Postoperative posterior lumbar muscle changes and their relationship to segmental motion preservation or restriction: a randomized prospective study

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>To date, it remains unclear whether the preservation of segmental motion by total disc replacement (TDR) or motion restriction by stand-alone anterior lumbar interbody fusion (ALIF) have an influence on postoperative degeneration of the posterior paraspinal muscles or the associated clinical results. Therefore, the purpose of the present prospective randomized study was to evaluate the clinical parameters and 3D quantitative radiological changes in the paraspinal muscles of the lumbar spine in surgically treated segments and superior adjacent segments after ALIF and TDR.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A total of 50 patients with chronic low-back pain caused by single-level intervertebral disc degeneration (Pfirrmann Grade ≥ III) and/or osteochondrosis (Modic Type ≤ 2) without symptomatic facet joint degeneration (Fujiwara Grade ≤ 2, infiltration test) of the segments L4–5 or L5–S1 were randomly assigned to 2 treatment groups. Twenty-five patients were treated with a stand-alone ALIF and the remaining 25 patients underwent TDR. For ALIF and TDR, a retroperitoneal approach was used. At 1 week and at 12 months after surgery, CT was used to analyze paraspinal lumbar muscle tissue volume and relative fat content. Residual muscle tissue volume at 12 months and change in the relative fat content were compared between the groups. In addition, clinical parameters (visual analog scale [VAS] for low-back pain and Oswestry Disability Index [ODI] Questionnaire Version 2 for function) were compared.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Compared with 1 week after surgery, the radiological analysis at 12 months revealed a small decrease in the posterior muscle volume (the mean decrease was &lt; 2.5%), along with a small increase in the relative fat content (the mean increase was &lt; 1.9%), in both groups at the index and superior adjacent segments. At the adjacent segment, the ALIF group presented significantly less muscle tissue volume atrophy and a smaller increase in fat content compared with the TDR group. At final follow-up, the clinical parameters related to pain and function were significantly improved in both groups compared with 1 week postsurgery, but there were no differences between the groups.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Motion restriction via stand-alone ALIF and motion preservation via TDR both present small changes in the posterior lumbar paraspinal muscles with regard to volume atrophy or fatty degeneration at the index and superior adjacent segments. Therefore, although the clinical outcome was not affected by the observed muscular changes, the authors concluded that the expected negative influence of motion restriction on the posterior muscles compared with motion preservation does not occur on a clinically relevant level.</jats:p></jats:sec>

Does pre-operative multifidus morphology on MRI predict clinical outcomes in adults following surgical treatment for degenerative lumbar spine disease? A systematic review

“…Alternatively, in cases where conservative treatment has failed or in those with concurrent spinal stenosis or radiculopathy, surgical management may be considered [8]. At present, there is some evidence to suggest that changes in the morphology of multifidus following a surgical procedure are associated with worse clinical outcomes, although the magnitude of this effect is unclear [10][11][12][13][14]. Furthermore, the association between the pre-operative morphological condition of multifidus and post-operative clinical outcomes is not well described [15][16][17][18][19].…”

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].…”

“…Second, paravertebral muscles are damaged, and muscle strength is reduced, which may accelerate the instability of adjacent segments. Strube et al [26] reported that the overall atrophy and fatty degeneration ratio at the adjacent segments after the anterioronly treatment option (ALIF) appears to be rather low.…”

Range of Motion According to the Fusion Level after Lumbar Spine Fusion: A Retrospective Study

“…This is why the posterior elements and ligaments are important in the maintenance of spinal stability. It has been established that posterior spinal surgery damages the paraspinal musculature, facet joint, and ligaments, causing limitations of ROM 9,17) . Thus, in clinical practice, postoperative posterior lumbar muscle damage plays an important role in the limitations of ROM.…”