Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction

Kadir Kotil M.D., Tamer Tunckale M.D., Zeynep Tatar M.D., Macit Koldas M.D., Alev Kural M.D., and Turgay Bilge M.D.
View More View Less
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online Sign in

Object

The aim of this study was to determine the extent of muscle injury caused by continuous or intermittent muscle retraction during macro- and microdiscectomy in lumbar disc surgery. Pain scores, serum creatine phosphokinase (CPK) levels, and histological findings obtained in muscle specimens were compared.

Methods

Sixty patients who underwent surgery for a one-level disc herniation during a 1-year period (January 2004–January 2005) and who had similar demographic characteristics were randomly assigned to one of four groups, each consisting of 15 patients: Group A, microdiscectomy in which the retractor was never released; Group B, microdiscectomy in which the retractor was released every 15 minutes; Group C, macrodiscectomy in which the retractor was never released; and Group D, macrodiscectomy in which the retractor was released every 15 minutes.

Muscle biopsy samples were acquired in each group, and biochemical studies were conducted to determine serum CPK levels. The duration of muscle retraction was 15 minutes followed by 3 minutes of relaxation in Groups B and D. In all groups, muscle degeneration and elevation in serum CPK levels were observed immediately after surgery. The overall results, however, were different. The decline of serum CPK levels started 1 week after surgery. The smallest degree of muscle injury (reflected by the lowest serum CPK level) was observed in Group B. When the pre- and postoperative CPK values were compared in all groups, the patients in Groups B and D reported the least amount of back pain (p < 0.001). No significant differences in serum CPK levels were observed between Groups A and C or between Groups B and D. The extent of back pain was evaluated using a visual analog scale, and the consumption of analgesics was also assessed. The groups exhibited significantly different responses: the lowest analgesic consumption and the lowest pain scores were demonstrated in Groups B and D.

Conclusions

In this prospective randomized clinical trial, the authors determined that muscle injury during lumbar disc surgery was closely related to muscle retraction and relaxation times whereas the size of the paravertebral skin incision had no effect on postoperative back pain and disability. There was no significant difference among the groups in terms of back pain during the long-term follow-up period (18–19 months).

Abbreviations used in this paper:

CPK = creatine phosphokinase; VAS = visual analog scale.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Arts MP, , Peul WC, , Brand R, , Koes BW, & Thomeer RT: Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial. BMC Musculoskelet Disord 7:41, 2006

    • Search Google Scholar
    • Export Citation
  • 2

    Caspar W: A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 4:7480, 1977

    • Search Google Scholar
    • Export Citation
  • 3

    Chiu D, , Wang HH, & Blumenthal MR: Creatine phosphokinase release as a measure of tourniquet effect on skeletal muscle. Arch Surg 111:7174, 1976

    • Search Google Scholar
    • Export Citation
  • 4

    Datta G, , Gnanalingham KK, , Peterson D, , Mendoza N, , O’Neill K, & Van Dellen J, et al.: Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction?. Neurosurgery 54:14131420, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Gejo R, , Kawaguchi Y, , Kondoh T, , Tabuchi E, , Matsui H, & Torii K, et al.: Magnetic resonance imaging and histologic evidence of postoperative back muscle injury in rats. Spine 25:941946, 2000

    • Search Google Scholar
    • Export Citation
  • 6

    Gejo R, , Matsui H, , Kawaguchi Y, , Ishihara H, & Tsuji H: Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24:10231028, 1999

    • Search Google Scholar
    • Export Citation
  • 7

    Henriksen L, , Schmidt K, , Eskesen V, & Jantzen E: A controlled study of microsurgical versus standard lumbar discectomy. Br J Neurosurg 10:289293, 1996

    • Search Google Scholar
    • Export Citation
  • 8

    Heppenstall RB, , Balderston R, & Goodwin C: Pathophysiologic effects distal to a tourniquet in the dog. J Trauma 19:234238, 1979

  • 9

    Hikida RS, , Staron RS, , Hagerman FC, , Leonardi M, , Gilders R, & Falkel J, et al.: Serum creatine kinase and its changes after a muscle biopsy. Clin Physiol 11:5159, 1991

    • Search Google Scholar
    • Export Citation
  • 10

    Huang TJ, , Hsu RW, , Li YY, & Cheng CC: Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. A review of 130 patients. J Orthop Res 23:406411, 2005

