INTRODUCTION: This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy. CLINICAL RATIONALE FOR THE STUDY: MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies. MATERIAL AND METHODS: This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05. RESULTS: The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.
- MeSH
- Lumbar Vertebrae * surgery diagnostic imaging MeSH
- Spinal Fusion * methods MeSH
- Paraspinal Muscles * diagnostic imaging pathology MeSH
- Cortical Bone surgery diagnostic imaging MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Pedicle Screws MeSH
- Postoperative Complications diagnostic imaging MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Spondylolisthesis * surgery diagnostic imaging MeSH
- Muscular Atrophy * etiology diagnostic imaging MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Bolesti dolní části zad (low back pain; LBP) jsou mimořádně častým a závažným zdravotním problémem. Paraspinální svaly hrají důležitou funkci při pohybech trupu, přispívají k udržení postury a stability páteře. U pacientů s chronickými LBP dochází ke strukturálním i funkčním změnám paraspinálních svalů. Makroskopické změny lze vyšetřit na CT a zejména na MR, mikroskopické změny pomocí svalové biopsie. V dostupné literatuře existují důkazy, že atrofie paraspinálních svalů a zvýšení podílu tukové tkáně uvnitř paraspinálních svalů jsou významně asociovány s nespecifickými LBP, a to zejména s chronickými bolestmi. Z diferenciálně diagnostického hlediska je nutné změny v paraspinálních svalech asociované s LBP odlišit od postižení paraspinálních svalů u pacientů s axiálními myopatiemi, které jsou však vzácné. Cílem tohoto sdělení je upozornit na strukturální i funkční změny paraspinálních svalů u pacientů s chronickými nespecifickými LBP. Je uveden diagnostický postup při chronických LBP spojených s degenerací paraspinálních svalů k vyloučení přítomnosti axiální myopatie.
Low back pain (LBP) is a frequent and major health problem. Paraspinal muscles play an important role in trunk movements, helping to maintain posture and spinal stability. Changes of paraspinal muscle morphology and function are described in patients with chronic LBP. Macroscopic changes can be evaluated by CT and especially by MRI, while microscopic changes are assed by muscle biopsy. There is evidence available in literature stating that atrophy of paraspinal muscles and increased fat deposits in the paraspinal muscles are significantly associated with non-specific LBP, especially with chronic LBP. From a ferential diagnostic point of view, changes in paraspinal muscles associated with LBP must be distinguished from paraspinal muscle involvement in patients with axial myopathies, but these are rare. The aim of this paper is to highlight the structural and functional changes of paraspinal muscles in patients with chronic non-specific LBP. A diagnostic algorithm for chronic LBP associated with degeneration of paraspinal muscles to exclude the presence of axial myopathy is presented.
- Keywords
- axiální myopatie, tuková infiltrace,
- MeSH
- Paraspinal Muscles * diagnostic imaging pathology MeSH
- Humans MeSH
- Low Back Pain * complications pathology MeSH
- Magnetic Resonance Imaging methods MeSH
- Muscular Diseases diagnosis pathology rehabilitation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Cíl: Zjištění možné souvislosti mezi bolestí dolní části zad a asymetrií plochy průřezu páteřního musculus multifidus pomocí UZ měření u fyzicky aktivních a neaktivních dospívajících chlapců. Soubor a metody: Celkem bylo zkoumáno 45 dospívajících chlapců - 28 chlapců bylo fyzicky aktivních a 17 fyzicky neaktivních. Byly u nich zaznamenány výška, hmotnost, přítomnost bolesti zad a ultrazvukem byla změřena plocha průřezu páteřního musculus multifidus. Výsledky byly uvedeny jako střední hodnota, směrodatná odchylka a procentuální změna výsledků. Rozdíl mezi dvěma vzorky byl vypočítán pomocí dvouvýběrového Studentova t-testu (hladina významnosti činila p < 0,05). Výsledky: Z výsledků vyplývá, že velikost musculus multifidus byla větší ve skupině s fyzickou neaktivitou (4,86 ± 1,91 cm2) než ve skupině s fyzickou aktivitou (4,06 ± 1,42 cm2). Byla zjištěna nevýznamná asymetrie vyjádřená jako procento plochy průřezu páteřního musculus multifidus u fyzicky aktivních i fyzicky neaktivních chlapců s bolestí zad: 17,7 (14,1-21,0) %, resp. 10,9 (3,3-18,5) %, a také bez bolesti zad: 6,9 (6,6-7,4) %, resp. 7,5 (6,9-8,0) %, avšak významná asymetrie vyjádřená jako procento plochy průřezu páteřního musculus multifidus byla zjištěna mezi chlapci s bolestí zad i a chlapci bez bolesti zad jak ve skupině fyzicky aktivních (p < 0,05), tak ve skupině fyzicky neaktivních (p < 0,05). Závěr: Tato pilotní studie ukázala, že může existovat souvislost mezi bolestí zad a asymetrií plochy průřezu musculus multifidus. Pro potvrzení těchto výsledků jsou nutné další studie.
