A model for evaluation of the electric activity and oxygenation in the erector spinae muscle during isometric loading adapted for spine patients

Abstract

Background: Simultaneous measurement of electromyography (EMG) and local muscle oxygenation is proposed in an isometric loading model adjusted for patients that have undergone spinal surgery. Methods: Twelve patients with degenerative lumbar spinal stenosis (DLSS) were included. They were subjected to a test protocol before and after surgery. The protocol consisted of two parts, a dynamic and an isometric Ito loading with a time frame of 60 seconds and accompanying rest of 120 seconds. The Ito test was repeated three times. EMG was measured bilaterally at the L4 level and L2 and was recorded using surface electrodes and collected (Biopac Systems Inc). EMG signal was expressed as RMS and median frequency (MF). Muscle tissue oxygen saturation (MrSO 2 ) was monitored using a Near-infrared spectroscopy (NIRS) device ( INVOS ® 5100C Oxymeter). Two NIRS sensors were positioned bilaterally at the L4 level. The intensity of the leg and back pain and perceived exertion before, during and after the test was evaluated with a Visual Analogue Scale (VAS) and Borg RPE-scale, respectively. Results: All patients were able to perform and complete the test protocol pre- and postoperatively. A consistency of lower median and range values was noted in the sensors of EMG1 (15.3 µV, range 4.5-30.7 µV) and EMG2 (13.6 µV, range 4.0 -46.5 µV) that were positioned lateral to NIRS sensors at L4 compared with EMG3 (18.9 µV, range 6.5 -50.0 µV) and EMG4 (20.4 µV, range 7.5 -49.0 µV) at L2. Right and left side of the erector spinae exhibited a similar electrical activity behaviour over time during Ito test (60s). Regional MrSO 2 decreased over time during loading and returned to the baseline level during recovery on both left and right side. Both low back and leg pain was significantly reduced postoperatively. Conclusion: Simultaneous measurement of surface EMG and NIRS seems to be a promising tool for objective assessment of paraspinal muscle function in terms of muscular activity and local muscle oxygenation changes in response to isometric trunk extension in patients that have undergone laminectomy for spinal stenosis. Keywords: Spinal stenosis, EMG, NIRS, paraspinal muscle, muscle oxygenation, muscle activity, laminectomy.