Back Pain and Disability After Lumbar Laminectomy: Is There a Relationship to Muscle Retraction?

Datta, Gorav; Gnanalingham, Kanna; Peterson, David H.; Mendoza, N. Zabalza Hermoso de; O’Neill, Kevin; Dellen, J. Van; McGregor, Alison H.; Hughes, Sean

doi:10.1227/01.neu.0000124751.57121.a6

Cited by 120 publications

(95 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,10,13,27,38 This technique, although commonly used in modern spine surgery, is associated with a significant amount of intra- operative blood loss, muscle necrosis, and atrophy, which translates to an increase in postoperative pain and hospital length of stay. 6,12,20,34,39,43 Percutaneous pedicle screw placement, first described by Magerl in 1977 for spinal external fixation, 26 was first applied to the minimally invasive TLIF by Foley et al…”

Section: Discussionmentioning

confidence: 99%

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Spitz¹,

Sandhu²,

Voyadzis³

2015

SPI

View full text Add to dashboard Cite

OBJECT Percutaneous pedicle screws are used to provide rigid internal fixation in minimally invasive spinal procedures and generally require the use of Kirchner wires (or K-wires) as a guide for screw insertion. K-wires can bend, break, advance, or pull out during the steps of pedicle preparation and screw insertion. This can lead to increased fluoroscopic and surgical times and potentially cause neurological, vascular, or visceral injury. The authors present their experience with a novel “K-wireless” percutaneous pedicle screw system that eliminates the inherent risks of K-wire use. METHODS A total of 100 screws were placed in 28 patients using the K-wireless percutaneous screw system. Postoperative dedicated spinal CT scans were performed in 25 patients to assess the accuracy of screw placement. Screw placement was graded A through D by 2 independent radiologists: A = within pedicle, B = breach < 2 mm, C = breach of 2–4 mm, and D = breach > 4 mm. Screw insertion and fluoroscopy times were also recorded in each case. Clinical complications associated with screw insertion were documented. RESULTS A total of 100 K-wireless percutaneous pedicle screws were placed into the lumbosacral spine in 28 patients. Postoperative CT was performed in 25 patients, thus the placement of only 90 screws was assessed. Eighty-seven screws were placed within the pedicle confines (Grade A), and 3 violated the pedicle (2 Grade B [1 lateral, 1 medial] and 1 Grade D [medial]) for an overall accuracy rate of 96.7%. One patient required reoperation for screw repositioning due to a postoperative L-5 radiculopathy secondary to a Grade D medial breach at L-5. This patient experienced improvement of the radiculopathy after reoperation. Average screw insertion and fluoroscopy times were 6.92 minutes and 22.7 seconds per screw, respectively. CONCLUSIONS The results of this study demonstrate that the placement of K-wireless percutaneous pedicle screws is technically feasible and can be performed accurately and safely with short procedure and fluoroscopy times.

show abstract

Section: Discussionmentioning

confidence: 99%

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Spitz¹,

Sandhu²,

Voyadzis³

2015

SPI

View full text Add to dashboard Cite

show abstract

“…Although several studies have focused on intramuscular pressure associated with posterior lumbar surgery, all of those studies examined intramuscular pressure generated by the muscle retractors during surgery, 6,8,9,19,22,23 which is one of the major causes of histological damage to the paraspinal muscles. To the best of our knowledge, ours is the first study of intramuscular pressure after surgery.…”

Section: Discussionmentioning

confidence: 99%

Intramuscular pressure of the multifidus muscle and low-back pain after posterior lumbar interbody fusion: comparison of mini-open and conventional approaches

