title: Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine.
abstract: The dorsal approach is increasingly preferred in the surgical treatment of vertebral fractures. However, the access and the implant's position cause muscle loss, which can lead to instability and a reduced capacity for rehabilitation. Morphological factors (bones, intervertebral discs) are typically blamed for chronic pain syndromes in the literature, while less importance is attached to functional factors (muscles). The objective of this study was therefore to investigate the isolated influence of dorsal spinal instrumentation on the back muscles by means of electromyography (EMG). A total of 32 patients with conditions after dorsal spondylodesis following the fracture of a vertebral body and 32 subjects with healthy backs were enrolled in this study. The EMG signal was recorded in three different muscle groups during isometric extension exercise. The evaluation was performed by comparing the mean rectified amplitudes of the three muscle groups in the patients and controls. The patients had significantly lower amplitudes in the multifidus muscle (MF) and significantly higher amplitudes in the iliocostal muscle (IL). Patients with severe pain were found to have lower electric muscle potentials in all investigated muscle groups than patients with mild pain. The muscle damage which was established in the multifidus muscle is compensated by increased activity in the iliocostal muscle. On the basis of anatomical considerations, the damage pattern can be identified as having been caused by surgery. It is extremely unlikely that trauma is the cause.
authors.affiliation: Department of Trauma Surgery, Hand and Reconstructive Surgery, University of Ulm, Germany. michael.kramer@medizin.uni-ulm.de
authors.forename: M
authors.initials: M
authors.lastname: Kramer
authors.forename: P
authors.initials: P
authors.lastname: Katzmaier
authors.forename: R
authors.initials: R
authors.lastname: Eisele
authors.forename: V
authors.initials: V
authors.lastname: Ebert
authors.forename: L
authors.initials: L
authors.lastname: Kinzl
authors.forename: E
authors.initials: E
authors.lastname: Hartwig
mesh_terms: D000293:Adolescent; D000328:Adult; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology / Q000503:physiopathology*; D009135:Muscular Diseases / Q000175:diagnosis* / Q000209:etiology*; D009984:Orthopedic Fixation Devices / Q000009:adverse effects*; D010147:Pain Measurement; D012016:Reference Values; D016103:Spinal Fractures / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*