Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients
Background Different studies have shown that atrophy of paraspinal muscles arises after open dorsal lumbar fusion, and the reasons for this atrophy are still not yet fully clarified. This prospective study investigates the extent of atrophy of the lumbar paraspinal muscles after open lumbar interbod...
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| Veröffentlicht in: | Acta neurochirurgica 2014-02, Vol.156 (2), p.235-244 |
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| creator | Waschke, Albrecht Hartmann, Christin Walter, Jan Dünisch, Pedro Wahnschaff, Falko Kalff, Rolf Ewald, Christian |
| description | Background
Different studies have shown that atrophy of paraspinal muscles arises after open dorsal lumbar fusion, and the reasons for this atrophy are still not yet fully clarified. This prospective study investigates the extent of atrophy of the lumbar paraspinal muscles after open lumbar interbody fusion, its possible causes, and their association with clinical outcome measures.
Methods
Thirty consecutive patients were prospectively included (13 male, 17 female, median age 60.5 years, range 33–80 years). Mono or bisegmental, posterior lumbar interbody fusion and instrumentation was performed applying a conventional, open lumbar midline approach. Clinical outcome was assessed by the Short Form (36) Health Survey (SF-36) questionnaire and visual analogue scale. Needle electromyography of paraspinal muscles was performed preoperatively, at 6 and 12 months. Serum values of creatine kinase, lactate dehydrogenase and myoglobin were determined preoperatively, at day 2 after surgery and at discharge. Paraspinal muscle volume was determined by volumetric analysis of thin-slice computed tomography scans preoperatively and 1 year after surgery.
Results
There was a significant increase of electromyographic denervation activity (
p
=0.024) and reduced recruitment of motor units (
p
= 0.001) after 1 year. Laboratory studies showed a significant increase of CK (
p
|
| doi_str_mv | 10.1007/s00701-013-1981-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1496881391</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1496881391</sourcerecordid><originalsourceid>FETCH-LOGICAL-c405t-4ca0d8a34f16a22125602d593f57841ca5bf76891b6695f01c2b211f6e3040bd3</originalsourceid><addsrcrecordid>eNqNkkuO1DAQhiMEYoaBA7BBltiwCfgVx16i5imNxGZYR45jd3uU2MF2etQ7DsFduA8noTIZEEJCYlO2q776q-SqqnpK8EuCcfsqg8GkxoTVRElSq3vVOVac1mDwfbhjiAoq5Fn1KOdreNGWs4fVGeVMciXVefX9jQ02HXXxMSAdBqRLivPhhKJDs046zz7oEU1LNqPNSLtiE4qzDWhcpl4n5AN4-jickFvyKuKByjkar4sd0I0vB2RGH7wBmbgUEyf74-s3O1oDlaZT3Cc9H7y5Lb67qo8RhG1J4PHhaHPx-605aIhh6Kl4G0p-XD1wesz2yd15UX1-9_Zq96G-_PT-4-71ZW04bkrNjcaD1Iw7IjSlhDYC06FRzDWt5MTopnetkIr0QqjGYWJoTwlxwjLMcT-wi-rFpjun-GWBdrrJZ2PHUQcbl9wRroSUhCnyPyiMAot2RZ__hV7HJcFH31JYSsmUAopslEkx52RdNyc_6XTqCO7WBei2BehgAbp1Abo159md8tJPdvid8WviANANyBAKe5v-KP1P1Z9bBL9s</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1490888399</pqid></control><display><type>article</type><title>Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Waschke, Albrecht ; Hartmann, Christin ; Walter, Jan ; Dünisch, Pedro ; Wahnschaff, Falko ; Kalff, Rolf ; Ewald, Christian</creator><creatorcontrib>Waschke, Albrecht ; Hartmann, Christin ; Walter, Jan ; Dünisch, Pedro ; Wahnschaff, Falko ; Kalff, Rolf ; Ewald, Christian</creatorcontrib><description>Background
Different studies have shown that atrophy of paraspinal muscles arises after open dorsal lumbar fusion, and the reasons for this atrophy are still not yet fully clarified. This prospective study investigates the extent of atrophy of the lumbar paraspinal muscles after open lumbar interbody fusion, its possible causes, and their association with clinical outcome measures.
