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      Incidence and risk factors of persistent low back pain following posterior decompression and instrumented fusion for lumbar disk herniation

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          Abstract

          Introduction

          The aim of this study was to explore the incidence and risk factors of persistent low back pain (PLBP) following posterior decompression and instrumented fusion for lumbar disk herniation and to provide references in decision-making and surgical planning for both spinal surgeons and surgically treated patients.

          Patients and methods

          By retrieving the medical records from January 2013 to December 2016, 221 patients were retrospectively reviewed. Patients were classified as having PLBP if numeric rating scale (NRS) scores were >50 at all postoperative follow-up time points (3 months, 6 months, and 12 months). According to the occurrence of PLBP, patients were divided into two groups: PLBP group and non (N)-PLBP group. To investigate risk values for PLBP, the following three categorized factors were analyzed statistically. Patient characteristics: age, gender, body mass index (BMI), preoperative low back pain, comorbidity, smoking, and drinking. Surgical variables: surgical strategy, surgical segment, the number of fusion levels, surgery time, blood loss, and size of incision. Radiographic parameters: preoperative lumbar lordosis (LL), correction of LL at immediate postoperation, Modic changes, and preoperative paraspinal muscle degeneration.

          Results

          PLBP was detected in 16 patients and were enrolled into the PLBP group. There was no difference between the two groups in age, gender, BMI, comorbidity, smoking, and drinking. The preoperative low back pain was more severe in the PLBP group than that in the N-PLBP group. There was no difference in surgery time, blood loss, surgical strategy, number of fusion levels, and the size of incision. Surgery segment at L 5–S 1 was more prevalent in the PLBP group than that in the N-PLBP group, and there was no difference in preoperative LL, correction of LL, preoperative lumbar mobility, and Modic changes. The fatty infiltration rate (FIR) was larger in the PLBP group than that in the N-PLBP group. Multivariate logistic regression model revealed that preoperative low back pain (NRS > 35), surgery segment at L 5–S 1, and FIR > 15% were independently associated with PLBP.

          Conclusion

          The incidence of PLBP following posterior decompression and instrumented fusion for lumbar disk herniation is 7.2%, and the risk factors include preoperative low back pain, surgery segment at L 5–S 1, and preoperative paraspinal muscle degeneration.

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          Most cited references 29

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          Correlation between the MRI changes in the lumbar multifidus muscles and leg pain.

          In the assessment of the lumbar spine by magnetic resonance imaging (MRI), changes in the paraspinal muscles are frequently overlooked. In this study, our objective was to investigate the relationships between lumbar multifidus (MF) muscle atrophy and low back pain (LBP), leg pain and intevertebral disc degeneration. A retrospective study of 78 patients (aged 17-72) with LBP presenting with back pain with or without associated leg pain was undertaken. Their MR images were visually analysed for signs of lumbar MF muscle atrophy, disc degeneration and nerve root compression. The clinical history in each case was obtained from their case notes and pain drawing charts. MF muscle atrophy was present in 80% of the patients with LBP. The correlation between MF muscle atrophy and leg pain was found to be significant (P < 0.01). However, the relationships between muscle atrophy and radiculopathy symptoms, nerve root compression, herniated nucleus pulposus and number of degenerated discs were statistically not significant. Examination of the paraspinal muscles looking for atrophy of MF muscle should be considered when assessing MR images of lumbar spine. This may explain the referred leg pain in the absence of other MR abnormalities. Copyright 2000 The Royal College of Radiologists.
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            Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome.

            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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              Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability.

              Prospective, cross-sectional observational study. The aim of this study was to determine if there was an association between wasting of psoas and multifidus as observed on MRI scans and the presenting symptoms, reported pathology, pain, or disability of a cohort of patients presenting with unilateral low back pain. Current physiotherapy practice is often based on localized spine stabilizing muscle exercises; most attention has been focused on transversus abdominus and multifidus with relatively little on psoas. Fifty consecutive patients presenting to a back pain triage clinic with unilateral low back pain lasting more than 12 weeks were recruited. The cross-sectional surface area (CSA) of the muscles was measured. Duration of symptoms, rating of pain, self-reported function, and the presence of neural compression were recorded. Data analysis compared the CSA between the symptomatic and asymptomatic sides. There was a statistically significant difference in CSA between the sides (P < 0.001). There was a positive correlation between the percentage decrease in CSA of psoas on the affected side and with the rating of pain (rho = 0.608, P < 0.01), reported nerve root compression (rho = 0.812, P < 0.01), and the duration of symptoms (rho = 0.886, P < 0.01). There was an association between decrease in the CSA of multifidus and duration of symptoms. Atrophy of multifidus has been used as one of the rationales for spine stabilization exercises. The evidence of coexisting atrophy of psoas and multifidus suggests that a future area for study should be selective exercise training of psoas, which is less commonly used in clinical practice.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                04 May 2017
                : 10
                : 1019-1025
                Affiliations
                [1 ]Department of Spine Surgery
                [2 ]Financial Statistics Department, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
                Author notes
                Correspondence: Wenyuan Ding, Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, People’s Republic of China, Email dingwenyuan2012@ 123456126.com
                Article
                jpr-10-1019
                10.2147/JPR.S132862
                5422571
                © 2017 Wang et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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