Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches

Objective:  To determine differences in paraspinal muscle injury between a modified minimally invasive approach (MMIA) and a traditional operative approach (TOPA) for one‐level instrumented posterior lumbar inter‐body fusion (PLIF). Methods:  From March 2006 to May 2008, a consecutive series of 91 p...

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Veröffentlicht in:Orthopaedic surgery 2010-08, Vol.2 (3), p.194-200
Hauptverfasser: Fan, Shun-wu, Hu, Zhi-jun, Fang, Xiang-qian, Zhao, Feng-dong, Huang, Yue, Yu, He-jun
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container_issue 3
container_start_page 194
container_title Orthopaedic surgery
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creator Fan, Shun-wu
Hu, Zhi-jun
Fang, Xiang-qian
Zhao, Feng-dong
Huang, Yue
Yu, He-jun
description Objective:  To determine differences in paraspinal muscle injury between a modified minimally invasive approach (MMIA) and a traditional operative approach (TOPA) for one‐level instrumented posterior lumbar inter‐body fusion (PLIF). Methods:  From March 2006 to May 2008, a consecutive series of 91 patients who underwent a one‐level instrumented PLIF procedure using one of two different approaches (MMIA in 41 patients and TOPA in 50), and who were operated on by one group of surgeons at a single institution, was studied. The following data were compared between the two groups: surgical time, blood loss, and changes in postoperative serum concentration of creatinine kinase (CK). More than 1 year post operation, low back pain was evaluated by a visual analog scale (VAS) and the Oswestry disability index (ODI). Some patients were also evaluated by MRI to allow comparison of the preoperative and postoperative cross sectional area (CSA) and fat degeneration grades at the operative level. Results:  There was no statistically significant difference in surgical time, but blood loss, serum concentration of CK, and scores of the VAS and ODI were markedly less in the MMIA group compared with the TOPA group. In the TOPA group, the postoperative CSA of the multifidus muscles was significantly smaller than it was pre‐operatively. In contrast, there was no significant difference between the pre‐ and post‐operative CSA of the multifidus muscles in the MMIA group. There was more fatty infiltration postoperatively than preoperatively in both the TOPA and MMIA groups, the increase in fatty infiltration being greater in the TOPA than in the MMIA group. Conclusion:  Compared with TOPA, MMIA can significantly lessen paraspinal muscle injury, and reduce the incidence of low back pain.
doi_str_mv 10.1111/j.1757-7861.2010.00086.x
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Methods:  From March 2006 to May 2008, a consecutive series of 91 patients who underwent a one‐level instrumented PLIF procedure using one of two different approaches (MMIA in 41 patients and TOPA in 50), and who were operated on by one group of surgeons at a single institution, was studied. The following data were compared between the two groups: surgical time, blood loss, and changes in postoperative serum concentration of creatinine kinase (CK). More than 1 year post operation, low back pain was evaluated by a visual analog scale (VAS) and the Oswestry disability index (ODI). Some patients were also evaluated by MRI to allow comparison of the preoperative and postoperative cross sectional area (CSA) and fat degeneration grades at the operative level. Results:  There was no statistically significant difference in surgical time, but blood loss, serum concentration of CK, and scores of the VAS and ODI were markedly less in the MMIA group compared with the TOPA group. In the TOPA group, the postoperative CSA of the multifidus muscles was significantly smaller than it was pre‐operatively. In contrast, there was no significant difference between the pre‐ and post‐operative CSA of the multifidus muscles in the MMIA group. There was more fatty infiltration postoperatively than preoperatively in both the TOPA and MMIA groups, the increase in fatty infiltration being greater in the TOPA than in the MMIA group. Conclusion:  Compared with TOPA, MMIA can significantly lessen paraspinal muscle injury, and reduce the incidence of low back pain.