Ramon Oliveira Soares, Nelson Astur, Lucas Rabello de Oliveira, Michel Kanas, Marcelo Wajchenberg, Delio Eulálio Martins
{"title":"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","authors":"Ramon Oliveira Soares, Nelson Astur, Lucas Rabello de Oliveira, Michel Kanas, Marcelo Wajchenberg, Delio Eulálio Martins","doi":"10.14444/8631","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To quantify fatty infiltration and degree of paraspinal muscle degeneration in patients submitted to tubular microdiscectomy and conventional open microdiscectomy.</p><p><strong>Methods: </strong>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%.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical relevance: </strong>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.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"448-454"},"PeriodicalIF":1.7000,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483563/pdf/","citationCount":"0","resultStr":"{\"title\":\"Qualitative Evaluation of Paraspinal Musculature After Minimally Invasive Lumbar Decompression: A Prospective Study.\",\"authors\":\"Ramon Oliveira Soares, Nelson Astur, Lucas Rabello de Oliveira, Michel Kanas, Marcelo Wajchenberg, Delio Eulálio Martins\",\"doi\":\"10.14444/8631\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>To quantify fatty infiltration and degree of paraspinal muscle degeneration in patients submitted to tubular microdiscectomy and conventional open microdiscectomy.</p><p><strong>Methods: </strong>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%.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical relevance: </strong>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.</p><p><strong>Level of evidence: 4: </strong></p>\",\"PeriodicalId\":38486,\"journal\":{\"name\":\"International Journal of Spine Surgery\",\"volume\":\" \",\"pages\":\"448-454\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483563/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Spine Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14444/8631\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Spine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14444/8631","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Qualitative Evaluation of Paraspinal Musculature After Minimally Invasive Lumbar Decompression: A Prospective Study.
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.
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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