Mukai¹,

Takenaka²,

Hosono³

et al. 2013

SPI

View full text Add to dashboard Cite

Object. This randomized study was designed to elucidate the time course of the perioperative development of intramuscular multifidus muscle pressure after posterior lumbar interbody fusion (PLIF) and to investigate whether the route of pedicle screw insertion affects this pressure and resultant low-back pain. Although several studies have focused on intramuscular pressure associated with posterior lumbar surgery, those studies examined intramuscular pressure generated by the muscle retractors during surgery. No study has investigated the intramuscular pressure after PLIF.Methods. Forty patients with L4-5 degenerative spondylolisthesis were randomly assigned to undergo either the mini-open PLIF procedure with pedicle screw insertion between the multifidus and longissimus muscles (n = 20) or the conventional PLIF procedure via a midline approach only (n = 20). Intramuscular pressure was measured 5 times (at 30 minutes and at 6, 12, 24, and 48 hours after surgery) with an intraoperatively installed sensor. Concurrently, the FACES Pain Rating Scale score for low-back pain and the total dose of postoperative analgesics were recorded.Results. With the patients in the supine position, for both groups the mean pressure values were consistently 40-50 mm Hg, which exceeded the critical capillary pressure of the muscle. With the patients in the lateral decubitus position, the pressure decreased over time (from 14 to 9 mm Hg in the mini-open group and from 20 to 10 mm Hg in the conventional group). Among patients in the mini-open group, the pressure was lower, but the difference was not statistically significant. Postoperative pain and postoperative analgesic dosages were also lower .Conclusions. To the authors' knowledge, this is the first study to evaluate postoperative intramuscular pressure after PLIF. Although the results did not demonstrate a significant difference in the intramuscular pressure between the 2 types of PLIF, mini-open PLIF was associated with less pain after surgery. Clinical trial registration no.: UMIN000010069 (www.umin.ac.jp/ctr/index.htm).

show abstract

“…However, paraspinal muscular atrophy due to mechanical injury, disuse secondary to immobilization or bracing, ischemia, and/ or denervation may also be a contributing factor. 2,5,12,14 At the 1-year follow-up, the surgical wound was aesthetically pleasing, and the patient's quality of life was significantly improved with minimal neck pain.…”

Section: Discussionmentioning

confidence: 98%

Cervical spinous process reconstruction

Panchal¹,

Duong²,

Shahlaie³

et al. 2014

SPI

View full text Add to dashboard Cite

C erviCal spondylotic myelopathy is considered one of the most common progressive diseases in the aging cervical spine. 13 A variety of methods for the treatment of cervical spondylotic myelopathy exist, and numerous factors influence the course of action chosen by the surgeon. 9,10 Posterior approaches are readily chosen because of their relatively simple operations and minimal complications. Multilevel cervical laminectomy with instrumented stabilization is frequently performed for multilevel spondylosis with loss of physiological lordosis. 4 As a consequence of such treatment, posterior musculature and ligamentous and bony structures are disrupted. In addition, resection of spinous processes creates a potential space that may result in a concave, crater-like cosmetic deformity despite careful layered closure. To reduce this possibility, posterior paraspinal muscles should be secured to remaining cephalad and caudad spinous processes with the fascia closure brought to midline. The overlying soft tissues should be closed in multiple layers to ensure that the dead space is minimized.1 This report presents a simple technique to repair the cosmetic defect resulting from such a procedure. Case ReportHistory and Examination. This 64-year-old man presented with a 5-year history of chronic neck pain, bilateral shoulder and arm pain, suboccipital headaches, and progressive weakness. He had severe neck pain extending from the suboccipital to the upper thoracic region, scored by the patient as 10 of 10 on the visual analog scale. The patient's condition had deteriorated to such an extent that he was no longer ambulatory. He had previously undergone 2 cervical spine decompressive surgeries and experienced postoperative infection after the second surgery. Until the last few years, he was ambulatory, but his condition gradually deteriorated and he became wheelchair bound and had developed bladder incontinence.On observation, the patient had a severe craniocervical spinal deformity with his chin almost touching his chest. There was a significant crater-like defect along the previous surgical scar at the posterior neck (Fig. 1). Left deltoid, biceps, triceps, wrist flexion and extension, and intrinsic hand muscle strength were all 3/5, and the left hip adductor muscles were 4-/5. All other tested muscle group strength in the upper and lower extremities was 0/5. The patient had hyperreflexia in all extremities.Cervical radiographs, CT scans, and MR images were available for review (Fig. 2). These studies demonstrated a kyphotic deformity with chronic fracture of the dens, C4-6 anterior fusion, and a C6-T1 laminectomy Department of Neurological Surgery, UC Davis Medical Center, Sacramento, CaliforniaPosterior neck deformity with an unsightly crater-like defect may result after cervicothoracic laminectomies. The authors present a new technique, spinous process reconstruction, to address this problem. A 64-year-old man presented with progressive quadriparesis secondary to cervical spondylotic myelopathy. Previously he had underg...

show abstract

Back Pain and Disability After Lumbar Laminectomy: Is There a Relationship to Muscle Retraction?

Cited by 120 publications

References 26 publications

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Intramuscular pressure of the multifidus muscle and low-back pain after posterior lumbar interbody fusion: comparison of mini-open and conventional approaches

Cervical spinous process reconstruction

Contact Info

Product

Resources

About