Motor unit number index in quantitatively assessing motor root lesions and monitoring treatment outcomes in patients with lumbosacral radiculopathy

Zheng, Chaojun; Zhu, Yu; Lyu, Feizhou; Ma, Xiaosheng; Weber, Robert J.; Dong, Tian; Jiang, Jianyuan; Xia, Xinlei

doi:10.1002/mus.26854

Cited by 9 publications

(16 citation statements)

References 29 publications

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“…These are increasing evidences that in ammatory stimulation presented with greater correlation with the radicular pain compared to the mechanical stimulation [1,2,[16][17][18]. Although in ammatory substances in the blood sample are similar between two patient groups in this study, the patients undergoing PTED presented with obviously fewer in ammatory substances in the drainage uid than those in the open discectomy patient group.…”

Section: Discussionmentioning

confidence: 44%

Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

Wang

2020

Preprint

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Background: Approximately one-third patients with lumbar disc herniation (LDH) who accepted traditional discectomy presented with reactive pain few days after operation, and this reactive pain affected short-term clinical outcomes and postoperative early functional exercise. Recent studies demonstrated that this reactive pain may be ascribed to the increased release of inflammatory mediators caused by surgical trauma. Percutaneous transforaminal endoscopic discectomy (PTED), one of the minimal invasive spinal surgical techniques, was demonstrated to be obviously associated with less soft tissue trauma. The aim of this study is to investigate the postoperative reactive pain in LDH patients undergoing PTED compared with open discectomy. Material and methods: This study included 72 patients (PTED vs. open discectomy: 41 vs. 31), and the incidence of reactive pain, as well as both the extent and duration of reactive pain, were evaluated in both patient groups. Furthermore, inflammation related markers in both blood and drainage fluid samples, including white blood cell (WBC) count, C-reactive protein (CRP), creatine kinase (CK), interleukin-6 (IL-6) and IL-1β, were tested before and/or after operation. Results: Compared with open discectomy, patients undergoing PTED showed lower CK and IL-6 in blood samples, as well as lower IL-6 and IL-1β in drainage fluid samples. Significantly greater number of patients undergoing open discectomy showed reactive pain compared to those undergoing PTED (13/31, 41.9% vs. 7/41, 17.0%; P < 0.05), and the duration of reactive pain is mildly longer in the former (P < 0.05). In both patient groups, the patients with reactive pain showed increased IL-6 and IL-1β in drainage fluid samples, as well as increased IL-6 in blood samples (P < 0.05), and there is significant correlation between the inflammation markers in drainage fluid and both duration and extent of reactive pain in both patient groups (P < 0.05). Conclusions: Local inflammatory substance accumulation may be potential cause for postoperative reactive pain, and PTED may effectively reduce the local inflammatory substances accumulation at the surgical site and reduce the risk of reactive pain.

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Section: Discussionmentioning

confidence: 44%

Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

Wang

2020

Preprint

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“…These are increasing evidences that in ammatory stimulation presented with greater correlation with the radicular pain compared to the mechanical stimulation [1,2,[18][19][20]. Although in ammatory substances in the blood sample are similar between two patient groups in this study, the patients undergoing PTED presented with obviously fewer in ammatory substances in the drainage uid than those in the open discectomy patient group.…”

Section: Discussionmentioning

confidence: 44%

“…Lumbar disc herniation (LDH) is a degenerative pathology, and it was estimated that approximately 70-80% of the adult population will be affected by this disease during their lifetime [1,2]. Lumbosacral radiculopathy caused by LDH always carries a series of signs and symptoms and often leads to surgical intervention when conservative management fails [2][3][4]. Traditional open discectomy through unilateral interlaminar approach has obtained satisfactory results [5,6].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

