Paraspinal muscle atrophy after posterior lumbar surgery with and without pedicle screw fixation with the classic technique

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Dirigiéndonos hacia abordajes posteriores" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1787 "Ancho" => 2083 "Tamanyo" => 251230 ] ] "descripcion" => array:1 [ "en" => "Morphometric parameters analysed according to the Spine Trauma Study Group's recommendations. (A) Cobb angle measurement in red (*). (B) Determination of the sagittal diameter, defined as the distance between the posterior and anterior borders of the canal. (C) Determination of the transverse diameter, defined as the distance between the medial borders of the pedicles at the mid-pedicle level." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Delgado-Fernández, Ricardo Gil Simoes, María Ángeles García Pallero, Juan Ramón Penanes Cuesta, Guillermo Blasco, Paloma Pulido, Rafael G. Sola" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Juan" "apellidos" => "Delgado-Fernández" ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Gil Simoes" ] 2 => array:2 [ "nombre" => "María Ángeles" "apellidos" => "García Pallero" ] 3 => array:2 [ "nombre" => "Juan Ramón" "apellidos" => "Penanes Cuesta" ] 4 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Blasco" ] 5 => array:2 [ "nombre" => "Paloma" "apellidos" => "Pulido" ] 6 => array:2 [ "nombre" => "Rafael G." 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Paraspinal atrophy appears rapidly in pathologies where the posterior branch of the spinal nerve is injured through the loss of the facet and discogenic reflexes,<a class="elsevierStyleCrossRefs" href="#bib0180">2,3</a> such as in the case of degenerative disc disease with associated atrophy, and especially of the multifidus and the ipsilateral psoas muscles.<a class="elsevierStyleCrossRef" href="#bib0190">4</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>It is known that with ageing overall muscle volume diminishes and this also includes the paraspinal muscle,<a class="elsevierStyleCrossRef" href="#bib0195">5</a> which in turn is associated with an increase in the prevalence of degenerative lumbar conditions and thereby greater atrophy. A vicious circle ensues of constant harm to the body and the biomechanics of the lumbar spine.<a class="elsevierStyleCrossRefs" href="#bib0200">6,7</a> However, no relationship has been found between paraspinal atrophy and body mass index or degree of lumbar deformity.<a class="elsevierStyleCrossRef" href="#bib0210">8</a>Muscle atrophy which occurs after lumbar surgery has been assessed in many studies and has been associated with the coagulation of the posterior branch of the spinal nerve, disinsertion of muscle fibres, coagulation of blood vessels and the effect of pressure on the retractor muscles, which occur to greater degree the more invasive the surgical intervention.<a class="elsevierStyleCrossRefs" href="#bib0215">9,10</a>Different experimental studies have demonstrated the reliability of magnetic resonance (MR), and in particular the use of sequences T1 and T2 in estimating the percentage of paraspinal muscle and the extent of degeneration of fatty tissue in comparison with histological studies.<a class="elsevierStyleCrossRef" href="#bib0225">11</a>This paper uses MR and quantitative methodology to study the degree of paraspinal muscle atrophy which occurs after performing hemilaminectomy for radicular nerve decompression and after a laminectomy with pedicle screw fixation for decompression of the lumbar canal, both procedures following the classic technique.Material and methodsStudy sampleAdult patients who had undergone lumbar spine surgery with a posterior approach were included and were divided into two groups depending on the degree of exposure of the paravertebral musculature, with a limited approach in half of the cases and an approach with greater exposure in the other half. The demographic characteristics and magnetic resonance imaging (MRI) results enhanced in T2 were retrospectively assessed, prior and subsequent to the programmed lumbar spine interventions.The first group of 21 patients (non-fixation group) underwent a hemilaminectomy, foraminotomy, partial facetectomy with or without diskectomy, and finally without instrumentation. Inclusion criteria in this group were patients with lumbar disc hernia and/or radiologic foraminal stenosis associated with clinical signs of radiculopathy which was refractory to conservative treatment for at least 8 weeks. All patients were required to have a pre and postoperative MRI.In the second group of 20 patients (fixation group) complete laminectomy with complete bilateral facetectomy was performed, separating the paravertebral muscular masses past part of the transverse apophysis for bone graft insertion and in all cases pedicle screws were inserted due to the instability resulting from extensive decompression during surgery. Inclusion criteria in this group were patients with radiologic stenosis of the degenerative or congenital lumbar canal associated with moderate to severe