The early changes in trunk muscle strength and disability following lumbar spine fusion

Abstract Background This study was aimed at investigating the causes of lower extremity weaknesses after posterior lumbar spine fusion surgery and looking at subsequent treatment strategies. Methods Patients who underwent posterior lumbar spine fusion surgery in the Peking University First Hospital between January 2009 and December 2018 were counted. Those who needed secondary surgery because of subsequent lower extremity weaknesses were selected. CT scans and MRIs were used to evaluate the reasons for weaknesses before secondary surgery. Muscle strength was evaluated after surgery. Results Thirty patients (30/4078, 0.74%) required a secondary surgery because of lower extremity weaknesses after posterior lumbar spine fusion surgery. The main causes of weakness were (1) internal fixation malposition and loosening (11 patients, 36%), (2) epidural hematomas (9 patients, 30%), (3) insufficient decompression (5 patients, 17%), and (4) nerve root edemas (5 patients, 17%). Weakness occurred on average 2.9 days after surgery (1–9 days). Twenty-seven patients (90%) got improved muscle strength after their secondary surgery. Conclusions Iatrogenic neurologic deficits and lower extremity weaknesses were rare complications after posterior lumbar spine fusion surgeries, but important to recognize and manage. The main causes of weakness were internal fixation malposition and loosening, epidural hematomas, insufficient decompression, or root edemas. There may be positive, therapeutic effects to subsequent, active surgical exploration.

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Early initiation of a strength training based rehabilitation after lumbar spine fusion improves core muscle strength: a randomized controlled trial

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-018-0853-7 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Dejan Kernc ◽

Vojko Strojnik ◽

Rok Vengust

Keyword(s):

Randomized Controlled Trial ◽

Lumbar Spine ◽

Muscle Strength ◽

Strength Training ◽

Controlled Trial ◽

Spine Fusion ◽

Early Initiation ◽

Randomized Controlled ◽

Lumbar Spine Fusion

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Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion

Global Spine Journal ◽

10.1177/21925682211010740 ◽

2021 ◽

pp. 219256822110107

Author(s):

Robert J. Owen ◽

Noah Quinlan ◽

Addisyn Poduska ◽

William Ryan Spiker ◽

Nicholas T. Spina ◽

...

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Lumbar Fusion ◽

Spine Fusion ◽

Erector Spinae ◽

Control Group ◽

Block Group ◽

Opioid Use ◽

Lumbar Spine Fusion ◽

Delivery Technique

Study Design: Retrospective review. Objective: To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. Methods: A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student’s t-test ( P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. Results: There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use ( P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. Conclusions: ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

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Relationship between trunk muscle strength and trunk muscle mass and thickness using bioelectrical impedance analysis and ultrasound imaging

Bio-Medical Materials and Engineering ◽

10.3233/bme-211218 ◽

2021 ◽

pp. 1-10

Author(s):

Ryo Miyachi ◽

Nana Koike ◽

Suzu Kodama ◽

Junya Miyazaki

Keyword(s):

Muscle Strength ◽

Muscle Mass ◽

Ultrasound Imaging ◽

Bioelectrical Impedance Analysis ◽

Muscle Thickness ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Trunk Muscle ◽

Trunk Muscles ◽

Trunk Muscle Strength

BACKGROUND: Although trunk muscles are involved in many important functions, evaluating trunk muscle strength is not an easy task. If trunk muscle mass and thickness could be used as indicators of trunk muscle strength, the burden of measurement would be reduced, but the relationship between trunk muscle strength and trunk muscle mass and thickness has not been clarified. OBJECTIVE: The purpose of this study was to clarify the relationship between trunk muscle strength and trunk muscle mass by bioelectrical impedance analysis and trunk muscle thickness by ultrasound imaging in healthy adults. METHODS: One hundred and twenty-one healthy university students were included in this study. Trunk flexion/extension muscle strength and trunk muscle mass by bioelectrical impedance analysis, and trunk muscle thickness by ultrasound imaging were measured. RESULTS: Both trunk flexion strength and trunk extension strength were significantly correlated with trunk muscle mass and oblique and rectus abdominis muscle thickness. Multiple regression analysis showed that trunk extension muscle strength had an independent relationship with trunk muscle mass. CONCLUSIONS: This study demonstrated that trunk muscle mass or trunk muscle thickness can be used as an alternative means for evaluating trunk muscle strength, making the evaluation of trunk muscles less burdensome.

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Degenerative Lumbar Spine Disease, Not Fusion, May Be a Risk Factor for Instability after Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0040-1719114 ◽

2020 ◽

Vol 4 (04) ◽

pp. 193-200

Author(s):

Daniel K. Witmer ◽

Evan R. Deckard ◽

R. Michael Meneghini

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Joint Disease ◽

Total Hip ◽

Female Sex ◽

Lumbar Spine Fusion ◽

Radiographic Measurements ◽

Acetabular Protrusio

AbstractDislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion have been reported as high as 20%. Few studies exist specifically for lumbar spine degenerative joint disease (DJD) and its relationship to THA instability. There were two study objectives: (1) report the incidence of lumbar spine DJD and previous lumbar spine fusion and (2) evaluate the relationship of these two conditions and other potential risk factors to postoperative dislocation after THA. We retrospectively reviewed 818 consecutive THAs performed by a single surgeon utilizing a posterior approach. Comprehensive medical chart and radiographic review was performed to identify patients with lumbar spine DJD and lumbar spine fusion. Radiographic measurements, patient factors, surgical factors, and incidences of dislocation also were recorded. Eight hundred and twelve THAs were analyzed. There were 10 dislocations (1.2%, 10/812). Lumbar spine DJD and previous lumbar spine fusion occurred in 33.4% (271/812) and 5.9% (48/812) of patients, respectively. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation using a Firth penalized maximum likelihood estimation specifically for rare events (area under receiver-operator characteristic curve = 0.91, 95% confidence interval 0.86, 0.96). Interestingly, only 2 of 10 dislocations had a previous lumbar spine fusion. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation, while lumbar spine fusion was largely unrelated. This study used data available to most practicing surgeons and provides useful information for counseling patients preoperatively.

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