</description><identifier>ISSN: 1757-7853</identifier><identifier>EISSN: 1757-7861</identifier><identifier>DOI: 10.1111/j.1757-7861.2010.00086.x</identifier><identifier>PMID: 22009948</identifier><language>eng</language><publisher>Melbourne, Australia: Blackwell Publishing Asia</publisher><subject>Back Injuries - blood ; Back Injuries - etiology ; Back Injuries - pathology ; Back Injuries - prevention &amp; control ; Blood Loss, Surgical ; Creatine Kinase - blood ; Disability Evaluation ; Female ; Humans ; Iatrogenic Disease - prevention &amp; control ; Low Back Pain - surgery ; Lumbar vertebrae ; Lumbar Vertebrae - surgery ; Lumbosacral Region - injuries ; Lumbosacral Region - pathology ; Male ; Middle Aged ; minimally invasive ; Minimally Invasive Surgical Procedures - adverse effects ; Minimally Invasive Surgical Procedures - methods ; Muscle, Skeletal - injuries ; Muscle, Skeletal - pathology ; Original ; Pain Measurement ; Spinal fusion ; Spinal Fusion - adverse effects ; Spinal Fusion - methods ; Surgical procedures ; Surgical procedures, minimally invasive ; Treatment Outcome</subject><ispartof>Orthopaedic surgery, 2010-08, Vol.2 (3), p.194-200</ispartof><rights>2010 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd</rights><rights>2010 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4896-b7e169e1f405bd7ba422576609999d7a6e1a64d7b63dca5b2f67064066d3c5263</citedby><cites>FETCH-LOGICAL-c4896-b7e169e1f405bd7ba422576609999d7a6e1a64d7b63dca5b2f67064066d3c5263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583124/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583124/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,729,782,786,887,1419,11569,27931,27932,45581,45582,46059,46483,53798,53800</link.rule.ids><linktorsrc>$$Uhttps://onlinelibrary.wiley.com/doi/abs/10.1111%2Fj.1757-7861.2010.00086.x$$EView_record_in_Wiley-Blackwell$$FView_record_in_$$GWiley-Blackwell</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22009948$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fan, Shun-wu</creatorcontrib><creatorcontrib>Hu, Zhi-jun</creatorcontrib><creatorcontrib>Fang, Xiang-qian</creatorcontrib><creatorcontrib>Zhao, Feng-dong</creatorcontrib><creatorcontrib>Huang, Yue</creatorcontrib><creatorcontrib>Yu, He-jun</creatorcontrib><title>Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches</title><title>Orthopaedic surgery</title><addtitle>Orthop Surg</addtitle><description>Objective:  To determine differences in paraspinal muscle injury between a modified minimally invasive approach (MMIA) and a traditional operative approach (TOPA) for one‐level instrumented posterior lumbar inter‐body fusion (PLIF). Methods:  From March 2006 to May 2008, a consecutive series of 91 patients who underwent a one‐level instrumented PLIF procedure using one of two different approaches (MMIA in 41 patients and TOPA in 50), and who were operated on by one group of surgeons at a single institution, was studied. The following data were compared between the two groups: surgical time, blood loss, and changes in postoperative serum concentration of creatinine kinase (CK). More than 1 year post operation, low back pain was evaluated by a visual analog scale (VAS) and the Oswestry disability index (ODI). Some patients were also evaluated by MRI to allow comparison of the preoperative and postoperative cross sectional area (CSA) and fat degeneration grades at the operative level. Results:  There was no statistically significant difference in surgical time, but blood loss, serum concentration of CK, and scores of the VAS and ODI were markedly less in the MMIA group compared with the TOPA group. In the TOPA group, the postoperative CSA of the multifidus muscles was significantly smaller than it was pre‐operatively. In contrast, there was no significant difference between the pre‐ and post‐operative CSA of the multifidus muscles in the MMIA group. There was more fatty infiltration postoperatively than preoperatively in both the TOPA and MMIA groups, the increase in fatty infiltration being greater in the TOPA than in the MMIA group. Conclusion:  Compared with TOPA, MMIA can significantly lessen paraspinal muscle injury, and reduce the incidence of low back pain.