Reattachment of the Multifidus Tendon in Lumbar Surgery to Decrease Postoperative Back Pain: A Technical Note

Klinger, Neil V.; Yılmaz, Emre; Halalmeh, Dia R.; Tubbs, R. Shane; Moisi, Marc

doi:10.7759/cureus.6366

Cited by 8 publications

(8 citation statements)

References 20 publications

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“…MF distributed segmentally and exert independent biomechanical effects in each segment. Also, MF is innervated by the medial branch of the dorsal rami uni-segmentally, each band of multifidus muscle receiving its innervation from one dorsal ramus only [34]. These independent anatomical features make MF tend to develop segmental degeneration.…”

Section: Factors Of Degeneration Patterns For Mf and Esmentioning

confidence: 99%

“…The traditional posterior approach dissects and seriously affects the paraspinal muscles, which interferes with postoperative recovery and normal spinal sequence maintenance. Studies have shown that patients with postoperative low back pain exhibit MF degeneration, including muscular atrophy, intramuscular adipose tissue accumulation and denervation [34]. The local anatomic structures make the ES and medial MF vulnerable to injury during traditional PLIF procedure [41].…”

Section: Paraspinal Muscles Degeneration In Degenerative Lumbar Diseasesmentioning

confidence: 99%

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Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients

Ding

Kong

et al. 2022

Eur Spine J

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Study design A retrospective study. Objective To evaluate the different degeneration patterns of paraspinal muscles in degenerative lumbar diseases and their correlation with lumbar spine degeneration severity. Summary of background data The degeneration characteristics of different paraspinal muscles in degenerative lumbar diseases remain unclear. Methods 78 patients diagnosed with single-level degenerative lumbar spondylolisthesis (DLS) and 76 patients with degenerative lumbar kyphosis (DLK) were included as DLS and DLK groups. Paraspinal muscle parameters of psoas major (PS), erector spinae (ES) and multifidus muscle (MF) were measured, including fatty infiltration (FI) and relative cross-sectional area (rCSA), namely the ratio of the paraspinal muscle CSA to the CSA of the vertebrae of the same segment. Sagittal parameters including lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. The paraspinal muscle parameters and ES/MF rCSA ratio were compared between the two groups. Paraspinal muscles parameters including rCSA and FI were also compared between each segments from L1 to L5 in both DLS and DLK groups. In order to determine the influence of sagittal spinal alignment on paraspinal muscle parameters, correlation analysis was conducted between the MF, ES, PS rCSA and FI and the LL in DLS and DLK group. Result MF atrophy is more significant in DLS patients compared with DLK. Also, MF fatty infiltration in the lower lumbar spine of DLS patients was greater compared to DLK patients. DLK patients showed more significant atrophy of ES and heavier ES fatty infiltration. MF FI was significantly different between all adjacent segments in both DLS and DLK groups. In DLS group, ES FI was significantly different between L2/L3 to L3/L4 and L4/L5 to L5/S1, while in DLK group, the difference of ES FI between all adjacent segments was not significant, and ES FI was found negatively correlated with LL. Conclusions Paraspinal muscles show different degeneration patterns in degenerative lumbar diseases. MF degeneration is segmental in both DLS and DLK patients, while ES degenerated diffusely in DLK patients and correlated with the severity of kyphosis. MF degeneration is more significant in the DLS group, while ES degeneration is more significant in DLK patients. MF is the stabilizer of the lumbar spine segments, while the ES tends to maintain the spinal sagittal balance.

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Section: Factors Of Degeneration Patterns For Mf and Esmentioning

confidence: 99%

Section: Paraspinal Muscles Degeneration In Degenerative Lumbar Diseasesmentioning

confidence: 99%

Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients

Ding

Kong

et al. 2022

Eur Spine J

View full text Add to dashboard Cite

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“…Second, the posterior approach requires a direct incision of the multifidus muscle, which causes degeneration and necrosis of muscle fibers due to abnormal loading. Finally, partial resection of the articular process would lead to injury of the posterior branch of the spinal nerve, resulting in denervation of the multifidus muscle 25 . Although there was no significant difference in the VAS score of the lower extremity, we found that there were more patients with paresthesia and other sensory abnormalities in the MTD group than in the PTED group (16.67% vs 5.7%).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microscope‐Assisted Tubular Discectomy for Lumbar Disc Herniation

