Paraspinal muscle changes of unilateral multilevel minimally invasive transforaminal interbody fusion

Abstract

PurposeWe attempted to identify changes in back muscle atrophy occurring in multilevel minimally invasive transforaminal interbody fusion (MITLIF) and the impact of these changes on clinical outcomes.MethodsThis study was conducted on 92 patients who underwent unilateral MITLIF between 2006 and 2013, had been tracked with a follow-up for at least 1 year, and had been assessed by pre- and postoperative computed tomography (CT). For the clinical evaluation, a pre- and postoperative visualized analog scale (VAS) of the back and legs, and Oswestry Disability Index (ODI) were measured. CT was used for the evaluation of back muscle atrophy and a cross-sectional area (CSA) of the multifidus was measured at the level below a fused segment, excluding metal artifacts.ResultsThere was no significant difference in the reduction of CSA between groups with one-, two-, or three-plus-segment fusion. In addition, no statistically significant differences were found in the pre- and postoperative VAS of the back, VAS of the legs, and ODI between the three groups. The reduction of CSA showed a statistically significant positive correlation with preoperative VAS of the back (p = 0.025, r = 0.562). On the other hand, no significant difference was found in VAS of the leg (p = 0.437, r = 0.082) and ODI (p = 0.106, r = 0.017).ConclusionWhen performing unilateral multilevel MITLIF, significant difference was not found in the atrophy of the multifidus according to the number of fused segments. The clinical outcomes also showed no significant difference. Therefore, unilateral MITLIF can be considered to be an effective surgical method to minimize lumbar muscle damage, even at multiple levels.

Assessment of Paraspinal Muscle Atrophy Percentage after Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Instrumentation Using a Novel Contralateral Intact Muscle-Controlled Model

“…Previous studies have demonstrated a decrease in the adjacent FCSA ranging from −2% to −38% using an open approach compared with +9.9% to −12.2% using minimally invasive techniques [ 8 9 14 16 19 28 29 30 31 32 33 34 ] ( Table 1 ). In our study, the functional integrity assessed by FCSA showed no significant difference proximal and distal to the arthrodesis 1 year after surgery ( p =0.5, p =0.922, respectively) ( Figs.…”

Quantitative analysis of paraspinal muscle atrophy after oblique lateral interbody fusion alone vs. combined with percutaneous pedicle screw fixation in patients with spondylolisthesis

“…Hu et al [23] demonstrated that FCSA assessed by CT is an acceptable method for evaluating paraspinal muscle atrophy, with a high consistency of 0.794 in the intraclass correlation between CT and MRI. Many studies have reported a decrease in the adjacent FCSA, ranging from − 2 to − 38% using an open approach, compared with + 9.9% to − 12.2% using minimally invasive techniques [17,[24][25][26].…”

“…To assess the degree of paravertebral lumbar muscle atrophy of the patients of the two groups, we used the functional cross-sectional area (FCSA) protocol, as previously described [17,18]. Lumbar CT was performed using an Aquilion 64-slice scanner (Toshiba, Tokyo, Japan) before and 24 months after surgery.…”

Spinal Biologics in Minimally Invasive Lumbar Surgery

“…Considering these factors, HA and β -TCP are often modified and combined with each other to enhance the functionality and take advantage of strengths of each material [ 10 , 99 ]. Multiple studies have also reported using HA, β -TCP, or calcium phosphate alone as a supplement to an osteoinductive source in anterior/lateral or posterior approach to MIS fusion [ 13 , 51 , 59 ].…”