Abstract
Degeneration of the multifidus muscle of the back after stabilizing operations on the lumbar spine and its impact on rehabilitation measures remains understudied. There are isolated data in publications on the partial effectiveness of minimally invasive surgery, but the problem has not been completely solved, there is no data on the effect of physical therapy and physiotherapy methods on the progress of degeneration of the multifidus muscle of the back. Purpose To study the effect of electroneuromyostimulation and physical therapy in the postoperative period in decompression-stabilizing operations on the progress of adipose degeneration of the multifidus muscle of the back. Materials and methods The parameters of the multifidus muscle of the back were analyzed and determined in 3 groups of patients who underwent operations with stabilizing systems in the lumbar spine: in group I (n = 56), it was recommended to limit physical activity for 2 months after surgery and wear a semi-rigid corset; in group II (n = 41), early rehabilitation was initiated in the form of physical therapy with the continuation of the recommended exercises after discharge, in group III (n = 43), patients after discharge were recommended to limit physical activity, but with the use of electroneuromyostimulation on the paravertebral muscles 2 times a day lasting 15–30 minutes. All patients underwent clinical examination, MRI, MSCT to assess the condition of the multifidus muscle. Results In group II, there was a decrease in the rate of adipose degeneration of the multifidus muscle, but with increase in pain and decrease in life quality compared to group I. Patients of group III had the lowest rate of increase in adipose degeneration with less pain and a higher level of life quality compared to groups II and I. Conclusions A combination of early postoperative stimulation for two months with a subsequent transition to physical therapy is optimal; otherwise exceeding the functional threshold may cause disruption of adaptation systems.
Highlights
Application of decompression and stabilization operations for degenerative stenosis became an integral part of current spinal surgery
The dynamics of indices according to the VAS and the Oswestry scales in the early postoperative period corresponded to the volume and type of surgical intervention and had no static differences from the data of other authors [20–23]
The data in the Table show that the exercises prescribed in the early period caused pain increase, while physical activity restrictions reduced the intensity of pain and the late follow-up in both tactics caused poor assessment of the quality of life of patients in the period from 12 to 24 months
Summary
Application of decompression and stabilization operations for degenerative stenosis became an integral part of current spinal surgery. The use of dorsal approaches leads to inevitable injury of the paraspinal muscles, in particular, the multifidus dorsi, that is involved in providing stability [1–6]. A number of studies indicate damage of the innervation of the paraspinal muscles during access and the absence of cross innervation, that plays a significant role in fatty degeneration of the latter [14, 15]. Does not provide enough information on the effect of electrical neuromyostimulation on the degeneration of the multifidus muscle of the spine in the postoperative period, the study of this problem is relevant
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