Abstract

BackgroundSimultaneous measurement of electromyography (EMG) and local muscle oxygenation is proposed in an isometric loading model adjusted for patients that have undergone spinal surgery.MethodsTwelve patients with degenerative lumbar spinal stenosis (DLSS) were included. They were subjected to a test protocol before and after surgery. The protocol consisted of two parts, a dynamic and an isometric Ito loading with a time frame of 60 s and accompanying rest of 120 s. The Ito test was repeated three times. EMG was measured bilaterally at the L4 level and L2 and was recorded using surface electrodes and collected (Biopac Systems Inc.). EMG signal was expressed as RMS and median frequency (MF). Muscle tissue oxygen saturation (MrSO2) was monitored using a near-infrared spectroscopy (NIRS) device (INVOS® 5100C Oxymeter). Two NIRS sensors were positioned bilaterally at the L4 level.The intensity of the leg and back pain and perceived exertion before, during, and after the test was evaluated with a visual analogue scale (VAS) and Borg RPE-scale, respectively.ResultsAll patients were able to perform and complete the test protocol pre- and postoperatively. A consistency of lower median and range values was noted in the sensors of EMG1 (15.3 μV, range 4.5–30.7 μV) and EMG2 (13.6 μV, range 4.0–46.5 μV) that were positioned lateral to NIRS sensors at L4 compared with EMG3 (18.9 μV, range 6.5–50.0 μV) and EMG4 (20.4 μV, range 7.5–49.0 μV) at L2. Right and left side of the erector spinae exhibited a similar electrical activity behaviour over time during Ito test (60 s). Regional MrSO2 decreased over time during loading and returned to the baseline level during recovery on both left and right side. Both low back and leg pain was significantly reduced postoperatively.ConclusionSimultaneous measurement of surface EMG and NIRS seems to be a promising tool for objective assessment of paraspinal muscle function in terms of muscular activity and local muscle oxygenation changes in response to isometric trunk extension in patients that have undergone laminectomy for spinal stenosis.

Highlights

  • Laminectomy or decompression surgery for degenerative lumbar spinal stenosis (DLSS) is a procedure with proven patient benefits

  • The literature indicates there is a lack of proper tools to determine how the spinal muscles perform their task after an intervention, such as lumbar spinal surgery for DLSS and how it relates to experienced pain or other factors that have an impact of daily life and quality of life

  • The purpose of this study is to develop and evaluate objective measurements utilizing EMG and near-infrared spectroscopy (NIRS) in order to quantify the muscle functional status during isometric trunk extension pre- and postoperatively in a cohort of a limited number of patients operated with laminectomy for symptomatic lumbar spinal stenosis

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Summary

Introduction

Laminectomy or decompression surgery for degenerative lumbar spinal stenosis (DLSS) is a procedure with proven patient benefits. Measuring muscle electric activity with electromyography (EMG) has been shown to be a reliable method and has previously been used in studies for evaluating the functionality of muscles in the lumbar spine [4,5,6,7,8,9,10,11]. Simultaneous measurement of electromyography (EMG) and local muscle oxygenation is proposed in an isometric loading model adjusted for patients that have undergone spinal surgery

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