Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The aim of this study was to determine the extent of muscle injury caused by continuous or intermittent muscle retraction during macro- and microdiscectomy in lumbar disc surgery. Pain scores, serum creatine phosphokinase (CPK) levels, and histological findings obtained in muscle specimens were compared.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Sixty patients who underwent surgery for a one-level disc herniation during a 1-year period (January 2004–January 2005) and who had similar demographic characteristics were randomly assigned to one of four groups, each consisting of 15 patients: Group A, microdiscectomy in which the retractor was never released; Group B, microdiscectomy in which the retractor was released every 15 minutes; Group C, macrodiscectomy in which the retractor was never released; and Group D, macrodiscectomy in which the retractor was released every 15 minutes.</jats:p> <jats:p>Muscle biopsy samples were acquired in each group, and biochemical studies were conducted to determine serum CPK levels. The duration of muscle retraction was 15 minutes followed by 3 minutes of relaxation in Groups B and D. In all groups, muscle degeneration and elevation in serum CPK levels were observed immediately after surgery. The overall results, however, were different. The decline of serum CPK levels started 1 week after surgery. The smallest degree of muscle injury (reflected by the lowest serum CPK level) was observed in Group B. When the pre- and postoperative CPK values were compared in all groups, the patients in Groups B and D reported the least amount of back pain (p &lt; 0.001). No significant differences in serum CPK levels were observed between Groups A and C or between Groups B and D. The extent of back pain was evaluated using a visual analog scale, and the consumption of analgesics was also assessed. The groups exhibited significantly different responses: the lowest analgesic consumption and the lowest pain scores were demonstrated in Groups B and D.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In this prospective randomized clinical trial, the authors determined that muscle injury during lumbar disc surgery was closely related to muscle retraction and relaxation times whereas the size of the paravertebral skin incision had no effect on postoperative back pain and disability. There was no significant difference among the groups in terms of back pain during the long-term follow-up period (18–19 months).</jats:p></jats:sec>

Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial

“…It seems to be true that after a certain time period a smaller skin incision does not inevitably lead to less pain. This is confirmed by a recent study comparing discectomy with or without a retraction system [19].…”

An evaluation of changes over time in serum creatine kinase activity and C-reactive protein concentration in dogs undergoing hemilaminectomy or ovariohysterectomy

“…In humans, both CRP and CK have been employed in attempts to quantitatively compare the degree of tissue trauma between different surgical techniques 6,17,18 . CK has also been used to evaluate the extent and cause of muscle damage resulting from lumbar back surgery 19,20,22 .…”

Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

“…Likewise, other research has reported LM muscle atrophy and injury following lumbar disc surgery, although this appears to vary with surgical approach 53,64,98 and the amount of intraoperative retraction time. 14,28,59,70 Moreover, such changes may be related to the development of failed back syndrome or postdiscectomy syndrome. 95,117 The transversus abdominis (TrA) is another muscle considered to be an important contributor to lumbar spine stability.…”