Paraspinal muscle changes after single-level posterior lumbar fusion: volumetric analyses and literature review

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Abstract

Background

Posterior lumbar fusion is a widely accepted surgical technique; however, it has been related to the possibility of paraspinal muscle atrophy after surgery. We investigated 1-year postoperative changes in paraspinal muscle volume using a simple formula applicable to magnetic resonance imaging (MRI) or computed tomography (CT) images.

Methods

Patients with degenerative lumbar spinal stenosis who underwent posterior interbody fusion (PLIF) at the L4/5 level in the period from May 2010 to June 2017 were enrolled in this study. Radiologic parameters were measured using MRI or CT images which were taken before surgery and at 1 year after surgery. The volume of the paraspinal muscles was calculated using a simple formula which was derived from the formula for calculating the volume of truncated elliptic cones.

Results

A total of 40 patients were included; 24 were analyzed using MRI and 16 were analyzed using CT. The mean age of the patients was 59.6 ± 12.1 years and 32 (80.5%) were female. When comparing the preoperative and 1-year-postoperative images, multifidus muscle (MF) reduction was consistently observed in the MRI and CT groups, right and left ( p = 0.003, p < 0.001, p = 0.005 and p < 0.001, respectively). In the erector spinae (ES) group, decrease in muscle volume was observed in the right-sided muscles of the CT group ( p < 0.001), but no significant change was observed in the MRI group. The psoas muscle showed no significant change after 1 year. Conversely, regression analysis showed a negative correlation between MF muscle volume loss and age in the MRI group (right and left, p = 0.002 and p = 0.015, respectively), that is, the younger the age, the greater loss of muscle mass.

Conclusion

After the posterior lumbar fusion, the volume of the MF muscles was markedly decreased, and the degree of decrease was apparent in the MRI. The volume of the ES muscles, which are located relatively laterally, also tended to decrease at 1 year after surgery.

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Most cited references 17

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Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome.

J Partanen, O Airaksinen, T Sihvonen … (1993)

Impairment and disability after back surgery is a common diagnostic and therapeutic problem. For the most part the reasons are unclear. Of 178 patients who had undergone laminectomies 2-5 years earlier, 14 patients with good recovery and 21 patients with poor recovery but no evidence of restenosis on computed tomography were selected by the Oswestry index. According to radiologic, neurophysiologic, and muscle biopsy evidence most patients (13 of 15 studied) suffering from the severe postoperative failed back syndrome had dorsal ramus lesions in one or more segments covered by the scar and local paraspinal muscle atrophy at the corresponding segments. Disturbed back muscle innervation and loss of muscular support leads to the disability and increased biomechanical strain and might be one important cause to the failed back syndrome. It may be possible to develop operating techniques that save back muscle innervation better than the usual ones.

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The role of the lumbar multifidus in chronic low back pain: a review.

Michael D Freeman, Mark A. Woodham, Andrew Woodham (2010)

Low back pain (LBP), a highly prevalent problem in society, is often a recurrent condition. Recent advances in the understanding of the biomechanics of LBP have highlighted the importance of muscular stabilization of the "neutral zone" range of motion in the low back. The lumbar multifidus muscles (LMM) are important stabilizers of this neutral zone, and dysfunction in these muscles is strongly associated with LBP. The dysfunction is a result of pain inhibition from the spine, and it tends to continue even after the pain has resolved, likely contributing to the high recurrence rate of LBP. Persisting LMM dysfunction is identified by atrophic replacement of multifidus muscle with fat, a condition that is best seen on magnetic resonance imaging. Muscle training directed at teaching patients to activate their LMM is an important feature of any clinical approach to the LBP patient with demonstrated LMM dysfunction or atrophy. Copyright 2010 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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Age- and Level-Dependence of Fatty Infiltration in Lumbar Paravertebral Muscles of Healthy Volunteers

R. Crawford, L. Filli, J. Elliott … (2016)

Normative age-related decline in paravertebral muscle quality is important for reference to disease and risk identification in patients. We aimed to establish age- and vertebral level–dependence of paravertebral (multifidus and erector spinae) muscle volume and fat content in healthy adult volunteers. In this prospective study multifidus and erector spinae fat signal fraction and volume at lumbar levels L1–L5 were measured in 80 healthy volunteers (10 women and men per decade, 20–62 years of age) by 2-point Dixon 3T MR imaging. ANOVA with post hoc Bonferroni correction compared fat signal fraction and volume among subgroups. Pearson and Spearman analysis were used for correlations ( P < .05). Fat signal fraction was higher in women (17.8% ± 10.7%) than men (14.7% ± 7.8%; P < .001) and increased with age. Multifidus and erector spinae volume was lower in women (565.4 ± 83.8 cm 3 ) than in men (811.6 ± 98.9 cm 3 ; P < .001) and was age-independent. No differences in fat signal fraction were shown between the right and left paravertebral muscles or among the L1, L2, and L3 lumbar levels. The fat signal fraction was highest at L5 (women, 31.9% ± 9.3%; men, 25.7% ± 8.0%; P < .001). The fat signal fraction at L4 correlated best with total lumbar fat signal fraction (women, r = 0.95; men, r = 0.92, P < .001). Total fat signal fraction was higher in the multifidus compared with erector spinae muscles at L1–L4 for both sexes ( P < .001). Lumbar paravertebral muscle fat content increases with aging, independent of volume, in healthy volunteers 20–62 years of age. Women, low lumbar levels, and the multifidus muscle are most affected. Further study examining younger and older subjects and the functional impact of fatty infiltrated paravertebral muscles are warranted.

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Author and article information

Contributors

Bum-Joon Kim:

ORCID: http://orcid.org/0000-0002-3701-4030

nsbjkim@korea.ac.kr

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 5 February 2020

Publication date PMC-release: 5 February 2020

Publication date Collection: 2020

Volume: 21

Electronic Location Identifier: 73

Affiliations

[1 ]ISNI 0000 0004 0474 0479, GRID grid.411134.2, Department of Neurosurgery, , Korea University Ansan Hospital, ; 123 Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do 15355 South Korea

[2 ]ISNI 0000 0001 0840 2678, GRID grid.222754.4, Medical Science Research Center, Ansan Hospital, , Korea University College of Medicine, ; Ansan, South Korea

Author information

Bum-Joon Kim http://orcid.org/0000-0002-3701-4030

Article

Publisher ID: 3104

DOI: 10.1186/s12891-020-3104-0

PMC ID: 7003350

PubMed ID: 32024500

SO-VID: 29d833d8-5f59-43d9-b8b9-ebce9d119d2c

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 5 June 2019

Date accepted : 30 January 2020

Funding

Funded by: Korea University

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: lumbar spinal fusion,paraspinal muscle atrophy,denervation,multifidus,back muscles

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: lumbar spinal fusion, paraspinal muscle atrophy, denervation, multifidus, back muscles

Paraspinal muscle changes after single-level posterior lumbar fusion: volumetric analyses and literature review

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Abstract

Background

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Orthopedics

Most cited references 17

Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome.

The role of the lumbar multifidus in chronic low back pain: a review.

Age- and Level-Dependence of Fatty Infiltration in Lumbar Paravertebral Muscles of Healthy Volunteers

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