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

Abstract

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).

Predictors of Prolonged Length of Stay After Lumbar Interbody Fusion: A Multicenter Study

“…Previous reports have shown shorter hospitalization in patients undergoing MIS procedures, with decreases in LOS ranging from 15.0% to 64.0%. [30][31][32][33][34] Our results are consistent with these findings. We note that the percentage of procedures performed using MIS in this study is relatively low and lower than the national average, despite the study being performed at multiple centers.…”

Postoperative Low Back Pain after Posterior Lumbar Interbody Fusion Surgery Using Cortical Bone Trajectory Screws

“…CBT surgeries usually involve a small skin incision. Back muscle retraction through this small skin incision increases the intramuscular pressure to a level that impedes local blood flow of the muscle and leads to muscle degeneration [ 19 , 20 ]. Postoperative magnetic resonance imaging demonstrated that the CBT screw head replaced the multifidus because of the screw’s medial-to-lateral orientation and caudo-cephalad pathway ( Fig.…”

Relationship Between the Ischiotibial and Paravertebral Muscles and Low Back Pain

“…They are located in the posterior vertebral spine and their function is the keep the torso upright while we are standing or sitting. [17][18][19][20][21][22] There is a close relationship between the paravertebral muscles and low back pain. Studies to evaluate the muscle strength of patients with mechanical low back pain have found severe hypotrophy of the paravertebral musculature of these patients among their results, showing the close relationship between mechanical low back pain and weakness of the paravertebrals.…”

“…The flexibility of the ischiotibial muscles is important for postural balance and to the maintenance of the total range of motion of the knee and hip. 19,20 Another very important factor is lack of physical activity, directly or indirectly related to back pain due to the shortening of muscles and overloads on the spine, making individuals more susceptible to low back pain. 3,[20][21][22][23][24] Sedentary individuals who had pain in the lumbar region and underwent a program of stretching followed by muscle strengthening experienced an improvement in body posture and a reduction in the incidence of lumbar pain at the end of treatment.…”