Risk Factors of Postoperative Low Back Pain for Low-Grade Degenerative Spondylolisthesis: An At Least 2-Year Follow-Up Retrospective Study

Does pre-operative multifidus morphology on MRI predict clinical outcomes in adults following surgical treatment for degenerative lumbar spine disease? A systematic review

“…At present, there is some evidence to suggest that changes in the morphology of multifidus following a surgical procedure are associated with worse clinical outcomes, although the magnitude of this effect is unclear [10][11][12][13][14]. Furthermore, the association between the pre-operative morphological condition of multifidus and post-operative clinical outcomes is not well described [15][16][17][18][19].…”

Reattachment of the Multifidus Tendon in Lumbar Surgery to Decrease Postoperative Back Pain: A Technical Note

“…The posterior approach to the lumbar spine, most commonly used for decompression and fusion procedures, involves significant manipulation of the paraspinal muscles, particularly the LM [1][2][3][4][5][6]. Upon standard superficial exposure, the tendon origin of the LM is dissected from the spinous process and, together with other paraspinal muscles, is retracted laterally to obtain an adequate surgical window [6,14].…”

“…Upon standard superficial exposure, the tendon origin of the LM is dissected from the spinous process and, together with other paraspinal muscles, is retracted laterally to obtain an adequate surgical window [6,14]. Such manipulation places the LM at a significant risk of iatrogenic damage resulting from crush injury, devascularization, and denervation, all of which have been associated with postoperative pain and muscle atrophy [1][2][3][4]. Cases involving the surgical removal of the spinous processes further disrupt the LM due to the inability to return the LM to its usual anatomical position.…”

“…However, procedures using the posterior approach are not without challenges and risks. Most commonly employed for decompression and fusion, the traditional posterior approach calls for significant manipulation of the paraspinal muscles, with muscle detachment and retraction that may potentially result in iatrogenic damages such as crush injury, devascularization, and denervation, all of which have been associated with postoperative pain [1][2][3][4][5][6][7][8][9][10][11]. The muscle most directly affected by the posterior approach is the lumbar multifidus (LM) [5].…”

“…The effects of the posterior approach on the integrity of the paraspinal musculature, particularly the LM, is concerning as studies have linked paraspinal muscle integrity to low back pain (LBP). Numerous reports have shown that patients with postoperative LBP exhibit gross and histological signs of LM degeneration, such as muscle atrophy (decreased crosssectional area [CSA]), LM intramuscular adipose tissue accumulation, and LM denervation [1,2,4,6,[8][9][10][13][14][15]. These findings have been attributed, in part, to the imprecise nature of the LM dissection as well as the intraoperative use of self-retaining retractors, both of which have been shown to result in ischemic necrosis, scar tissue formation, denervation, and atrophy [5,8,10,14].…”