title: Back muscle changes after pedicle based dynamic stabilization.
abstract: OBJECTIVE
  Many studies have investigated paraspinal muscle changes after posterior lumbar surgery, including lumbar fusion. However, no study has been performed to investigate back muscle changes after pedicle based dynamic stabilization in patients with degenerative lumbar spinal diseases. In this study, the authors compared back muscle cross sectional area (MCSA) changes after non-fusion pedicle based dynamic stabilization.
  
  
  METHODS
  Thirty-two consecutive patients who underwent non-fusion pedicle based dynamic stabilization (PDS) at the L4-L5 level between February 2005 and January 2008 were included in this retrospective study. In addition, 11 patients who underwent traditional lumbar fusion (LF) during the same period were enrolled for comparative purposes. Preoperative and postoperative MCSAs of the paraspinal (multifidus+longissimus), psoas, and multifidus muscles were measured using computed tomographic axial sections taken at the L4 lower vertebral body level, which best visualize the paraspinal and psoas muscles. Measurements were made preoperatively and at more than 6 months after surgery.
  
  
  RESULTS
  Overall, back muscles showed decreases in MCSAs in the PDS and LF groups, and the multifidus was most affected in both groups, but more so in the LF group. The PDS group showed better back muscle preservation than the LF group for all measured muscles. The multifidus MCSA was significantly more preserved when the PDS-paraspinal-Wiltse approach was used.
  
  
  CONCLUSIONS
  Pedicle based dynamic stabilization shows better preservation of paraspinal muscles than posterior lumbar fusion. Furthermore, the minimally invasive paraspinal Wiltse approach was found to preserve multifidus muscles better than the conventional posterior midline approach in PDS group.
authors: Spine Center, Department of Neurosurgery, Ansan 21st Century Hospital, Ansan, Korea.
authors: Kyung Yun
authors: KY
authors: Moon
authors: Soo-Eon
authors: SE
authors: Lee
authors: Ki-Jeong
authors: KJ
authors: Kim
authors: Seung-Jae
authors: SJ
authors: Hyun
authors: Hyun-Jib
authors: HJ
authors: Kim
authors: Tae-Ahn
authors: TA
authors: Jahng
keywords: Dynamic stabilization; Lumbar fusion; Lumbar spine; Multifidus; Paraspinal muscle
references: Spine (Phila Pa 1976). 2007 May 15;32(11):1236-41
references: 17495782
references: J Korean Neurosurg Soc. 2008 May;43(5):221-6
references: 19096600
references: Spine (Phila Pa 1976). 1993 Apr;18(5):575-81
references: 8484148
references: Spine (Phila Pa 1976). 2007 Mar 15;32(6):685-90
references: 17413475
references: Spine (Phila Pa 1976). 1994 Nov 15;19(22):2598-602
references: 7855687
references: Spine (Phila Pa 1976). 2002 Jun 1;27(11):1131-41
references: 12045508
references: Spine (Phila Pa 1976). 2006 Feb 15;31(4):442-9
references: 16481955
references: Spine (Phila Pa 1976). 2006 Oct 1;31(21):2491-9
references: 17023860
references: J Korean Med Sci. 2007 Aug;22(4):646-51
references: 17728503
references: Spine (Phila Pa 1976). 2002 Dec 15;27(24):2758-62
references: 12486343
references: Spine (Phila Pa 1976). 1997 May 1;22(9):1018-23
references: 9152453
references: J Spinal Disord Tech. 2006 Apr;19(2):77-86
references: 16760779
references: J Spinal Disord Tech. 2006 Jul;19(5):318-22
references: 16826001
references: Eur Spine J. 2002 Oct;11 Suppl 2:S170-8
references: 12384741
references: Neurosurg Focus. 2007 Dec 15;22(1):E8
references: 17608342
references: Asian Spine J. 2009 Dec;3(2):89-95
references: 20404953
references: Orthopedics. 2007 Oct;30(10):859-65
references: 17990413
references: Eur Spine J. 2003 Apr;12(2):178-89
references: 12709856
references: Spine (Phila Pa 1976). 1998 Nov 1;23(21):2282-7; discussion 2288
references: 9820907
references: Spine (Phila Pa 1976). 2008 Dec 15;33(26):2909-14
references: 19092623
references: Orthop Clin North Am. 2004 Jan;35(1):43-56
references: 15062717
references: Spine (Phila Pa 1976). 2005 Jan 1;30(1):123-9
references: 15626992
references: Spine (Phila Pa 1976). 1996 Apr 15;21(8):941-4
references: 8726197
references: Neurol Med Chir (Tokyo). 2000 Mar;40(3):151-4; discussion 154-5
references: 10842484
references: J Bone Joint Surg Am. 2009 Jan;91(1):176-85
references: 19122093
references: Z Orthop Ihre Grenzgeb. 2003 Jul-Aug;141(4):418-24
references: 12928999
references: Spine (Phila Pa 1976). 2008 Jun 1;33(13):1418-22
references: 18520936
references: Spine (Phila Pa 1976). 1999 Nov 1;24(21):2268-72
references: 10562995
references: J Anat. 1982 Mar;134(Pt 2):383-97
references: 7076562
references: Chin Med J (Engl). 2011 Dec;124(23):3868-74
references: 22340311
references: J Spinal Disord Tech. 2003 Aug;16(4):418-23
references: 12902959
references: Spine (Phila Pa 1976). 2003 Aug 1;28(15 Suppl):S26-35
references: 12897471
references: Stud Health Technol Inform. 2006;123:461-6
references: 17108469
references: Surg Neurol. 2008 Feb;69(2):109-13; discussion 113
references: 18261638
references: Eur Spine J. 2007 Aug;16(8):1223-31
references: 17206401
references: Spine (Phila Pa 1976). 1989 Jan;14(1):33-6
references: 2913665
references: SAS J. 2008 Jun 01;2(2):69-75
references: 25802605