Liu

Xue

Jiang

et al. 2021

Orthopaedic Surgery

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The aim of the present study was to compare the clinical outcomes and quality of life following percutaneous transforaminal endoscopic discectomy (PTED) and microscope-assisted tubular discectomy (MTD) for lumbar disc herniation (LDH).Methods: This study had a retrospective design. From June 2017 to June 2018, the clinical data of 120 patients with LDH treated with PTED (60 cases, PTED group) and MTD (60 cases, MTD group) were analyzed and followed up for at least 20 months. There were 59 men and 61 women. Patients were aged between 22 and 80 years. The operation time, intraoperative blood loss, incision length, frequency of intraoperative fluoroscopy, cost, hospital stay, types of herniated discs, complications, and clinical outcomes were evaluated. Clinical outcomes were assessed using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified Macnab criteria. Short-Form 36 (SF-36) and the EQ-5D-5L were used to evaluate the quality of life of patients. The data between the two groups were compared by independent sample t-tests. Multiple comparisons between samples were analyzed by analysis of variance.Results: Compared with the MTD group, the PTED group had shorter incision length (9.20 AE 1.19 mm vs 26.38 AE 1.82 mm), less intraoperative blood loss (18.00 AE 4.97 mL vs 39.83 AE 6.51 mL), and shorter hospital stay (5.42 AE 5.08 days vs 10.58 AE 3.69 days) (P = 0.00). PTED was much more appropriate for foraminal and extraforaminal disc herniation. The incidence of paresthesia was lower in the PTED group (6.67% vs 16.67%). At each follow up, the VAS and ODI scores of all patients were significantly improved compared with those before surgery (P = 0.00). At 3 days postoperatively, the lumbar VAS score of the PTED group was significantly lower (1.58 AE 1.00 vs 2.37 AE 1.10, P = 0.00). The excellent rate of the PTED group reached 91.67%, and that of the MTD group reached 93.33%. Compared with the preoperative SF-36 scores for physiological function, mental health, and social function, the postoperative scores were significantly improved in both groups (P = 0.00). The EQ-5D-5L in the PTED group increased from 0.30 AE 0.17 before the operation to 0.69 AE 0.13 after 6 months of follow up (P = 0.00) and 0.73 AE 0.14 after 20 months of follow up. The EQ-5D-5L in the MTD group increased from 0.28 AE 0.17 before the operation to 0.68 AE 0.13 after a 6-month follow up (P = 0.00), and 0.73 AE 0.12 after a 20-month follow up. Conclusion:Although both PTED and MTD are effective for LDH, PTED is much more appropriate for various types of LDH and has the advantages of the low incidence of low back pain, fewer complications, and early recovery.

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“…Sole SRS was shown to affect distant metastases also without concomitant immunotherapy. Even when its mechanisms are not fully understood, it is based on the release of cytokines and tumor cell antigens within irradiated metastases that stimulate a cytotoxic immune response [ 13 ]. It not only affects remaining tumor cells locally, but also acts on distant metastases [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

MRI characteristics in treatment for cerebral melanoma metastasis using stereotactic radiosurgery and concomitant checkpoint inhibitors or targeted therapeutics

et al. 2021

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Introduction Combination therapy for melanoma brain metastases (MM) using stereotactic radiosurgery (SRS) and immune checkpoint-inhibition (ICI) or targeted therapy (TT) is currently of high interest. In this collective, time evolution and incidence of imaging findings indicative of pseudoprogression is sparsely researched. We therefore investigated time-course of MRI characteristics in these patients. Methods Data were obtained retrospectively from 27 patients (12 female, 15 male; mean 61 years, total of 169 MMs). Single lesion volumes, total MM burden and edema volumes were analyzed at baseline and follow-up MRIs in 2 months intervals after SRS up to 24 months. The occurrence of intralesional hemorrhages was recorded. Results 17 patients (80 MM) received ICI, 8 (62 MM) TT and 2 (27 MM) ICI + TT concomitantly to SRS. MM-localization was frontal (n = 89), temporal (n = 23), parietal (n = 20), occipital (n = 10), basal ganglia/thalamus/insula (n = 10) and cerebellar (n = 10). A volumetric progression of MM 2–4 months after SRS was observed in combined treatment with ICI (p = 0.028) and ICI + TT (p = 0.043), whereas MMs treated with TT showed an early volumetric regression (p = 0.004). Edema volumes moderately correlated with total MM volumes (r = 0.57; p < 0.0001). Volumetric behavior did not differ significantly over time regarding lesions’ initial sizes or localizations. No significant differences between groups were observed regarding rates of post-SRS intralesional hemorrhages. Conclusion Reversible volumetric increases in terms of pseudoprogression are observed 2–4 months after SRS in patients with MM concomitantly treated with ICI and ICI + TT, rarely after TT. Edema volumes mirror total MM volumes. Medical treatment type does not significantly affect rates of intralesional hemorrhage.

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Reattachment of the Multifidus Tendon in Lumbar Surgery to Decrease Postoperative Back Pain: A Technical Note

Cited by 8 publications

References 20 publications

Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients

Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients

Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microscope‐Assisted Tubular Discectomy for Lumbar Disc Herniation

MRI characteristics in treatment for cerebral melanoma metastasis using stereotactic radiosurgery and concomitant checkpoint inhibitors or targeted therapeutics

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