neurogenic claudication with or without symptoms of radicular compression. All patients were required to have a pre and postoperative MRI.These operations were performed in the Neurosurgery Department of the University Hospital La Paz in Madrid – Spain between 2013 and 2015. Patients who presented with recurrent symptoms of severe nerve compression and complications which may have compromised the oedema of the musculature and therefore altered the postoperative signal on the MR imaging were excluded.Magnetic resonanceThe resonance used for this study was of 1.5 T and the sequences used for analysis were T1 or T2 enhanced. Axial slices at the level of the intervertebral space of the affected levels in both groups were recorded. These measures were analysed with the Image J 1.46 (National Institutes of Health, Bethesda, MD, EE. UU., <a id="intr0010" class="elsevierStyleInterRef" href="http://rsbweb.nih.gov/ij/download.html">http://rsbweb.nih.gov/ij/download.html</a>)<a class="elsevierStyleCrossRef" href="#bib0230">12</a> programme by the grey scale intensity calculated as the percentage of muscle area and fatty tissue infiltrate. The pixels compatible with musculature were marked in red, and the pixels compatible with fatty tissue infiltrate or fibrosis were not marked (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>In the non-fixation group the percentage of the ipsilateral paraspinal muscle area was calculated at the affected region level and in the fixation groups the bilateral muscle area and mean of all fixed levels was calculated. Regional limits were drawn by hand, with posterior limit reference being the thoracolumbar fascia and at the posterior side of the quadratus lumborum muscle, the facets, the vertebral laminas and the lateral vertebra as anterior limit.Two observers assessed the axial images with the software and reliability was measured with the interclass interobserver correlation coefficient. Final analysis of data was made with the mean of the two evaluations made by the two assessors.Statistical analysisBivariate analysis was performed using the statistical tests for nonparametric tests. The intraclass correlation coefficient and the Bland–Altman graph for measuring concordance between observers were used. Dispersion graphs were made and the Spearman correlation coefficent was calculated for quantitative variables. Multivariate analysis of multiple lineal regression was performed to predict postoperative atrophy. p values of .05 were considered statistically significant and statistical programmes used were Stata version 12.0 and SPSS version 23.ResultsThe mean age of the sample was 61.39±12.4 years, in the fixation group it was 62.3±13.5 and in the non-fixation group it was 60.5±11.6 (p=.48) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The sample had a predominance of females (63.4%), in the fixation group this was 80% compared with the non-fixation group where it was 47.6% (p=.05). The median of times in which control MR was performed for the non fixation group was 1.48±.36 years, and for the fixation group it was 2.37 years±.88 (Logrank p=.079). In the fixation group fixation at level 65% was the most common followed by two 20% levels and 3 15% levels (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The intraclass correlation coefficient between the measurements of both investigators was .84 (p<.01) considered as a good correlation. The existence of measurement bias was also evaluated by the Bland–Altman graph, observing that there was no proportional bias in the differences of measurements of the two assessors (p=.056).Mean percentage of preoperative musculature in the fixation group was 59.1±1.67% and in the non-fixation group it was 61.05±2.15% (p=.62). Greater musculature was observed in the males at 62.8±2.69 than in the females at 58.5±1.44%, with no significant differences (p=.10) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The mean of postoperative musculature in the non-fixation group was 56.4±2.19%, higher than in the fixation group at 50.75±1.48% with these differences being statistically significant (p=.027). The difference of pre and postoperative musculature (postoperative atrophy) in both groups was 6.48±1.02%. This atrophy was greater for the fixation group at 8.35±1.46% than for the non-fixation group at 4.7±1.34%. The atrophy difference between both groups was not significant (p=.077) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Correlation analysisAge and preoperative musculature. Correlation between age and preoperative musculature had a negative lineal correlation, which older patients being those who presented with less musculature (rho=−.44 p=.039) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). This correlation in the fixation group was higher and more significant (rho=−.64 p=.002) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>), and was not significant in the non-fixation group.<elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia>Age and postoperative muscle atrophy. Correlation analysis between age and postoperative atrophy in both groups showed there was a low and negative correlation coefficient (rho=−.21 p=.18) which was not significant in either of the two groups (fixation group p=.26 and non-fixation group p=.34). During analysis of subgroups a significant correlation was observed of “age>50 years” with a greater loss of muscle mass (rho=−.37 p=.029). This was not significant in other cut off points.Preoperative musculature and postoperative muscle atrophy. A positive and significant correlation was also observed between the preoperative musculature and postoperative atrophy, i.e. a higher loss if the initial musculature was greater (rho=.32 p=.041) (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). The correlation in the subgroup of patients above 50 was higher in the non-fixation group (rho=.36 p=.034) and the fixation group (rho=.57 p=.008).<elsevierMultimedia ident="fig0030"></elsevierMultimedia>Multivariate analysisA multiple lineal regression model was performed to predict the “postoperative atrophy” and correct the confusion and interaction between the variables, noting that the residuals for each covariate were of normal distribution.The following variables were included: (1) age over 50 years (p=.029), (2) preoperative musculature (p=.041), (3) type of surgery which in vicariate analysis was not significant but we considered it appropriate to consider (p=.077). With the inclusion of age and gender variables, the multivariate model was performed. The preoperative musculature variable was subsequently classed into 3 subvariables to improve final prediction (R2=.313), i.e. the model predicted 31% of postoperative atrophy in the patients who were assessed.Adjusted by age, gender and type of surgery, a musculature of over 70% is associated with muscular atrophy of 13.8% compared with those who present a muscle mass<50%. When adjusted by preoperative musculature and age, surgery with fixation is associated with loss of musculature of 5.3% compared with surgery without fixation. Adjusted by previous musculature, the type of surgery and gender, age variable is not associated with greater postoperative atrophy (p=.395) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionIn general the number of lumbar spine operations are currently increasing due to degenerative pathology related to the greater longevity of the population, and this has become a common cause of disability in older patients, even in people of middle age.<a class="elsevierStyleCrossRef" href="#bib0235">13</a> The European sarcopenia work group has estimated a 5–10% rate of sarcopenia in people over 65 years of age.<a class="elsevierStyleCrossRefs" href="#bib0195">5,14</a> In this study we corroborated this negative correlation between age and paraspinal muscle atrophy which was even greater in more advanced ages.The ways in which musculature and fatty tissue infiltrate are measured have been evaluated using different methods such as ultrasound, computerised tomography and MR<a class="elsevierStyleCrossRefs" href="#bib0245">15–17</a>; MR is currently the most reliable technique compared with the histology gold standard and has therefore been the most used test during recent years in many studies on lumbar paraspinal muscle,<a class="elsevierStyleCrossRefs" href="#bib0225">11,17,18</a> with acceptable intraclass correlation coefficients having been demonstrated.<a class="elsevierStyleCrossRefs" href="#bib0225">11,19</a> In our study we observed that it is quite an objective test for analysing musculature and reproducing estimations.In this study, there were slightly fewer females in the non fixation group (47.6%), in keeping with the female/male ratio of the degenerative disc pathology which, according to epidemiological studies is around 1/1.5.<a class="elsevierStyleCrossRefs" href="#bib0270">20,21</a> However, in the laminectomy group with fixation due to stenosis of the lumbar canal we observed a predominance of females (80%), which we find striking due to the fact that other studies report a predominance of females around 60%. This high predominance could be due to the fact that the females had more control MR studies associated with less favourable outcomes also observed in other studies,<a class="elsevierStyleCrossRefs" href="#bib0270">20,22</a> and therefore were more prone to being included in our retrospective study.The difference of the paraspinal musculature between the sexes has been assessed in several studies with the observation of a greater fatty tissue infiltrate and lower musculature in females.<a class="elsevierStyleCrossRef" href="#bib0210">8</a> In the male group of our study a higher percentage of preoperative and postoperative muscle was observed, in addition to lower postoperative atrophy compared with the females, although differences were not significant.Although age is clearly related to muscle atrophy in the population,<a class="elsevierStyleCrossRefs" href="#bib0195">5,8</a> it is unclear whether a greater age also influences the postoperative muscle atrophy. We did not find any studies which assessed this relationship in postoperative studies and in our study no significant correlation was observed. As a result we believe that atrophy is more related to other variables such as the severity of the nerve compression, the type of surgical approach and the pattern of symptoms, as has been reported in other studies.