Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis
Kawaguchi, Y.; Matsui, H.; Tsuji, H.
Spine 21(8): 941-944
1996
ISSN/ISBN: 0362-2436 PMID: 8726197 Document Number: 462108
Study Design: Back muscle injury after posterior lumbar surgery was studied by muscle histology an serum creatine phosphokinase MM isoenzyme activity. Objectives: To investigate intraoperative factors influencing the magnitude of back muscle injury after posterior lumbar surgery. Summary of Background Data: The authors previously have reported iatrogenic back muscle injury in an animal model and in humans. Serious injury of the back muscle has been shown by short-term and long-term follow-up evaluation. Methods: The retraction pressure was monitored, and the retraction pressure-time products were calculated in 24 patients. Early histologic changes of multifidus muscle, which were taken at completion of surgery, and serum creatine phosphokinase MM isoenzyme activity changes were examined. Results: The magnitude of back muscle injury was significant as the pressure-time product increased. Creatine phosphokinase MM isoenzyme activity increased after surgery and reached a plateau 1 day after surgery, followed by recovery to the normal value 1 week after surgery. Creatine phosphokinase MM isoenzyme activity tended to be high in cases with multilevel exposure and with, high pressure-time product. Conclusions: Back muscle injury occurs in all patients who underwent posterior lumbar surgery, an these injuries are related to the retraction pressure, time, and extent of exposure.