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Acta Neurochirurgica

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01-02-2014 | Clinical Article - Spine

Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients

Authors: Albrecht Waschke, Christin Hartmann, Jan Walter, Pedro Dünisch, Falko Wahnschaff, Rolf Kalff, Christian Ewald

Published in: Acta Neurochirurgica | Issue 2/2014

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.

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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
Authors: Albrecht Waschke
Christin Hartmann
Jan Walter
Pedro Dünisch
Falko Wahnschaff
Rolf Kalff
Christian Ewald
Publication date: 01-02-2014
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 2/2014
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-013-1981-9

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Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

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