<a class="elsevierStyleCrossRefs" href="#bib0285">23–26</a>We also observed that surgery with fixation was associated with higher muscular atrophy than non-fixation surgery which has been corroborated in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0215">9,10</a> During the last decade this has led to an increase in alternative approaches and minimally invasive approaches due to association with a minor muscle tissue lesion according to different authors.<a class="elsevierStyleCrossRefs" href="#bib0305">27–29</a> However, this is not the only parameter to be taken into account since other potential advantages such as lower blood loss, less time spent in hospital, less postoperative pain and other possible disadvantages such as the learning curve by the surgeon and the clinical efficacy of the intervention which could be lower than classic techniques also exist. These facts have not yet been corroborated by high quality studies with patients with disc pathologies and lumbar canal stenosis.<a class="elsevierStyleCrossRefs" href="#bib0320">30,31</a>Although it was not reported in previous studies, in our series we observed a direct and proportional relationship to the fact that patients with higher preoperative musculature are those who finally develop greater atrophy after surgery, especially in the group who present with a preoperative musculature of over 70%. Several studies have observed that minimally invasive approaches which do not include fixation, are associated with lower muscular atrophy,<a class="elsevierStyleCrossRefs" href="#bib0315">29,32–34</a> but it is unclear whether this lower atrophy is associated with better long-term functional outcomes.This study has limitations due to its retrospective nature and that we only report a radiologic follow-up, without correlating the long-term clinical data of follow-up.ConclusionsIn patients with a degenerative lumbar pathology the paraspinal muscle measured by MR decreases with age. Atrophy after lumbar surgery is greater if a more extensive approach is used, such as that of complete laminectomy with bilateral facetectomy and pedicle screw fixation. Greater previous musculature, regardless of age, gender and type of surgery, may also lead to higher postoperative atrophy.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1155845" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1083187" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1155844" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1083186" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Magnetic resonance" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Correlation analysis" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Multivariate analysis" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-14" "fechaAceptado" => "2018-11-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1083187" "palabras" => array:6 [ 0 => "Paraspinal muscle atrophy" 1 => "Posterior lumbar fusion" 2 => "Pedicle screw fixation" 3 => "Lumbar laminectomy" 4 => "Lumbar stenosis" 5 => "Lumbar disc herniation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1083186" "palabras" => array:6 [ 0 => "Atrofia muscular paraespinal" 1 => "Fusión lumbar posterior" 2 => "Fijación transpedicular" 3 => "Laminectomía lumbar" 4 => "Estenosis lumbar" 5 => "Hernia discal lumbar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesLumbar spine surgery causes a muscular injury during its approach that could worsen long-term postoperative functional results. This study aims to analyse the postoperative paraspinal atrophy associated with two types of intervention. Material and methodsClinical records and lumbar magnetic resonance imaging were collected from a group of 41 patients, 20 underwent laminectomy with lumbar fixation due to lumbar spinal stenosis (fixation group) and another group of 21 underwent hemilaminectomy without fixation due to lumbar disc disease (non-fixation group). In which muscle atrophy was analysed quantitatively. ResultsWe found a negative correlation between age and preoperative muscle, which was higher in those who underwent lumbar fixation (rho=−0.64 p=.002). We also found a positive correlation between preoperative muscle and postoperative atrophy (rho=0.32 p=.041). In the age, sex and fixation adjusted multivariate linear regression model (R2=0.31), laminectomy with fixation is attributed to 5.3% atrophy (IC95 1.4–9.5%, p=.017); preoperative musculature>70% is attributed to atrophy of 13.8% (95% CI 5.5–22%, p=.002). Age did not correlate with postoperative atrophy. ConclusionsParaspinal muscle atrophy after lumbar spinal surgery is greater if an extensive approach is performed such as complete laminectomy with bilateral facetectomy and transpedicular fixation. A greater previous musculature regardless of age, sex and type of surgery also predicts greater postoperative atrophy." