Abstract
Introduction Morphological, biochemical and histopathological characteristics of paraspinal muscles have been well described in patients with idiopathic scoliosis. However, there is a paucity of literature on morphological picture of paraspinal muscles in patients with severe idiopathic scoliosis. Objective To explore how the magnitude of thoracic spine deformity affects morphological characteristics of paraspinal muscles in patients with severe idiopathic scoliosis. Material and methods A total 21 patients with idiopathic scoliosis were reviewed. The patients were assigned to two groups depending on magnitude of preoperative thoracic spine deformity. A major group consisted of patients with scoliosis of ≥ 60º (n = 11) and control group included patients with a curve < 60º (n=10). Biopsy samples were taken from muscle fragments (multifidus muscle) at the apex of the curve (major arc) at the Th6-Th10 level on the convex side while approaching to the posterior spinal structures during surgical correction of kyphoscoliosis using light microscope. The specimens were examined histologically with light microscope. Results Patients with severe idiopathic scoliosis (≥ 60º) showed evident muscle fiber atrophy and dystrophy of different extent. There were nucleus free areas and homogenized muscle fragments observed with connective tissue layers being swollen and frayed with multiple fibroblasts seen in nearly all the samples. Arterial walls were normally fibrotized. Structural changes ranged from minimal with a curve of 60º to degrading muscles with the fibers replaced by fat and connective tissues with a curve angle of 145º. Conclusion Morphological characteristics of paraspinal muscles have been shown to be severely affected by the magnitude of thoracic spine deformity in patients with severe idiopathic scoliosis. The findings should be considered in surgical correction of kyphoscoliosis with special focus on postoperative vascular and neurotropic therapy to allow wound healing and lower complication rate.
Highlights
Morphological, biochemical and histopathological characteristics of paraspinal muscles have been well described in patients with idiopathic scoliosis
Morphological evaluation of paraspinal muscles were relatively uniform in most fields of vision with in patients with idiopathic scoliosis measuring < 60o the endomysium between the fibers being extrinsical
Our findings showed different severity of atrophy and dystrophy of muscle fibers in patients with severe idiopathic scoliosis of ≥ 60°
Summary
Morphological, biochemical and histopathological characteristics of paraspinal muscles have been well described in patients with idiopathic scoliosis. There is a paucity of literature on morphological picture of paraspinal muscles in patients with severe idiopathic scoliosis. Among causative factors muscles of the human paraspinal region have been the focus of attention in patients with idiopathic scoliosis [8, 12–16]. Paraspinal muscle morphology and structure are generally explored in patients with idiopathic scoliosis measuring a mean of 48o to 68o (range, 28o to 115o) [14, 16, 20–22]. Patients with idiopathic scoliosis present lower electromyographic activity in the paravertebral muscles of the thoracic spine after spine fusion, probably because of atrophy [26]. There is a limited number of papers reporting morphological evaluation of the paravertebral muscles in patients with severe and rigid idiopathic scoliosis [21, 27]
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