The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

Lin, Geng-Xiong; Ma, Yanming; Xiao, Yong-Chun; Xiang, Dian; Luo, Jiankai; Zhang, Guowei; Ji, Zhisheng; Lin, Hongsheng

doi:10.1186/s12891-021-04943-w

Cited by 11 publications

(8 citation statements)

References 38 publications

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“…In our study, the segmental distribution of the PS in the preoperative patients increased from L2-3 to L4-5, which was consistent with previous research. Besides, in the present study, compared to preoperative PS, the tCSA and fCSA of the PS increased and the FI decreased after surgery from L2–3 to L5–S1 in patients with DLSS, which was similar to that reported in a previous study [ 34 ]. This demonstrated that compensatory hypertrophy of the PS occurs after surgery, which may play an important role in postoperative adaption and maintenance of spinal stability.…”

Section: Discussionsupporting

confidence: 92%

Preoperative and follow-up variations of psoas major muscle are related to S1 screw loosening in patients with degenerative lumbar spinal stenosis

Zhou,

Xu,

Sun

et al. 2024

BMC Musculoskelet Disord

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Background It was reported the paraspinal muscle played an important role in spinal stability. The preoperative paraspinal muscle was related to S1 screw loosening. But the relationship between preoperative and postoperative change of psoas major muscle (PS) and S1 pedicle screw loosening in degenerative lumbar spinal stenosis (DLSS) patients has not been reported. This study investigated the effects of preoperative and follow-up variations in the psoas major muscle (PS) on the first sacral vertebra (S1) screw loosening in patients with DLSS. Methods 212 patients with DLSS who underwent lumbar surgery were included. The patients were divided into the S1 screw loosening group and the S1 screw non-loosening group. Muscle parameters were measured preoperatively and at last follow-up magnetic resonance imaging. A logistic regression analysis was performed to investigate the risk factors for S1 screw loosening. Results The S1 screw loosening rate was 36.32% (77/212). The relative total cross-sectional areas and relative functional cross-sectional areas (rfCSAs) of the PS at L2–S1 were significantly higher after surgery. The increased rfCSA values of the PS at L3–S1 in the S1 screw non-loosening group were significantly higher than those in the S1 screw loosening group. The regression analysis showed male, lower CT value of L1 and longer segment fusion were independent risk factors for S1 screw loosening, and postoperative hypertrophy of the PS was a protective factor for S1 screw loosening. Conclusions Compared to the preoperative muscle, the PS size increased and fatty infiltration decreased after surgery from L2–3 to L5–S1 in patients with DLSS after short-segment lumbar fusion surgery. Postoperative hypertrophy of the PS might be considered as a protective factor for S1 screw loosening. MRI morphometric parameters and postoperative selected exercise of PS for DLSS patients after posterior lumbar fusion surgery might contribute to improvement of surgical outcome.

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Section: Discussionsupporting

confidence: 92%

Preoperative and follow-up variations of psoas major muscle are related to S1 screw loosening in patients with degenerative lumbar spinal stenosis

Zhou,

Xu,

Sun

et al. 2024

BMC Musculoskelet Disord

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“…Furthermore, the dynamic stabilization system has the advantage of limiting the abnormal activity of the surgical segment of the lumbar spine and reducing the excessive mechanical load on the posterior column structure of the lumbar spine while maintaining a certain degree of mobility of the surgical segment, as well as avoiding to some extent the abnormal distribution of stress in the adjacent segments of the disc, thereby effectively reducing the incumbency [ 11 , 12 ]. The surgical segment load transfer center of the Isobar TTL system is close to the anterior middle column of the spine, similar to the physiological state, and the TTL system is subjected to less compressive stress than conventional rigid fixation devices while still allowing the disc of the operated segment to be subjected to a certain stress load [ 13 ]. Some studies have found that when the spinal unit's instability is reduced to a certain extent, this compressive stress load can lead to spontaneous repair of the intervertebral disc [ 14 – 16 ].…”

Section: Discussionmentioning

confidence: 99%

Isobar hybrid dynamic stabilization with posterolateral fusion in mild and moderate lumbar degenerative disease