Methods
Thirty consecutive patients were prospectively included (13 male, 17 female, median age 60.5 years, range 33–80 years). Mono or bisegmental, posterior lumbar interbody fusion and instrumentation was performed applying a conventional, open lumbar midline approach. Clinical outcome was assessed by the Short Form (36) Health Survey (SF-36) questionnaire and visual analogue scale. Needle electromyography of paraspinal muscles was performed preoperatively, at 6 and 12 months. Serum values of creatine kinase, lactate dehydrogenase and myoglobin were determined preoperatively, at day 2 after surgery and at discharge. Paraspinal muscle volume was determined by volumetric analysis of thin-slice computed tomography scans preoperatively and 1 year after surgery.
Results
There was a significant increase of electromyographic denervation activity (
p
=0.024) and reduced recruitment of motor units (
p
= 0.001) after 1 year. Laboratory studies showed a significant increase of CK (
p
< 0.001) and myoglobin (
p
< 0.001) serum levels at day 2 after surgery. The paraspinal muscle volume decreased from 67.8 to 60.4 % (
p
< 0.001) after 1 year. Correlation analyses revealed a significant negative correlation between denervation and muscle volume (
K
= -0.219,
p
= 0.002). Paraspinal muscle volume is significantly correlated with physical outcome (
K
= 0.169,
p
= 0.020), mental outcome (
K
= 0.214,
p
= 0.003), and pain (
K
= 0.382,
p
< 0.001) after 1 year.
Conclusions
Atrophy of paraspinal muscles after open, posterior lumbar interbody fusion seems to be associated with denervation, as well as direct muscle trauma during surgery. While muscle atrophy is also correlated with a worse clinical outcome, it seems to be a determining factor for successful lumbar spine surgery.</description><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-013-1981-9</identifier><identifier>PMID: 24384989</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Adult ; Age ; Aged ; Aged, 80 and over ; Clinical Article - Spine ; Clinical outcomes ; Denervation - methods ; Electromyography ; Female ; Humans ; Interventional Radiology ; Lumbar Vertebrae - surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgery ; Muscular Atrophy - etiology ; Muscular Atrophy - physiopathology ; Neurology ; Neuroradiology ; Neurosurgery ; Paraspinal Muscles - innervation ; Paraspinal Muscles - physiopathology ; Paraspinal Muscles - surgery ; Prospective Studies ; Spinal Fusion - adverse effects ; Spinal Fusion - methods ; Surgical Orthopedics ; Treatment Outcome</subject><ispartof>Acta neurochirurgica, 2014-02, Vol.156 (2), p.235-244</ispartof><rights>Springer-Verlag Wien 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-4ca0d8a34f16a22125602d593f57841ca5bf76891b6695f01c2b211f6e3040bd3</citedby><cites>FETCH-LOGICAL-c405t-4ca0d8a34f16a22125602d593f57841ca5bf76891b6695f01c2b211f6e3040bd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-013-1981-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-013-1981-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24384989$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Waschke, Albrecht</creatorcontrib><creatorcontrib>Hartmann, Christin</creatorcontrib><creatorcontrib>Walter, Jan</creatorcontrib><creatorcontrib>Dünisch, Pedro</creatorcontrib><creatorcontrib>Wahnschaff, Falko</creatorcontrib><creatorcontrib>Kalff, Rolf</creatorcontrib><creatorcontrib>Ewald, Christian</creatorcontrib><title>Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Background
Different studies have shown that atrophy of paraspinal muscles arises after open dorsal lumbar fusion, and the reasons for this atrophy are still not yet fully clarified. This prospective study investigates the extent of atrophy of the lumbar paraspinal muscles after open lumbar interbody fusion, its possible causes, and their association with clinical outcome measures.
Methods
Thirty consecutive patients were prospectively included (13 male, 17 female, median age 60.5 years, range 33–80 years). Mono or bisegmental, posterior lumbar interbody fusion and instrumentation was performed applying a conventional, open lumbar midline approach. Clinical outcome was assessed by the Short Form (36) Health Survey (SF-36) questionnaire and visual analogue scale. Needle electromyography of paraspinal muscles was performed preoperatively, at 6 and 12 months. Serum values of creatine kinase, lactate dehydrogenase and myoglobin were determined preoperatively, at day 2 after surgery and at discharge. Paraspinal muscle volume was determined by volumetric analysis of thin-slice computed tomography scans preoperatively and 1 year after surgery.
