Abstract
In this prospective cohort study, we aimed to determine the surgical and adjacent segment changes in paraspinal muscles and facet joints in patients with lumbar spinal stenosis after minimally invasive posterior lumbar interbody fusion (PLIF) using the cortical bone trajectory (CBT) technique. We enrolled 30 consecutive patients who underwent the single-level CBT technique between October 2017 and October 2018. We evaluated preoperative and 1-month, 3-month, 6-month, and 1-year postoperative clinical data including Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI). Magnetic resonance imaging (MRI) was performed a year after surgery. The erector spinae (ES) muscle area, volume, and fat infiltration (FI) on the surgical and adjacent segments were evaluated using the thresholding method, and the degree of adjacent facet joint degeneration was calculated using the Weishaupt scale. FI rate was graded using the Kjaer method. All patients underwent a 12-month follow-up. The VAS and ODI scores significantly improved after surgery in all patients. No patient showed degeneration of the adjacent facet joints (P > 0.05) during the 1-year follow-up postoperation. There was no significant difference in ES muscle volume, area, and FI on the surgical and adjacent segments (P > 0.05). The FI rate of the upper ES muscles increased postoperatively (P < 0.05); however, there were no significant changes in FI rate of the lower ES muscles. Patients with lumbar spinal stenosis could obtain satisfactory short-term clinical outcomes via minimally invasive PLIF using the CBT technique. Moreover, this technique may reduce the impact on the paravertebral muscles, especially the ES muscle, and the adjacent facet joints.
Highlights
Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people
Single-level L4/5 Posterior lumbar interbody fusion (PLIF) was performed on all patients, respectively. e mean body mass index was 24.54 ± 3.83 kg/m2 and the average operation time was 153.33 ± 29.87 min. e mean intraoperative blood loss was 183.33 ± 69.89 ml, and the average hospital stay was 7.97 ± 2.20 days
E mean preoperative and postoperative Oswestry Disability Index (ODI) scores and Visual Analogue Scale (VAS) scores are presented in Table 2, while the upper and lower segment erector spinae (ES) muscle areas, surgical segment ES muscle areas, and ES muscle volumes are presented in Table 3. e
Summary
Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people. Posterior lumbar interbody fusion (PLIF) surgery is a widely accepted surgical technique for the treatment of LSS [1]. Paraspinal muscle degeneration may lead to loss of functional muscle support, segmental movement disorders, and increased biomechanical strain, resulting in persistent postoperative low back pain [3]. Traditional pedicle screws point lateral to the pars interarticularis, and the operation lacks protection of the paravertebral muscles and requires a relatively wide dissection of the paraspinal muscles [5], which may predispose to injury to the medial and posterior branches of the spinal nerve and causes volume atrophy of the paravertebral muscles [1, 6]. The violation of the adjacent facet joint surface could lead to adjacent segment degeneration (ASD) [8]. erefore, traditional PLIF with pedicle
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