The Lumbar Multifidus Muscle Five Years After Surgery for a Lumbar Intervertebral Disc Herniation

Rantanen, Jussi; Hurme, Matti; Falck, Björn; Alaranta, Hannu; Nykvist, Finn; Lehto, Matti; Einola, Sakari; Kalimo, Hannu

doi:10.1097/00007632-199304000-00008

Cited by 335 publications

(168 citation statements)

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“…However, these alterations could not be proven to be related directly to the surgery as they also occur with disuse. Intraoperative and 5-year postoperative biopsies showed that patients who did clinically well had less type II atrophy at the time of surgery, whereas the atrophy persisted in those patients who did not do as well [69]. It seems that the type II atrophy is due to inactivity and is irreversible.…”

Section: Survey Of the Literaturementioning

confidence: 96%

Is there a rational basis for post-surgical lifting restrictions? 1. Current understanding

et al. 1999

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IntroductionAfter surgery it is a common practice to prescribe lifting restrictions. These seem to be based on a premise that the spine is weaker and thus subject to re-injury when there has been some disruption of the functional spinal motion unit (FSU) due to surgery. Re-injury is not, however, often reported in the literature. More often a failure of fusion is reported [3, 6, 12, 23, 27,72,79].Recurrent low back pain (LBP) or other impairments may exist after back surgery in up to 50% of operated patients [61]. Robert et al. [71] studied the outcome after operation for lumbar herniated nucleus pulposus (HNP). The median duration of postoperative work incapacity was 3.5 months. Seventy-eight percent of the patients resumed full-time work in their previous job, and 75% were pain free. Predictive factors for a good outcome were a preoperative work incapacity of less than 4 weeks and, for men, no daily lifting of heavy weights.Although most surgeons employ some kind of postoperative lifting restrictions, there is not much scientific literature upon which to base those limitations. If the empirical basis for limitations were correct, one would expect a consensus on the limitations (i.e., there would be a tendency for physicians to agree on the correct restrictions).Lifting restrictions are not a trivial issue. A restriction may prevent return to work if the employer is unable, or Abstract Lifting restrictions postoperatively are quite common, but there appears to be little scientific basis for them. Lifting restrictions are inhibitory in terms of return to work and may be a factor in chronicity. The mean functional spinal motion unit stiffness changes with in vitro or computer-simulated discectomies, facetectomies and laminectomies were reviewed from the literature. We modified the NIOSH lifting equation to include another multiplier related to stiffness change post surgery. The new recommended lifts were computed for different lifting conditions seen in industry. The reduction of rotational stiffness ranged from 21% to 41% for a discectomy, 1% to 59% for a facetectomy and 4% to 16% for a partial laminectomy. The recommended lifts based on our modified equation were adjusted accordingly. There is no rational basis for current lifting restrictions. The risk to the spine is a function of many other variables as well as weight (i.e., distance of weight from body). The adjusted NIOSH guidelines provide a reasonable way to estimate weight restrictions and accommodations such as lifting aids. Such restrictions should be as liberal as possible so as to facilitate, not prevent, return to work. Patients need more advice regarding lifting activities and clinicians should be more knowledgeable about the working conditions and constraints of a given workplace to effectively match the solution to the patient's condition.Key words Lifting · Surgery · Return to work · Low back pain · NIOSH ORIGINAL ARTICLE Eur Spine J (1999) 8 : 170-178

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Section: Survey Of the Literaturementioning

confidence: 96%

Is there a rational basis for post-surgical lifting restrictions? 1. Current understanding

et al. 1999

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“…Microscopic studies of low back patients and healthy volunteers with marked atrophy of the back muscles have demonstrated structural changes in the back muscles [18,27,30]. Fortunately, morphologic information on muscles can be obtained in a non-invasive way by computer tomography (CT) [3,15,16,20,30], magnetic resonance imaging (MRI) [7,9,24,25], and ultrasonic imaging techniques [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have shown that the lumbar multifidus (MF) is an important muscle for lumbar segmental stability [4,5,6,10,23,32]. Results of MF muscle biopsies of patients with a poor outcome showed muscle atrophy and an increase in frequency of pathologic changes in the MF [27]. Ultrasound imaging has been used to document muscle size of the MF and showed that, in the acute stage, the wasting of the MF can be isolated to one level [12].…”

Section: Introductionmentioning

confidence: 99%

CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects

Danneels

Vanderstraeten

Cambier

et al. 2000

European Spine Journal

572

490

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“…We did not perform an invasive needle EMG examination, as other studies have already shown that signs of denervation only occur in a small percentage of patients with conditions after spine surgery and thus do not constitute an explanation for pain [3,18]. Clinical examination did not reveal a sensibility deficit above the paravertebral muscles in any of the patients.…”

Section: Limitations Of the Studymentioning

confidence: 93%

“…Braunswarth and Kallitzas [3] and Rantanen et al [18] established fibre type grouping as a sign of nerve damage in a small percentage of the patients with conditions after spine surgery. The discussion on how a nerve injury can lead to the isolated damage established for the multifidus muscles should be guided by the anatomical course of the dorsal branch of the spinal nerve.…”

Section: Trauma and Operation As The "Indirect" Causementioning

confidence: 99%

Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine

et al. 2001

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The Lumbar Multifidus Muscle Five Years After Surgery for a Lumbar Intervertebral Disc Herniation

Cited by 335 publications

References 0 publications

Is there a rational basis for post-surgical lifting restrictions? 1. Current understanding

Is there a rational basis for post-surgical lifting restrictions? 1. Current understanding

CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects

Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine

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