Results
There was a significant increase of electromyographic denervation activity (
p
=0.024) and reduced recruitment of motor units (
p
= 0.001) after 1 year. Laboratory studies showed a significant increase of CK (
p
< 0.001) and myoglobin (
p
< 0.001) serum levels at day 2 after surgery. The paraspinal muscle volume decreased from 67.8 to 60.4 % (
p
< 0.001) after 1 year. Correlation analyses revealed a significant negative correlation between denervation and muscle volume (
K
= -0.219,
p
= 0.002). Paraspinal muscle volume is significantly correlated with physical outcome (
K
= 0.169,
p
= 0.020), mental outcome (
K
= 0.214,
p
= 0.003), and pain (
K
= 0.382,
p
< 0.001) after 1 year.
Conclusions
Atrophy of paraspinal muscles after open, posterior lumbar interbody fusion seems to be associated with denervation, as well as direct muscle trauma during surgery. While muscle atrophy is also correlated with a worse clinical outcome, it seems to be a determining factor for successful lumbar spine surgery.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Clinical Article - Spine</subject><subject>Clinical outcomes</subject><subject>Denervation - methods</subject><subject>Electromyography</subject><subject>Female</subject><subject>Humans</subject><subject>Interventional Radiology</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgery</subject><subject>Muscular Atrophy - etiology</subject><subject>Muscular Atrophy - physiopathology</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Paraspinal Muscles - innervation</subject><subject>Paraspinal Muscles - physiopathology</subject><subject>Paraspinal Muscles - surgery</subject><subject>Prospective Studies</subject><subject>Spinal Fusion - adverse effects</subject><subject>Spinal Fusion - methods</subject><subject>Surgical Orthopedics</subject><subject>Treatment Outcome</subject><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkkuO1DAQhiMEYoaBA7BBltiwCfgVx16i5imNxGZYR45jd3uU2MF2etQ7DsFduA8noTIZEEJCYlO2q776q-SqqnpK8EuCcfsqg8GkxoTVRElSq3vVOVac1mDwfbhjiAoq5Fn1KOdreNGWs4fVGeVMciXVefX9jQ02HXXxMSAdBqRLivPhhKJDs046zz7oEU1LNqPNSLtiE4qzDWhcpl4n5AN4-jickFvyKuKByjkar4sd0I0vB2RGH7wBmbgUEyf74-s3O1oDlaZT3Cc9H7y5Lb67qo8RhG1J4PHhaHPx-605aIhh6Kl4G0p-XD1wesz2yd15UX1-9_Zq96G-_PT-4-71ZW04bkrNjcaD1Iw7IjSlhDYC06FRzDWt5MTopnetkIr0QqjGYWJoTwlxwjLMcT-wi-rFpjun-GWBdrrJZ2PHUQcbl9wRroSUhCnyPyiMAot2RZ__hV7HJcFH31JYSsmUAopslEkx52RdNyc_6XTqCO7WBei2BehgAbp1Abo159md8tJPdvid8WviANANyBAKe5v-KP1P1Z9bBL9s</recordid><startdate>20140201</startdate><enddate>20140201</enddate><creator>Waschke, Albrecht</creator><creator>Hartmann, Christin</creator><creator>Walter, Jan</creator><creator>Dünisch, Pedro</creator><creator>Wahnschaff, Falko</creator><creator>Kalff, Rolf</creator><creator>Ewald, Christian</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20140201</creationdate><title>Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients</title><author>Waschke, Albrecht ; Hartmann, Christin ; Walter, Jan ; Dünisch, Pedro ; Wahnschaff, Falko ; Kalff, Rolf ; Ewald, Christian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-4ca0d8a34f16a22125602d593f57841ca5bf76891b6695f01c2b211f6e3040bd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Clinical Article - Spine</topic><topic>Clinical outcomes</topic><topic>Denervation - methods</topic><topic>Electromyography</topic><topic>Female</topic><topic>Humans</topic><topic>Interventional Radiology</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgery</topic><topic>Muscular Atrophy - etiology</topic><topic>Muscular Atrophy - physiopathology</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Paraspinal Muscles - innervation</topic><topic>Paraspinal Muscles - physiopathology</topic><topic>Paraspinal Muscles - surgery</topic><topic>Prospective Studies</topic><topic>Spinal Fusion - adverse effects</topic><topic>Spinal Fusion - methods</topic><topic>Surgical