J Korean Neurosurg Soc.  2013 Mar;53(3):174-179. 10.3340/jkns.2013.53.3.174.

Back Muscle Changes after Pedicle Based Dynamic Stabilization

• Moon KY
• Lee SE
• Kim KJ
• Hyun SJ
• Kim HJ
• Jahng TA

• KMID: 2190754
• DOI: http://doi.org/10.3340/jkns.2013.53.3.174

Abstract

OBJECTIVE
Many studies have investigated paraspinal muscle changes after posterior lumbar surgery, including lumbar fusion. However, no study has been performed to investigate back muscle changes after pedicle based dynamic stabilization in patients with degenerative lumbar spinal diseases. In this study, the authors compared back muscle cross sectional area (MCSA) changes after non-fusion pedicle based dynamic stabilization.
METHODS
Thirty-two consecutive patients who underwent non-fusion pedicle based dynamic stabilization (PDS) at the L4-L5 level between February 2005 and January 2008 were included in this retrospective study. In addition, 11 patients who underwent traditional lumbar fusion (LF) during the same period were enrolled for comparative purposes. Preoperative and postoperative MCSAs of the paraspinal (multifidus+longissimus), psoas, and multifidus muscles were measured using computed tomographic axial sections taken at the L4 lower vertebral body level, which best visualize the paraspinal and psoas muscles. Measurements were made preoperatively and at more than 6 months after surgery.
RESULTS
Overall, back muscles showed decreases in MCSAs in the PDS and LF groups, and the multifidus was most affected in both groups, but more so in the LF group. The PDS group showed better back muscle preservation than the LF group for all measured muscles. The multifidus MCSA was significantly more preserved when the PDS-paraspinal-Wiltse approach was used.
CONCLUSION
Pedicle based dynamic stabilization shows better preservation of paraspinal muscles than posterior lumbar fusion. Furthermore, the minimally invasive paraspinal Wiltse approach was found to preserve multifidus muscles better than the conventional posterior midline approach in PDS group.

Keyword

Dynamic stabilization; Lumbar fusion; Paraspinal muscle; Lumbar spine; Multifidus

MeSH Terms

Humans
Muscles
Psoas Muscles
Retrospective Studies
Spinal Diseases

Figure

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  Fig. 1 Postoperative lateral CT image in axial section at the lower L4 body level (left). This imaging technique best visualized paraspinal and psoas muscles and reduced metallic artifacts.

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  Fig. 2 Postoperative muscle cross-sectional area changes for paraspinal muscles in the posterior dynamic stabilization (PDS) and lumbar fusion (LF) groups. *p<0.05 (Wilcoxon's signed ranks test).

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  Fig. 3 The longitudinal changes in paraspinal muscle cross-sectional areas in the PDS (A) and LF (B) groups. A : Paraspinal muscle cross-sectional areas changes in patients that underwent dynamic stabilization. B : Paraspinal muscle cross-sectional areas changes in patients that underwent posterior lumbar fusion. PDS : posterior dynamic stabilization, LF : lumbar fusion.

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