    • Search Google Scholar
    • Export Citation
  • 11

    Jackson RK: The long-term effects of wide laminectomy of lumbar disc excision. J Bone Joint Surg Br 53:609616, 1971

  • 12

    Johnson EW, , Burkhart JA, & Earl WC: Electromyography in postlaminectomy patients. Arch Phys Med Rehabil 53:407409, 1972

  • 13

    Kawaguchi Y, , Matsui H, , Gejo R, & Tsuji H: Preventive measures of back muscle injury after posterior lumbar spine surgery in rats. Spine 23:22822288, 1998

    • Search Google Scholar
    • Export Citation
  • 14

    Kawaguchi Y, , Matsui H, & Tsuji H: Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine 21:941944, 1996

    • Search Google Scholar
    • Export Citation
  • 15

    Kawaguchi Y, , Matsui H, & Tsuji H: Back muscle injury after posterior lumbar spine surgery. Part 1: histologic and histochemical analyses in rats. Spine 9:25902597, 1994

    • Search Google Scholar
    • Export Citation
  • 16

    Kawaguchi Y, , Matsui H, & Tsuji H: Back muscle injury after posterior lumbar spine surgery. Part 2: histologic and histochemical analyses in humans. Spine 19:25982602, 1994

    • Search Google Scholar
    • Export Citation
  • 17

    Kawaguchi Y, , Matsui H, & Tsuji H: Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine 22:10181023, 1997

    • Search Google Scholar
    • Export Citation
  • 18

    Kawaguchi Y, , Yabuki S, , Styf J, , Olmarker K, , Rydevik B, & Matsui H, et al.: Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine 21:26832688, 1996

    • Search Google Scholar
    • Export Citation
  • 19

    Lagarrigue J, & Chaynes P: [Comparative study of disc surgery with or without microscopy. A prospective study of 80 cases.]. Neurochirurgie 40:116120, 1994. (Fr)

    • Search Google Scholar
    • Export Citation
  • 20

    Mayer TG, , Vanharanta H, , Gatchel RJ, , Mooney V, , Barnes D, & Judge L, et al.: Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine 14:3336, 1989

    • Search Google Scholar
    • Export Citation
  • 21

    Muramatsu K, , Hachiya Y, & Morita C: Postoperative magnetic resonance imaging of lumbar disc herniation: comparison of microendoscopic discectomy and Love’s method. Spine 26:15991605, 2001

    • Search Google Scholar
    • Export Citation
  • 22

    Sapega AA, , Heppenstall RB, , Change B, , Park YS, & Sokolow D: Optimizing tourniquet application and release times in extremity surgery. J Bone Joint Surg Am 67:303314, 1985

    • Search Google Scholar
    • Export Citation
  • 23

    Schick U, , Dohnert J, , Richter A, , Konig A, & Vitzthum HE: Micro-endoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine J 11:2026, 2002

    • Search Google Scholar
    • Export Citation
  • 24

    Sihvonen T, , Herno A, , Paljarvi L, , Airaksinen O, , Partanen J, & Tapaninaho A: Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575581, 1993

    • Search Google Scholar
    • Export Citation
  • 25

    Suwa H, , Hanakita J, , Ohshita N, , Gotoh K, , Matsuoka N, & Morizane A: Postoperative changes in paraspinal muscle thickness after various lumbar back surgery procedures. Neurol Med Chir (Tokyo) 40:151155, 2000

    • Search Google Scholar
    • Export Citation
  • 26

    Taylor RS: Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome: results of a systematic review and meta-analysis. J Pain Symptom Manage 31:4 Suppl S13S19, 2006

    • Search Google Scholar
    • Export Citation
  • 27

    Tullberg T, , Isacson J, & Weidenhielm L: Does microscopic removal of lumbar disc herniation lead to better results than the standard procedure? Results of a one-year randomized study. Spine 18:2427, 1993

    • Search Google Scholar
    • Export Citation
  • 28

    Weber BR, , Grob D, , Dvorak J, & Muntener M: Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine 22:17651772, 1997

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 764 112 10
Full Text Views 157 9 2
PDF Downloads 133 13 7
EPUB Downloads 0 0 0