Postoperative Paraspinal Muscles Assessment After Endoscopic Stenosis Lumbar Decompression: Magnetic Resonance Imaging Study

Jin-Woo An; Hyeun-Sung Kim; Harshavardhan D. Raorane; Wu Pang Hung; Il-Tae Jang

doi:10.14444/8217

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Figure 1
(A) Measurement of functional cross-sectional area of erector spinae outlined with red line and multifidus outlined with blue line on T1 axial magnetic resonance imaging images. Fatty infiltration scale: (B) grade 0 ( 10%); (C) grade 1 (10%–50%); and (D) grade 2 (>50%).
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Figure 2
Box plot with interquartile range and median value showing for the single-level lumbar endoscopic unilateral laminotomy with bilateral decompression preoperative and 6-month follow-up changes in functional cross-sectional area of (A) ipsilateral multifidus (MF), (B) contralateral MF, (C) ipsilateral erector spinae (ES), and (D) contralateral ES.
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Figure 3
Box plot with interquartile range and median value showing for the multilevel lumbar endoscopic unilateral laminotomy with bilateral decompression preoperative and 6-month follow-up changes in functional cross-sectional area of (A) ipsilateral multifidus (MF), (B) contralateral MF, (C) ipsilateral erector spinae (ES), and (D) contralateral ES.
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Figure 4
Saggital and axial T2-weighted images of a 56-year-old female patient operated for single-level lumbar endoscopic unilateral laminotomy with bilateral decompression L4-5 showing significant increase and maintenance of dural sac cross-sectional area for long-term follow-up without post-operative paraspinal muscle atrophy.

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Table 1

Demographical data and clinical results of single-level and multilevel ESLD.

	Single-Level ESLD Group	Multilevel ESLD Group	P Value
Patients	120	39
Age, y, mean	60.5	67.28
Gender (M:F)	60:60 (50%)	18:21 (46.15%)
Levels of ESLD	120	83
L1-2	1	2
L2-3	9	15
L3-4	15	26
L4-5	82	28
L5-S1	13	12
VAS score, mean ± SD
Preoperative	7.83 ± 1.37	7.84 ± 1.38
Immediate postoperative	3.15 ± 0.67	3.50 ± 0.60	<0.001*
6-mo follow-up	2.19 ± 0.88	2.44 ± 0.79	<0.001*
ODI, mean ± SD
Preoperative	74.09 ± 7.18	74.1 ± 7.72
Immediate postoperative	27.88 ± 4.40	31.30 ± 4.46	<0.001*
6-mo follow-up	23.88 ± 4.56	24.90 ± 4.75	<0.001*

Statistically significant values are marked with an asterisk (*).
ESLD, end-stage liver disease; ODI, Oswestry Disability Index; VAS, visual analog scale.

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Table 2

Radiological results of single-level and multilevel ESLD.

Outcome Measure	Preoperative	Six-mo Follow-Up	P Value
Single-level ESLD
MF FCSA (in mm2)
Ipsilateral	594.47 ± 208.24	604.56 ± 199.99	0.112
Contralateral	597.96 ± 227.05	613.79 ± 219.18	0.66
ES FCSA (in mm²)
Ipsilateral	1101.26 ± 429.1	1177.88 ± 636.6	0.123
Contralateral	1138.26 ± 465.4	1144.65 ± 463.2	0.621
Fatty infiltration scale, n (%)
0	47 (39.83)	62 (52.54)	0.221
1	51 (43.22)	42 (35.59)	0.358
2	22 (16.95)	14 (11.86)	0.119
DS CSA (in mm²)	79.23 ± 28.54	163.97 ± 37.86	<0.001^*
Multilevel ESLD
MF FCSA (in mm²)
Ipsilateral	513.81 ± 198.56	520.92 ± 189.22	0.458
Contralateral	507.48 ± 218.49	516.23 ± 206.64	0.344
ES FCSA (in mm²)
Ipsilateral	1316.89 ± 523.7	1332.92 ± 541.68	0.432
Contralateral	1296.36 ± 563.25	1316.27 ± 563.43	0.311
Fatty infiltration scale, n (%)
0	37 (97.37)	38 (100)	0.865
1	33 (86.84)	33 (86.84)	0.697
2	13 (28.95)	10 (26.32)	0.771
DS CSA (in mm²)	69.83 ± 19.94	157.81 ± 23.6	<0.001*

Note: Data presented as mean ± SD unless otherwise noted. Statistically significant values are marked with an asterisk (*).
CSA, cross-sectional area; DS, dural sac; ES, erector spinae; ESLD, end-stage liver disease; FCSA, functional cross-sectional area; MF, multifidus.