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Multifidus innervation and muscle assessment post-spinal surgery.

Derek T Cawley¹, Michael Alexander, Seamus Morris

¹Department of Trauma and Orthopedic Surgery, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland, derekcawley@hotmail.com.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

|August 27, 2013

Summary

Minimally invasive spinal surgery (MISS) better preserves multifidus muscles and nerve function compared to open spinal surgery (OSS) for lumbar fractures. This leads to less muscle atrophy and improved nerve integrity, especially at adjacent surgical levels.

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Area of Science:

Spinal Surgery
Orthopedics
Neurosurgery

Background:

Lumbar spine fractures often require surgical intervention.
Assessing the impact of surgical approach on paraspinal muscles and nerves is crucial for patient outcomes.
Open spinal surgery (OSS) may lead to significant muscle damage and denervation.

Purpose of the Study:

To compare the integrity of multifidus muscles and nerve roots after open spinal surgery (OSS) versus minimally invasive spinal surgery (MISS) for lumbar spine fractures.
To evaluate muscle cross-sectional area (CSA) and nerve function post-operatively.

Main Methods:

Retrospective analysis of six patients undergoing MISS and six age/sex-matched patients undergoing OSS for similar lumbar fractures.
Ultrasound muscle quantification to measure multifidus muscle cross-sectional area (CSA) at and adjacent to surgical levels.

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Electromyographic (EMG) studies to assess nerve function at instrumented and non-instrumented levels.

Main Results:

MISS group showed significantly larger mean multifidus CSA at adjacent levels (4.46 cm² vs. 2.87 cm², p=0.05).
EMG revealed normal nerve function in 5/6 adjacent levels for MISS versus 1/6 for OSS (p=0.03).
OSS group exhibited moderate-severe denervation in 5/12 instrumented levels.

Conclusions:

Posterior instrumented MISS offers superior preservation of the medial branch of the posterior ramus of the spinal nerve compared to OSS.
MISS results in less multifidus muscle atrophy, particularly at levels adjacent to the surgical site.
These findings suggest MISS may lead to better functional recovery and reduced neurological deficits.