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Multifidus innervation and muscle assessment post-spinal surgery

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Abstract

Purpose

Assessment of the integrity of the multifidus muscles and corresponding nerve roots, post-open (OSS) versus minimally invasive spinal surgery (MISS) for lumbar spine fractures.

Methods

We investigated the first six patients undergoing MISS in our institution and age- and sex-matched them with 6 random patients who previously had OSS. All had a similar lumbar fracture configuration without evidence of spinal cord injury. All were assessed using ultrasound muscle quantification and electromyographic studies at a minimum of 6 months post-operatively. Mean cross-sectional area (CSA) was measured at sequential levels within and adjacent to the operative field. Concentric needle electromyography was performed at instrumented and adjacent non-instrumented levels in each patient.

Results

Mean CSA across all lumbar multifidus muscles was 4.29 cm2 in the MISS group, 2.26 cm2 for OSS (p = 0.08). At the instrumented levels, mean CSA was 4.21 cm2 for MISS and 2.03 cm2 for OSS (p = 0.12). At non-instrumented adjacent levels, mean CSA was 4.46 cm2 in the MISS group, 2.87 cm2 for OSS (p = 0.05).

Electromyography at non-instrumented adjacent levels demonstrated nerve function within normal limits in 5/6 levels in the MISS group compared to 1/6 levels in the OSS (p = 0.03). Instrumented levels demonstrated nerve function within normal limits in 5/12 levels in the MISS group compared with 4/12 in the OSS group, including moderate–severe denervation at 5 levels in the OSS group (p = 0.15).

Conclusions

Posterior instrumented MISS demonstrates a significantly superior preservation of the medial branch of the posterior ramus of the spinal nerve and less muscle atrophy, particularly at adjacent levels when compared to OSS.

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Acknowledgments

Medtronic for funding of co-authors to attend conference. The results of this study were presented at Britspine 2012 and Spineweek 2012.

Conflict of interest

None.

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Authors and Affiliations

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

    Derek T. Cawley & Seamus Morris

  2. Department of Neurophysiology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland

    Michael Alexander

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  1. Derek T. Cawley
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  2. Michael Alexander
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Correspondence to Derek T. Cawley.

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Cawley, D.T., Alexander, M. & Morris, S. Multifidus innervation and muscle assessment post-spinal surgery. Eur Spine J 23, 320–327 (2014). https://doi.org/10.1007/s00586-013-2962-7

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  • DOI: https://doi.org/10.1007/s00586-013-2962-7

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