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosLa cirugía de columna lumbar produce una lesión muscular durante su abordaje que podría empeorar los resultados funcionales postoperatorios a largo plazo. Este estudio pretende analizar la atrofia paraespinal postoperatoria asociada a dos tipos de intervenciones. Material y métodosSe recogieron historias clínicas y resonancias magnéticas lumbares pre- y postoperatorias de un grupo de 41 pacientes, 20 se sometieron a laminectomía con fijación lumbar por estenosis de canal (Grupo fijación) y otro grupo de 21 se sometieron a una hemilaminectomía sin fijación por enfermedad discal (Grupo no fijación). En los que se analizó la atrofia muscular de manera cuantitativa. ResultadosSe halló una correlación negativa entre la edad y la musculatura preoperatoria, siendo mayor en el grupo laminectomía con fijación (rho = −0,64 p = 0,002). Observamos también una correlación positiva entre la musculatura preoperatoria y la atrofia postoperatoria (rho = 0,32 p = 0,041). En el modelo de regresión lineal multivariado ajustado por la edad, sexo y tipo de intervención, observamos que la predicción de la atrofia postoperatoria fue del 31% (R2 = 0,31); a la laminectomía con fijación se le atribuye una atrofia del 5,3% (IC95 1,4-9,5%, p = 0,017); a la musculatura preoperatoria > 70% se le atribuye una atrofia del 13,8% (IC95 5,5-22%, p = 0,002). La edad no se correlacionó con la atrofia postoperatoria. ConclusionesLa atrofia muscular paraespinal que se produce después de la cirugía lumbar es mayor si se realiza un abordaje más amplio como la laminectomía completa con facetectomía bilateral y fijación transpedicular. Una mayor musculatura previa independientemente de la edad, el sexo y el tipo de cirugía también predice una mayor atrofia postoperatoria." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Palpan Flores A, García Feijoo P, Isla Guerrero A. Atrofia de la musculatura paraespinal después de cirugía lumbar posterior con y sin fijación transpedicular por la técnica clásica. Neurocirugia. 2019;30:69–76." ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 774 "Ancho" => 1563 "Tamanyo" => 127618 ] ] "descripcion" => array:1 [ "en" => "MR axial slice (T2) of the lumbar paraspinal muscle." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3780 "Ancho" => 2167 "Tamanyo" => 823289 ] ] "descripcion" => array:1 [ "en" => "(A) Pre and postoperative MR in a case of laminectomy and pedicle screw fixation at L5-S1 level. (B) RM Pre and postoperative MR in a case where hemilaminectomy and diskectomy of left L4–L5 was performed." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1572 "Ancho" => 2167 "Tamanyo" => 146479 ] ] "descripcion" => array:1 [ "en" => "Age distribution in both groups." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1149 "Ancho" => 1584 "Tamanyo" => 95667 ] ] "descripcion" => array:1 [ "en" => "Dispersion graph between age and preoperative musculature (rho=−.44 p=.039)." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1154 "Ancho" => 1587 "Tamanyo" => 90981 ] ] "descripcion" => array:1 [ "en" => "Dispersion graph between preoperative musculature and age in the fixation group (rho=−.64 p=.002)." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1095 "Ancho" => 1504 "Tamanyo" => 99416 ] ] "descripcion" => array:1 [ "en" => "Dispersion graph between preoperative musculature and postoperative atrophy (rho=.32 p=.041)." ] ] 6 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "The central tendency measurements of the variables are expressed as means and the time is expressed as median." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Fixation group N=20 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Non-fixation group N=21 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.3±3.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.52±2.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.480 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Women (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.052 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time to control MR (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.48±.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.37±.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.079 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative musculature (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.1±1.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.04±2.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.620 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative musculature (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.75±1.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.4±2.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.027 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative atrophy (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.35±1.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.71±1.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.077 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1973123.