Journal of Korean Neurosurgical Society

  • 제59권3호
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  • Pages.276-281
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  • 2016
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Do Trunk Muscles Affect the Lumbar Interbody Fusion Rate? : Correlation of Trunk Muscle Cross Sectional Area and Fusion Rates after Posterior Lumbar Interbody Fusion Using Stand-Alone Cage

  • Choi, Man Kyu (Department of Medicine, Graduate School, Kyung Hee University) ;
  • Kim, Sung Bum (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine) ;
  • Park, Bong Jin (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine) ;
  • Park, Chang Kyu (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine) ;
  • Kim, Sung Min (Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine)
  • 투고 : 2015.08.05
  • 심사 : 2015.10.14
  • 발행 : 2016.05.01
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초록

Objective : Although trunk muscles in the lumbar spine preserve spinal stability and motility, little is known about the relationship between trunk muscles and spinal fusion rate. The aim of the present study is to evaluate the correlation between trunk muscles cross sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion (PLIF) using stand-alone cages. Methods : A total of 89 adult patients with degenerative lumbar disease who were performed PLIF using stand-alone cages at L4-5 were included in this study. The cross-sectional area of the psoas major (PS), erector spinae (ES), and multifidus (MF) muscles were quantitatively evaluated by preoperative lumbar magnetic resonance imaging at the L3-4, L4-5, and L5-S1 segments, and bone union was evaluated by dynamic lumbar X-rays. Results : Of the 89 patients, 68 had bone union and 21 did not. The MCSAs at all segments in both groups were significantly different (p<0.05) for the PS muscle, those at L3-4 and L4-5 segments between groups were significantly different (p=0.048, 0.021) for the ES and MF muscles. In the multivariate analysis, differences in the PS MCSA at the L4-5 and L5-S1 segments remained significant (p=0.048, 0.043 and odds ratio=1.098, 1.169). In comparison analysis between male and female patients, most MCSAs of male patients were larger than female's. Fusion rates of male patients (80.7%) were higher than female's (68.8%), too. Conclusion : For PLIF surgery, PS muscle function appears to be an important factor for bone union and preventing back muscle injury is essential for better fusion rate.

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참고문헌

  1. Boden SD, Sumner DR : Biologic factors affecting spinal fusion and bone regeneration. Spine (Phila Pa 1976) 20 (24 Suppl) : 102S-112S, 1995 https://doi.org/10.1097/00007632-199512151-00006
  2. Burkus JK, Foley K, Haid RW, LeHuec JC : Surgical Interbody Research Group--radiographic assessment of interbody fusion devices : fusion criteria for anterior lumbar interbody surgery. Neurosurg Focus 10 : E11, 2001
  3. Cheung NK, Ferch RD, Ghahreman A, Bogduk N : Long-term follow-up of minimal-access and open posterior lumbar interbody fusion for spondylolisthesis. Neurosurgery 72 : 443-450; discussion 450-451, 2013 https://doi.org/10.1227/NEU.0b013e31827fce96
  4. Daggfeldt K, Huang QM, Thorstensson A : The visible human anatomy of the lumbar erector spinae. Spine (Phila Pa 1976) 25 : 2719-2725, 2000 https://doi.org/10.1097/00007632-200011010-00002
  5. Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X : Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion : minimally invasive procedure versus conventional open approach. Eur Spine J 19 : 316-324, 2010 https://doi.org/10.1007/s00586-009-1191-6
  6. Fan SW, Hu ZJ, Fang XQ, Zhao FD, Huang Y, Yu HJ : Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion : modified minimally invasive and traditional open approaches. Orthop Surg 2 : 194-200, 2010 https://doi.org/10.1111/j.1757-7861.2010.00086.x
  7. Han YC, Liu ZQ, Wang SJ, Li LJ, Tan J : Comparison of unilateral versus bilateral pedicle screw fixation in degenerative lumbar diseases : a meta-analysis. Eur Spine J 23 : 974-984, 2014 https://doi.org/10.1007/s00586-014-3221-2
  8. Hansen L, de Zee M, Rasmussen J, Andersen TB, Wong C, Simonsen EB : Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling. Spine (Phila Pa 1976) 31 : 1888-1899, 2006 https://doi.org/10.1097/01.brs.0000229232.66090.58
  9. Hayashi N, Tamaki T, Yamada H : Experimental study of denervated muscle atrophy following severance of posterior rami of the lumbar spinal nerves. Spine (Phila Pa 1976) 17 : 1361-1367, 1992 https://doi.org/10.1097/00007632-199211000-00016
  10. Hebert JJ, Kjaer P, Fritz JM, Walker BF : The relationship of lumbar multifidus muscle morphology to previous, current, and future low back pain : a 9-year population-based prospective cohort study. Spine (Phila Pa 1976) 39 : 1417-1425, 2014 https://doi.org/10.1097/BRS.0000000000000424
  11. Hu Y, Leung HB, Lu WW, Luk KD : Histologic and electrophysiological changes of the paraspinal muscle after spinal fusion : an experimental study. Spine (Phila Pa 1976) 33 : 1418-1422, 2008 https://doi.org/10.1097/BRS.0b013e3181753bea
  12. Janevic J, Ashton-Miller JA, Schultz AB : Large compressive preloads decrease lumbar motion segment flexibility. J Orthop Res 9 : 228-236, 1991 https://doi.org/10.1002/jor.1100090211
  13. Kaigle AM, Holm SH, Hansson TH : Experimental instability in the lumbar spine. Spine (Phila Pa 1976) 20 : 421-430, 1995 https://doi.org/10.1097/00007632-199502001-00004
  14. Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB : Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 21 : 2265-2270, 2012 https://doi.org/10.1007/s00586-012-2281-4
  15. Masuda K, Kikuhara N, Takahashi H, Yamanaka K : The relationship between muscle cross-sectional area and strength in various isokinetic movements among soccer players. J Sports Sci 21 : 851-858, 2003 https://doi.org/10.1080/0264041031000102042
  16. McGill SM : Linking latest knowledge of injury mechanisms and spine function to the prevention of low back disorders. J Electromyogr Kinesiol 14 : 43-47, 2004 https://doi.org/10.1016/j.jelekin.2003.09.012
  17. Penning L : Psoas muscle and lumbar spine stability : a concept uniting existing controversies. Critical review and hypothesis. Eur Spine J 9 : 577-585, 2000 https://doi.org/10.1007/s005860000184
  18. Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, et al. : Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7 : intractable low-back pain without stenosis or spondylolisthesis. J Neurosurg Spine 2 : 670-672, 2005 https://doi.org/10.3171/spi.2005.2.6.0670
  19. Richardson C, Jull G, Hodges P, Hides J : Therapeutic exercise for spinal segmental stabilization in low back pain : scientific basis and clinical approach. Edinburgh, London : Churchill Livingstone, 1998
  20. Suwa H, Hanakita J, Ohshita N, Gotoh K, Matsuoka N, Morizane A : Postoperative changes in paraspinal muscle thickness after various lumbar back surgery procedures. Neurol Med Chir (Tokyo) 40 : 151-154; discussion 154-155, 2000 https://doi.org/10.2176/nmc.40.151
  21. Talia AJ, Wong ML, Lau HC, Kaye AH : Comparison of the different surgical approaches for lumbar interbody fusion. J Clin Neurosci 22 : 243-251, 2015 https://doi.org/10.1016/j.jocn.2014.08.008
  22. Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O'Sullivan R, et al. : Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J 15 : 1593-1601, 2015 https://doi.org/10.1016/j.spinee.2015.03.039