Qualitative Evaluation of Paraspinal Musculature After Minimally Invasive Lumbar Decompression: A Prospective Study.

IF 1.7 Q2 SURGERY
Ramon Oliveira Soares, Nelson Astur, Lucas Rabello de Oliveira, Michel Kanas, Marcelo Wajchenberg, Delio Eulálio Martins
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引用次数: 0

Abstract

Background: To quantify fatty infiltration and degree of paraspinal muscle degeneration in patients submitted to tubular microdiscectomy and conventional open microdiscectomy.

Methods: A prospective cohort of patients was submitted to microdiscectomy for lumbar disc herniation after failure of conservative treatment. Selection of the technique was based on the surgeon's preference. Analysis of the multifidus muscle was performed using the Goutallier system and the percentage of fat in the muscle. Preoperative and 1-year postoperative T2-weighted magnetic resonance imaging was used, and statistical analysis was carried out using the Wilcoxon test and Spearman correlation test using a significance level of 5%.

Results: Thirty-two patients were included in the study. The percentage of fatty infiltration in the muscle increased on both sides of the spine 1 year after surgery, although only the ipsilateral side presented statistical significance in patients submitted to conventional microdiscectomy (43.3% preoperative and 57.8% postoperative). Muscular degeneration increased significantly ipsilateral to the disc herniation according to the Goutallier classification (grades 1-2) for both interventions. No statistically significant difference was found for fatty infiltration scores or for the degree of muscular degeneration of the multifidus in the comparative analysis of the methods.

Conclusions: Muscular damage resulting from surgery of lumbar disc herniation significantly increases fatty infiltration and degeneration of the multifidus. Muscular degeneration was associated with worsening back pain.

Clinical relevance: While no significant difference was found between the techniques, the tubular minimally invasive approach shows a tendency for less muscle damage. These findings highlight the importance of minimizing muscle injury during surgery to improve postoperative recovery and long-term outcomes.

Level of evidence: 4:

微创腰椎减压术后脊柱旁肌肉组织的定性评估:一项前瞻性研究
背景:量化管状显微椎间盘切除术和传统开放式显微椎间盘切除术患者的脂肪浸润和脊柱旁肌肉变性程度:量化接受管状显微椎间盘切除术和传统开放式显微椎间盘切除术患者的脂肪浸润和脊柱旁肌肉变性程度:方法:对保守治疗失败后接受显微椎间盘切除术治疗的腰椎间盘突出症患者进行前瞻性队列研究。根据外科医生的偏好选择技术。使用 Goutallier 系统对多裂肌进行了分析,并测定了肌肉中脂肪的百分比。使用术前和术后1年的T2加权磁共振成像,使用Wilcoxon检验和Spearman相关性检验进行统计分析,显著性水平为5%:研究共纳入 32 例患者。术后1年,脊柱两侧肌肉中脂肪浸润的比例均有所增加,但在接受传统显微椎间盘切除术的患者中,只有同侧的脂肪浸润比例具有统计学意义(术前为43.3%,术后为57.8%)。根据 Goutallier 分级法(1-2 级),两种治疗方法的椎间盘突出症同侧肌肉退行性变均明显增加。在两种方法的比较分析中,脂肪浸润评分和多裂肌的肌肉变性程度没有发现明显的统计学差异:结论:腰椎间盘突出症手术造成的肌肉损伤会显著增加多裂肌的脂肪浸润和变性。结论:腰椎间盘突出症手术导致的肌肉损伤会明显增加多裂肌的脂肪浸润和退变,肌肉退变与腰痛加重有关:临床相关性:虽然两种技术之间没有发现明显差异,但管状微创方法对肌肉的损伤更小。这些发现强调了在手术中尽量减少肌肉损伤对改善术后恢复和长期疗效的重要性:4:
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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