</description><subject>Back Injuries - blood</subject><subject>Back Injuries - etiology</subject><subject>Back Injuries - pathology</subject><subject>Back Injuries - prevention &amp; control</subject><subject>Blood Loss, Surgical</subject><subject>Creatine Kinase - blood</subject><subject>Disability Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Iatrogenic Disease - prevention &amp; control</subject><subject>Low Back Pain - surgery</subject><subject>Lumbar vertebrae</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Lumbosacral Region - injuries</subject><subject>Lumbosacral Region - pathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>minimally invasive</subject><subject>Minimally Invasive Surgical Procedures - adverse effects</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Muscle, Skeletal - injuries</subject><subject>Muscle, Skeletal - pathology</subject><subject>Original</subject><subject>Pain Measurement</subject><subject>Spinal fusion</subject><subject>Spinal Fusion - adverse effects</subject><subject>Spinal Fusion - methods</subject><subject>Surgical procedures</subject><subject>Surgical procedures, minimally invasive</subject><subject>Treatment Outcome</subject><issn>1757-7853</issn><issn>1757-7861</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUc1u1DAQthCIlsIrIL9AtnZ-7KQHJLTQFqmih7ZC4jKaxA714tiRvVl2n4MXxmEhglt9mZG_n5nRRwjlbMXTO9-suKxkJmvBVzlLv4yxWqz2z8jpAjxf-qo4Ia9i3DAmmkLKl-QkzxlrmrI-JT_XfhgxmOgd9T1NLcbROLR0mGJnNTVuM4VDKtQ7nVm905baaWgx0NHHrQ7Gh4SmJmu9OtB-isa7Czp4ZXqjFR2MMwNaO3vsMJqdpugU3QZUZpuoaZQftaM4jsFj96jja_KiRxv1mz_1jDxcfrxfX2c3t1ef1u9vsq6sG5G1UnPRaN6XrGqVbLHM80oKkS5rGiVRaI6iTIAoVIdVm_dCMlEyIVTRVbkozsi7o-84tYNWnXZpKQtjSPuGA3g08D_izCN88zsQVV3wvEwG9dGgCz7GoPtFyxnMQcEG5gxgzgPmoOB3ULBP0rf_zl6Ef5NJhIsj4Yex-vBkY7i9q-fLsqPYpIT2ixjDdxCykBV8-XwFH9jd1-vyfg118QvWpLWp</recordid><startdate>201008</startdate><enddate>201008</enddate><creator>Fan, Shun-wu</creator><creator>Hu, Zhi-jun</creator><creator>Fang, Xiang-qian</creator><creator>Zhao, Feng-dong</creator><creator>Huang, Yue</creator><creator>Yu, He-jun</creator><general>Blackwell Publishing Asia</general><scope>BSCLL</scope><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>5PM</scope></search><sort><creationdate>201008</creationdate><title>Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches</title><author>Fan, Shun-wu ; Hu, Zhi-jun ; Fang, Xiang-qian ; Zhao, Feng-dong ; Huang, Yue ; Yu, He-jun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4896-b7e169e1f405bd7ba422576609999d7a6e1a64d7b63dca5b2f67064066d3c5263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Back Injuries - blood</topic><topic>Back Injuries - etiology</topic><topic>Back Injuries - pathology</topic><topic>Back Injuries - prevention &amp; control</topic><topic>Blood Loss, Surgical</topic><topic>Creatine Kinase - blood</topic><topic>Disability Evaluation</topic><topic>Female</topic><topic>Humans</topic><topic>Iatrogenic Disease - prevention &amp; control</topic><topic>Low Back Pain - surgery</topic><topic>Lumbar vertebrae</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Lumbosacral Region - injuries</topic><topic>Lumbosacral Region - pathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>minimally invasive</topic><topic>Minimally Invasive Surgical Procedures - adverse effects</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Muscle, Skeletal - injuries</topic><topic>Muscle, Skeletal - pathology</topic><topic>Original</topic><topic>Pain Measurement</topic><topic>Spinal fusion</topic><topic>Spinal Fusion - adverse effects</topic><topic>Spinal Fusion - methods</topic><topic>Surgical procedures</topic><topic>Surgical procedures, minimally invasive</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fan, Shun-wu</creatorcontrib><creatorcontrib>Hu, Zhi-jun</creatorcontrib><creatorcontrib>Fang, Xiang-qian</creatorcontrib><creatorcontrib>Zhao, Feng-dong</creatorcontrib><creatorcontrib>Huang, Yue</creatorcontrib><creatorcontrib>Yu, He-jun</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Orthopaedic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Fan, Shun-wu</au><au>Hu, Zhi-jun</au><au>Fang, Xiang-qian</au><au>Zhao, Feng-dong</au><au>Huang, Yue</au><au>Yu, He-jun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches</atitle><jtitle>Orthopaedic surgery</jtitle><addtitle>Orthop Surg</addtitle><date>2010-08</date><risdate>2010</risdate><volume>2</volume><issue>3</issue><spage>194</spage><epage>200</epage><pages>194-200</pages><issn>1757-7853</issn><eissn>1757-7861</eissn><abstract>Objective:  To determine differences in paraspinal muscle injury between a modified minimally invasive approach (MMIA) and a traditional operative approach (TOPA) for one‐level instrumented posterior lumbar inter‐body fusion (PLIF). Methods:  From March 2006 to May 2008, a consecutive series of 91 patients who underwent a one‐level instrumented PLIF procedure using one of two different approaches (MMIA in 41 patients and TOPA in 50), and who were operated on by one group of surgeons at a single institution, was studied. The following data were compared between the two groups: surgical time, blood loss, and changes in postoperative serum concentration of creatinine kinase (CK). More than 1 year post operation, low back pain was evaluated by a visual analog scale (VAS) and the Oswestry disability index (ODI). Some patients were also evaluated by MRI to allow comparison of the preoperative and postoperative cross sectional area (CSA) and fat degeneration grades at the operative level. Results:  There was no statistically significant difference in surgical time, but blood loss, serum concentration of CK, and scores of the VAS and ODI were markedly less in the MMIA group compared with the TOPA group. In the TOPA group, the postoperative CSA of the multifidus muscles was significantly smaller than it was pre‐operatively. In contrast, there was no significant difference between the pre‐ and post‐operative CSA of the multifidus muscles in the MMIA group. There was more fatty infiltration postoperatively than preoperatively in both the TOPA and MMIA groups, the increase in fatty infiltration being greater in the TOPA than in the MMIA group. Conclusion:  Compared with TOPA, MMIA can significantly lessen paraspinal muscle injury, and reduce the incidence of low back pain.</abstract><cop>Melbourne, Australia</cop><pub>Blackwell Publishing Asia</pub><pmid>22009948</pmid><doi>10.1111/j.1757-7861.2010.00086.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Back Injuries - blood
Back Injuries - etiology
Back Injuries - pathology
Back Injuries - prevention & control
Blood Loss, Surgical
Creatine Kinase - blood
Disability Evaluation
Female
Humans
Iatrogenic Disease - prevention & control
Low Back Pain - surgery
Lumbar vertebrae
Lumbar Vertebrae - surgery
Lumbosacral Region - injuries
Lumbosacral Region - pathology
Male
Middle Aged
minimally invasive
Minimally Invasive Surgical Procedures - adverse effects
Minimally Invasive Surgical Procedures - methods
Muscle, Skeletal - injuries
Muscle, Skeletal - pathology
Original
Pain Measurement
Spinal fusion
Spinal Fusion - adverse effects
Spinal Fusion - methods
Surgical procedures
Surgical procedures, minimally invasive
Treatment Outcome
title Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches
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