Aim: To determine the possible relationship between low back pain (LBP) and asymmetry of the cross-sectional area of the multifidus spinal muscle as measured by US in physically active and inactive adolescent boys. Materials and methods: In total, 45 adolescent boys were examined - 28 boys were physically active and 17 physically inactive. Height, weight, occurrence of back pain were recorded, and the spinal multifidus cross-sectional area was measured by US. The results were listed as mean, standard deviation, and percentage change of results. The difference between two samples was deducted using a two-tailed Student t-test (the level of significance was p < 0.05). Results: The results showed that the multifidus muscle size was larger in the physically inactive group (4.86 ± 1.91 cm2) than the physically active group (4.06 ± 1.42 cm2). The non-significant asymmetry expressed as a percentage of the cross-sectional area of the multifidus spinal muscle was found between boys who were physically active and physically inactive with back pain: 17.7 (14.1-21.0)% and 10.9 (3.3-18.5)%, resp.; and also without back pain: 6.9 (6.6-7.4)% and 7.5 (6.9-8.0)%, resp.; but the significant asymmetry expressed as a percentage of the cross-sectional area of the multifidus spinal muscle was found between boys with back pain and boys without back pain in both the physically active (p < 0.05) and physically (p < 0.05) inactive groups. Conclusion: The pilot study showed that there might be a relationship between back pain and asymmetry of the cross-sectional area of the multifidus spinal muscle. Further studies are needed to confirm these results.
OBJECTIVES: Sarcopenia is associated with a poor prognosis in the ICU. The purpose of this study was to describe a simple sarcopenia index using routinely available renal biomarkers and evaluate its association with muscle mass and patient outcomes. DESIGN: A retrospective cohort study. SETTING: A tertiary-care medical center. PATIENTS: High-risk adult ICU patients from October 2008 to December 2010. INTERVENTIONS: The gold standard for muscle mass was quantified with the paraspinal muscle surface area at the L4 vertebrae in the subset of individuals with an abdominal CT scan. Using Pearson's correlation coefficient, serum creatinine-to-serum cystatin C ratio was found to be the best performer in the estimation of muscle mass. The relationship between sarcopenia index and hospital and 90-day mortality, and the length of mechanical ventilation was evaluated. MEASUREMENTS AND MAIN RESULTS: Out of 226 enrolled patients, 123 (54%) were female, and 198 (87%) were white. Median (interquartile range) age, body mass index, and body surface area were 68 (57-77) years, 28 (24-34) kg/m, and 1.9 (1.7-2.2) m, respectively. The mean (± SD) Acute Physiology and Chronic Health Evaluation III was 70 (± 22). ICU, hospital, and 90-day mortality rates were 5%, 12%, and 20%, respectively. The correlation (r) between sarcopenia index and muscle mass was 0.62 and coefficient of determination (r) was 0.27 (p < 0.0001). After adjustment for Acute Physiology and Chronic Health Evaluation III, body surface area, and age, sarcopenia index was independently predictive of both hospital (p = 0.001) and 90-day mortality (p < 0.0001). Among the 131 patients on mechanical ventilator, the duration of mechanical ventilation was significantly lower on those with higher sarcopenia index (-1 d for each 10 unit of sarcopenia index [95% CI, -1.4 to -0.2; p = 0.006]). CONCLUSIONS: The sarcopenia index is a fair measure for muscle mass estimation among ICU patients and can modestly predict hospital and 90-day mortality among patients who do not have acute kidney injury at the time of measurement.
- MeSH
- Biomarkers blood MeSH
- Cystatin C blood MeSH
- Paraspinal Muscles diagnostic imaging MeSH
- Glomerular Filtration Rate MeSH
- Intensive Care Units MeSH
- Cohort Studies MeSH
- Creatinine blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Hospital Mortality * MeSH
- Tomography, X-Ray Computed MeSH
- Retrospective Studies MeSH
- Sarcopenia diagnosis MeSH
- Aged MeSH
- Respiration, Artificial statistics & numerical data MeSH
- Age Factors MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