Orthopedics</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Waschke, Albrecht</creatorcontrib><creatorcontrib>Hartmann, Christin</creatorcontrib><creatorcontrib>Walter, Jan</creatorcontrib><creatorcontrib>Dünisch, Pedro</creatorcontrib><creatorcontrib>Wahnschaff, Falko</creatorcontrib><creatorcontrib>Kalff, Rolf</creatorcontrib><creatorcontrib>Ewald, Christian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Waschke, Albrecht</au><au>Hartmann, Christin</au><au>Walter, Jan</au><au>Dünisch, Pedro</au><au>Wahnschaff, Falko</au><au>Kalff, Rolf</au><au>Ewald, Christian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2014-02-01</date><risdate>2014</risdate><volume>156</volume><issue>2</issue><spage>235</spage><epage>244</epage><pages>235-244</pages><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Background
Different studies have shown that atrophy of paraspinal muscles arises after open dorsal lumbar fusion, and the reasons for this atrophy are still not yet fully clarified. This prospective study investigates the extent of atrophy of the lumbar paraspinal muscles after open lumbar interbody fusion, its possible causes, and their association with clinical outcome measures.
Methods
Thirty consecutive patients were prospectively included (13 male, 17 female, median age 60.5 years, range 33–80 years). Mono or bisegmental, posterior lumbar interbody fusion and instrumentation was performed applying a conventional, open lumbar midline approach. Clinical outcome was assessed by the Short Form (36) Health Survey (SF-36) questionnaire and visual analogue scale. Needle electromyography of paraspinal muscles was performed preoperatively, at 6 and 12 months. Serum values of creatine kinase, lactate dehydrogenase and myoglobin were determined preoperatively, at day 2 after surgery and at discharge. Paraspinal muscle volume was determined by volumetric analysis of thin-slice computed tomography scans preoperatively and 1 year after surgery.
Results
There was a significant increase of electromyographic denervation activity (
p
=0.024) and reduced recruitment of motor units (
p
= 0.001) after 1 year. Laboratory studies showed a significant increase of CK (
p
< 0.001) and myoglobin (
p
< 0.001) serum levels at day 2 after surgery. The paraspinal muscle volume decreased from 67.8 to 60.4 % (
p
< 0.001) after 1 year. Correlation analyses revealed a significant negative correlation between denervation and muscle volume (
K
= -0.219,
p
= 0.002). Paraspinal muscle volume is significantly correlated with physical outcome (
K
= 0.169,
p
= 0.020), mental outcome (
K
= 0.214,
p
= 0.003), and pain (
K
= 0.382,
p
< 0.001) after 1 year.
Conclusions
Atrophy of paraspinal muscles after open, posterior lumbar interbody fusion seems to be associated with denervation, as well as direct muscle trauma during surgery. While muscle atrophy is also correlated with a worse clinical outcome, it seems to be a determining factor for successful lumbar spine surgery.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>24384989</pmid><doi>10.1007/s00701-013-1981-9</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0001-6268 |
| ispartof | Acta neurochirurgica, 2014-02, Vol.156 (2), p.235-244 |
| issn | 0001-6268 0942-0940 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1496881391 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Age Aged Aged, 80 and over Clinical Article - Spine Clinical outcomes Denervation - methods Electromyography Female Humans Interventional Radiology Lumbar Vertebrae - surgery Male Medicine Medicine & Public Health Middle Aged Minimally Invasive Surgery Muscular Atrophy - etiology Muscular Atrophy - physiopathology Neurology Neuroradiology Neurosurgery Paraspinal Muscles - innervation Paraspinal Muscles - physiopathology Paraspinal Muscles - surgery Prospective Studies Spinal Fusion - adverse effects Spinal Fusion - methods Surgical Orthopedics Treatment Outcome |
| title | Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients |
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