Guan

Liu

et al. 2023

BMC Musculoskelet Disord

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Objective The aim of this study was to investigate the feasibility of using the Isobar TTL system and posterolateral fusion in a two-segment hybrid fixation approach, combined with spinal decompression, for treating mild and moderate lumbar degenerative disease. Specifically, we sought to evaluate the effectiveness of this approach for managing two-segment mild and moderate lumbar degenerative disease, and to determine whether it could provide a safe and reliable alternative to traditional surgical methods. Methods This retrospective study included 45 consecutive patients with two-level lumbar disc herniation or spinal stenosis, 24 of whom underwent the TTL system and posterolateral fusion combined (TTL group), and 21 of whom underwent posterolateral fusion alone (Rigid group). The surgical segment, admission diagnosis, operation time, and intraoperative bleeding were recorded separately for the two groups of patients. Imaging studies included pre- and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain. Results All patients completed the surgery successfully with a mean follow-up of 56.09 months. The operative time and intraoperative bleeding were lower in the TTL group than in the Rigid group (p < 0.05). All patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, and ODI scores (p < 0.05). ODI scores, the TTL group was better than the Rigid group at 1 year after surgery and at the final follow-up (p < 0.05). Postoperative surgical segment range of motion (ROM) decreased in both groups (p < 0.05). The postoperative ROM of the upper adjacent segment increased in both groups and was significantly higher in both groups at the last follow-up compared with the preoperative period (p < 0.05), and the superior adjacent segment rom of the TTL group was lower than the Rigid group (p < 0.05). The modified Pfrrmann classification of the superior adjacent segment was significantly increased in both groups at the last follow-up (p < 0.05). And in the TTL group, ROM, DH, and modified Pfrrmann grading of dynamic segment outperformed fusion segments. According to the UCLA classification, the incidence of adjacent segment degeneration (ASD) was 4.2% in the TTL group and 23.8% in the Rigid group, and the incidence of ASD was lower in the TTL group than in the Rigid group (P < 0.05). Conclusion The Isobar TTL System was utilized in two-level lumbar hybrid surgery, resulting in no evident indications of lumbar instability being detected on X-rays captured at a minimum of 4 years after the operation, while retaining partial range of motion of the surgical segment. The general clinical efficacy is equivalent to titanium rod fusion surgery, presenting an alternative treatment for individuals with mild and moderate lumbar degenerative disease.

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“…In the local intervertebral disc degeneration assessment, the Waveflex group showed obvious symptom improvement and clinical efficacy compared with the PLIF group. Related biomechanical studies have pointed out that the significant decrease in the ROM of the fusion segments leads to excessive stress concentration in the adjacent segments 22 . Moreover, the compensatory ROM increase, resulting in the change of the original sagittal balance and biomechanics, leads to the degeneration of the adjacent segments and loss of intervertebral space and IFHs, which are the main manifestations of degeneration 23 .…”

Section: Discussionmentioning

confidence: 99%

Long-term efficacy of Waveflex semi-rigid-dynamic-internal-fixation system in delaying intervertebral disc degeneration at adjacent segments and improving spinal sagittal imbalance

Gao,

Wang,

Chen

et al. 2024

Sci Rep

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The Waveflex semi-rigid-dynamic-internal-fixation system shows good short-term effects in the treatment of lumbar degenerative diseases, but there are few long-term follow-up studies, especially for recovery of sagittal balance. Fifty patients with lumbar degenerative diseases treated from January 2016 to October 2017 were retrospectively analysed: 25 patients treated with Waveflex semi-rigid-dynamic-internal-fixation system (Waveflex group) and 25 patients treated with double-segment PLIF (PLIF group). Clinical efficacy was evaluated by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Imaging data before surgery and at 3 months, 1 year, and 5 years postoperatively was used for imaging indicator assessment. Local disc degeneration of the cephalic adjacent segment (including disc height index (DHI), intervertebral foramen height (IFH), and range of motion (ROM)) and overall spinal motor function (including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and |PI-LL|) were analysed. Regarding clinical efficacy, comparison of VAS and ODI scores between the Waveflex and PLIF groups showed no significant preoperative or postoperative differences. The comparison of the objective imaging indicators showed no significant differences in the DHI, IFH, LL, |PI-LL|, and SS values between the Waveflex and PLIF groups preoperatively and 3 months postoperatively (P > 0.05). These values were significantly different at 1 and 5 years postoperatively (P < 0.05), and the Waveflex group showed better ROM values than those of the PLIF group (P < 0.05). PI values were not significantly different between the groups, but PT showed a significant improvement in the Waveflex group 5 years postoperatively (P < 0.05). The Waveflex semi-rigid dynamic fixation system can effectively reduce the probability of intervertebral disc degeneration in upper adjacent segments. Simultaneously, patients in the Waveflex group showed postoperative improvements in LL, spinal sagittal imbalance, and quality of life.

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The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

Cited by 11 publications

References 38 publications

Preoperative and follow-up variations of psoas major muscle are related to S1 screw loosening in patients with degenerative lumbar spinal stenosis

Preoperative and follow-up variations of psoas major muscle are related to S1 screw loosening in patients with degenerative lumbar spinal stenosis

Isobar hybrid dynamic stabilization with posterolateral fusion in mild and moderate lumbar degenerative disease

Long-term efficacy of Waveflex semi-rigid-dynamic-internal-fixation system in delaying intervertebral disc degeneration at adjacent segments and improving spinal sagittal imbalance

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