosis of the interstitial space associated with residual myocytes were noted. Intramuscular nervous conductors were subjected to complete involution, singular nervous fibers were deformed, internal space was fibrotic. Neuromuscular spindles had unusually increased connective tissue capsule filled with lipocytes. Arterial vessels had fibrosis of t. adventicia and t. media, narrowed or obliterated lumen, and venous vessels were thin-walled and tortuous, which causes their permeability and can cause hemorrhage. The revealed changes in myocytes with the presence of nemaline rods are characteristic of primary nemaline myopathy.Conclusion. The atypicality of clinical manifestations, primarily of the neurological status in scoliosis, requires excluding neuromuscular disease by conducting a histopathological examination of the surgical material.
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