Effect of Protein Supplement on Paraspinal Muscles in Spine Fusion Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

Background: Dysfunction and weakness due to atrophy of the paraspinal muscles is a major issue after posterior spinal fusion (PSF) surgery, resulting in pain and disability. Considering the role of protein in muscle regeneration, it seems that protein supplements after surgery may prevent muscle atrophy. To date, to our knowledge, no intervention study has investigated the effect of protein supplementation on the volume of paraspinal muscles, pain, or disability after PSF.Methods: In this randomized, double-blind, placebo-controlled clinical trial, patients were randomly assigned to a control (placebo þ diet with 1.2 g/kg body weight of protein, n ¼ 40) or a protein supplementation (36 g/day þ a diet with 1.2 g/kg body weight of protein, n ¼ 40) group, which received intervention from 48 hours before to 1 month after surgery. The cross-sectional area (CSA) of the paraspinal muscles was measured by thin-slice computed tomography, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index.Results: After 4 weeks of protein supplementation, the CSAs of multifidus and psoas muscles on both sides were significantly higher in the supplementation group than the placebo group (P ,.001). Less atrophy was seen in the right erector spinae and quadratus lumborum muscles in the group receiving protein supplements than the placebo group (P , .001). In addition, protein supplementation was significantly negatively correlated with both pain (P , .001) and disability (P , .001).Conclusions: In conclusion, we demonstrated that 36 g/day protein supplementation significantly increased the CSA of muscles and reduced the atrophy, pain, and disability after PSF surgery.

Perioperative Nutritional Supplementation Decreases Wound Healing Complications Following Elective Lumbar Spine Surgery: A Randomized Controlled Trial

“…This study found that patients who had perioperative nutritional supplementation had increased cross-sectional areas of their paraspinal muscles, signifying less atrophy than the control group 26. This group later followed up these results by examining the effects of protein supplementation, as a part of an Enhanced Recovery After Surgery (ERAS) protocol 26. Patients who underwent posterior spinal fusion and provided with perioperative nutritional supplementation had higher rates of successful vertebral fusions 26.…”

“…Because of the hypermetabolic state, a patient is often in following lumbar spine surgery, protein supplementation may theoretically help maintain a proper balance and counteract the net loss due to increased energy utilization 26–28. Several studies have concluded that the protein intake required for recovery is not often met by the preoperative diet of a patient; thus patients may benefit from nutritional supplementation postoperatively 29–31.…”

“…Khalooeifard et al 26 prospectively assessed the use of protein supplementation in patients undergoing posterior spinal fusion during the month following surgery. This study found that patients who had perioperative nutritional supplementation had increased cross-sectional areas of their paraspinal muscles, signifying less atrophy than the control group 26. This group later followed up these results by examining the effects of protein supplementation, as a part of an Enhanced Recovery After Surgery (ERAS) protocol 26.…”

“…This group later followed up these results by examining the effects of protein supplementation, as a part of an Enhanced Recovery After Surgery (ERAS) protocol 26. Patients who underwent posterior spinal fusion and provided with perioperative nutritional supplementation had higher rates of successful vertebral fusions 26. In addition, they reported that these patients had increases in their levels of tissue-healing mediators, including albumin and alkaline phosphatase 26…”

“…Patients who underwent posterior spinal fusion and provided with perioperative nutritional supplementation had higher rates of successful vertebral fusions 26. In addition, they reported that these patients had increases in their levels of tissue-healing mediators, including albumin and alkaline phosphatase 26…”