Asian Spine J.  2018 Apr;12(2):256-262. 10.4184/asj.2018.12.2.256.

Assessment of Paraspinal Muscle Atrophy Percentage after Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Instrumentation Using a Novel Contralateral Intact Muscle-Controlled Model

• Ortega-Porcayo LA
• Leal-López A
• Soriano-López ME
• Gutiérrez-Partida CF
• Ramírez-Barrios LR
• Soriano-Solis S
• Rodríguez-García M
• Soriano-Solis HA
• Soriano-Sánchez JA

• KMID: 2410844
• DOI: http://doi.org/10.4184/asj.2018.12.2.256

Abstract

STUDY DESIGN: Retrospective comparative clinical study. PURPOSE: This study aimed to assess paraspinal muscle atrophy in patients who underwent minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and unilateral pedicle screw fixation using a novel contralateral intact muscle-controlled model. OVERVIEW OF LITERATURE: The increased incidence of paravertebral lumbar muscle injuries after open techniques has raised the importance of implementing minimally invasive spine surgical techniques using tubular retractors and minimally invasive screw placement. The functional cross-sectional area (FCSA) represents the lean muscle mass; furthermore, FCSA is a useful marker of the contractile ability of a muscle following a spine surgery. However, the benefits of unilateral fixation and MI-TLIF on paraspinal muscles have not been defined.
METHODS
We performed a retrospective imagenological review on eleven patients who underwent unilateral MI-TLIF and unilateral transpedicular screw lumbar placement. FCSAs of the multifidus and erector spinae were measured 1 year after surgery at adjacent levels and were compared to the contralateral intact muscles. Measurement differences between the surgical and nonsurgical sites were compared. The interobserver reliability was calculated using an intraclass correlation coefficient.
RESULTS
The mean FCSA at the surgical site was 20.97±5.07 cm² at the superior level and 8.89±2.87 cm² at the inferior level. The mean FCSA at the contralateral nonsurgical site was 20.15±5.95 cm² at the superior level and 9.20±2.66 cm² at the inferior level was. The superior and inferior FCSA measurements showed no significant difference between the surgical and nonsurgical sites (p=0.5, p=0.922, respectively).
CONCLUSIONS
Using a mini-open tubular approach through the sulcus between the longissimus and iliocostalis, MI-TLIF and unilateral pedicle screw instrumentation produced minimal paraspinal muscle damage at the superior and inferior adjacent levels.

Keyword

Computed tomography; Functional cross-sectional area; Minimally invasive; Lumbar vertebrae; Paraspinal muscles

MeSH Terms

Atrophy*
Clinical Study
Humans
Incidence
Lumbar Vertebrae
Muscles
Paraspinal Muscles*
Pedicle Screws
Retrospective Studies
Spine