Yang

Wang

2020

Preprint

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Background: Approximately one-third patients with lumbar disc herniation (LDH) showed postoperative reactive pain, and this reactive pain may be related to the postoperative increased release of inflammatory mediators. Percutaneous transforaminal endoscopic discectomy (PTED) can obviously reduce the intraoperative soft tissue trauma. The aim of this study is to investigate the reactive pain in LDH patients undergoing PTED compared with open discectomy. Material and methods: This study retrospectively included 72 patients (PTED vs. open discectomy: 41 vs. 31), and the incidence of reactive pain, as well as both the extent and duration of reactive pain, were evaluated. Furthermore, inflammation related markers in both blood and drainage fluid samples, including white blood cell (WBC) count, C-reactive protein (CRP), creatine kinase (CK), interleukin-6 (IL-6) and IL-1β, were tested before and after operation. Results: Significantly greater number of patients undergoing open discectomy showed reactive pain compared to those undergoing PTED (13/31, 41.9% vs. 7/41, 17.0%; P < 0.05), and the duration of reactive pain is mildly longer in the former (P < 0.05). In both patient groups, the patients with reactive pain showed increased IL-6 and IL-1β in drainage fluid, as well as increased IL-6 in blood samples (P < 0.05), and there is significant correlation between the inflammation markers in drainage fluid and both duration and extent of reactive pain in both patient groups (P < 0.05). Conclusions: Local inflammatory substance accumulation may be potential cause for postoperative reactive pain, and PTED may reduce this inflammatory accumulation at the surgical site and subsequently reduce the risk of reactive pain. Trial registration: This retrospective cohort analysis was retrospectively registered at September 9, 2020.

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“…Motor unit number index (MUNIX) is a recently developed quantitative method that provides an estimated index of the number and size of the functional motor units in the tested muscle [8]. According to the previous studies, MUNIX was demonstrated to be very sensitive in detecting motor unit loss in many different neuromuscular diseases [8][9][10][11], and both Li et al and Marciniak et al demonstrated MUNIX detection can be used to assess the integrity of lower motor neuron in patients with SCI [12,13].…”

Section: Introductionmentioning

confidence: 99%

Motor unit number index detects the effectiveness of surgical treatment in improving distal motor neuron loss in patients with incomplete cervical spinal cord injury

Zhu

Yang

et al. 2020

BMC Musculoskelet Disord

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Background: Recovery of motor dysfunction is important for patients with incomplete cervical spinal cord injury (SCI). To enhance the recovery of muscle strength, both research and treatments mainly focus on injury of upper motor neurons at the direct injury site. However, accumulating evidences have suggested that SCI has a downstream effect on the peripheral nervous system, which may contribute to the poor improvement of the muscle strength after operation. The aim of this study is to investigate the impact of early vs. delayed surgical intervention on the lower motor neurons (LMNs) distal to the injury site in patients with incomplete cervical SCI. Methods: Motor unit number index (MUNIX) was performed on the tibialis anterior (TA), extensor digitorum brevis (EDB) and abductor hallucis (AH) in 47 patients with incomplete cervical SCI (early vs. delayed surgical-treatment: 17 vs. 30) and 34 healthy subjects approximately 12 months after operation. All patients were further assessed by American spinal injury association (ASIA) motor scales and Medical Research Council (MRC) scales. Results: There are no difference of both ASIA motor scores and MRC scales between the patients who accepted early and delayed surgical treatment (P > 0.05). In contrast, the patients undergoing early surgical treatment showed lower MUSIX values in both bilateral EDB and bilateral TA, along with greater MUNIX values in both right-side EDB and right-side TA, compared to the patients who accepted delayed surgical treatment (P < 0.05). Conclusions: Cervical SCI has a negative effect on the LMNs distal to the injury site. Early surgical intervention in Cervical SCI patients may improve the dysfunction of LMNs distal to the injury site, reducing secondary motor neuron loss, and eventually improving clinical prognosis.

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Motor unit number index in quantitatively assessing motor root lesions and monitoring treatment outcomes in patients with lumbosacral radiculopathy

Cited by 9 publications

References 29 publications

Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

Motor unit number index detects the effectiveness of surgical treatment in improving distal motor neuron loss in patients with incomplete cervical spinal cord injury

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