Multifidus innervation and muscle assessment post-spinal surgery

Purpose Assessment of the integrity of the multifidus muscles and corresponding nerve roots, post-open (OSS) versus minimally invasive spinal surgery (MISS) for lumbar spine fractures. Methods We investigated the first six patients undergoing MISS in our institution and age- and sex-matched them wit...

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Bibliographic Details
Published in:European spine journal 2014-02, Vol.23 (2), p.320-327
Main Authors: Cawley, Derek T., Alexander, Michael, Morris, Seamus
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Electromyography
Female
Humans
Lumbar Vertebrae - surgery
Lumbosacral Region - innervation
Lumbosacral Region - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Minimally Invasive Surgical Procedures - methods
Neurosurgery
Original
Original Article
Paraspinal Muscles - innervation
Postoperative Complications
Spinal Fractures - surgery
Surgical Orthopedics
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Summary:Purpose Assessment of the integrity of the multifidus muscles and corresponding nerve roots, post-open (OSS) versus minimally invasive spinal surgery (MISS) for lumbar spine fractures. Methods We investigated the first six patients undergoing MISS in our institution and age- and sex-matched them with 6 random patients who previously had OSS. All had a similar lumbar fracture configuration without evidence of spinal cord injury. All were assessed using ultrasound muscle quantification and electromyographic studies at a minimum of 6 months post-operatively. Mean cross-sectional area (CSA) was measured at sequential levels within and adjacent to the operative field. Concentric needle electromyography was performed at instrumented and adjacent non-instrumented levels in each patient. Results Mean CSA across all lumbar multifidus muscles was 4.29 cm 2 in the MISS group, 2.26 cm 2 for OSS ( p  = 0.08). At the instrumented levels, mean CSA was 4.21 cm 2 for MISS and 2.03 cm 2 for OSS ( p  = 0.12). At non-instrumented adjacent levels, mean CSA was 4.46 cm 2 in the MISS group, 2.87 cm 2 for OSS ( p  = 0.05). Electromyography at non-instrumented adjacent levels demonstrated nerve function within normal limits in 5/6 levels in the MISS group compared to 1/6 levels in the OSS ( p  = 0.03). Instrumented levels demonstrated nerve function within normal limits in 5/12 levels in the MISS group compared with 4/12 in the OSS group, including moderate–severe denervation at 5 levels in the OSS group ( p  = 0.15). Conclusions Posterior instrumented MISS demonstrates a significantly superior preservation of the medial branch of the posterior ramus of the spinal nerve and less muscle atrophy, particularly at adjacent levels when compared to OSS.
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-013-2962-7