Rhabdomyolysis and spine surgery: A systematic review of the literature

Abstract

Rhabdomyolysis is characterized by the rupture of skeletal muscles due to a lot of reasons such as exercise, drug addiction, toxins, infections, trauma and some medications. The etiology of postoperative rhabdomyolysis is potentially multifactorial and has been documented in several types of surgery. The lysis of cell membrane releases organic and inorganic intracellular components that can be toxic and life threatening. Creatinephosphokinase (CPK) is one of the components and it is the most sensitive indicator of myocyte injury. The classic triad of symptoms is characterized by myalgia, weakness and brown-red urine. There is not a clearly agreed level of serum CPK that is evident for diagnosis of rhabdomyolysis. However, a CPK level higher than 5 times of its normal value is accepted by many authors as diagnostic criteria. Acute kidney injury is the most serious complication of rhabdomyolysis in the days following initial presentation and develops in 33% of patients. The objective of this study was to perform a review of the literature, aiming at a better understanding about the changes in CPK levels and the frequency of rhabdomyolysis in spine surgery, with special attention in posterior lumbar fusion. Nineteen studies were selected for analysis. The studies had different characteristics considering patients age, body mass index, comorbidities and type of surgery. The best available evidence points out to the prognosis depend on the extension and clinical severity of rhabdomyolysis, as well as on the early and prompt medical intervention.