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Variables analysed according to type of surgery." ] ] 7 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Women (N=26) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Men (N=15) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.8±12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.9±11.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.222 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative musculature (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.104 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative musculature (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.056 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative atrophy (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.530 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1973121.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Musculature according to gender." ] ] 8 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">R: .56 R2: .3131 Adjusted R2: .1919 p value: .036 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Beta \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95%CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative musculature<50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative musculature 50–59% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.39–13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.045 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative musculature 60–69% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.34–13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.040 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative musculature>70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5–22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type of surgery: fixation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4–9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age>50 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.01–7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.395 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−5.09–3.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.725 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1973122.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Predictors of postoperative atrophy: multivariate analysis." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib0175" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.L. 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Paraspinal muscle atrophy after posterior lumbar surgery with and without pedicle screw fixation with the classic technique

Atrofia de la musculatura paraespinal después de cirugía lumbar posterior con y sin fijación transpedicular por la técnica clásica

Alexis Palpan Flores

Corresponding author

alexispalpanflores@gmail.com

Corresponding author.

, Pablo García Feijoo, Alberto Isla Guerrero

Departamento de Neurocirugía, Hospital Universitario La Paz, Madrid, Spain

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        "titulo" => "Atrofia de la musculatura paraespinal despu&#233;s de cirug&#237;a lumbar posterior con y sin fijaci&#243;n transpedicular por la t&#233;cnica cl&#225;sica"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Age distribution in both groups&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The paraspinal muscle is formed by the erector spinae and multifius muscles&#44; with the latter actively participating in the biomechanics of the spine for both rotatory and static stability<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Paraspinal atrophy appears rapidly in pathologies where the posterior branch of the spinal nerve is injured through the loss of the facet and discogenic reflexes&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">2&#44;3</span></a> such as in the case of degenerative disc disease with associated atrophy&#44; and especially of the multifidus and the ipsilateral psoas muscles&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">It is known that with ageing overall muscle volume diminishes and this also includes the paraspinal muscle&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> which in turn is associated with an increase in the prevalence of degenerative lumbar conditions and thereby greater atrophy&#46; A vicious circle ensues of constant harm to the body and the biomechanics of the lumbar spine&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#44;7</span></a> However&#44; no relationship has been found between paraspinal atrophy and body mass index or degree of lumbar deformity&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Muscle atrophy which occurs after lumbar surgery has been assessed in many studies and has been associated with the coagulation of the posterior branch of the spinal nerve&#44; disinsertion of muscle fibres&#44; coagulation of blood vessels and the effect of pressure on the retractor muscles&#44; which occur to greater degree the more invasive the surgical intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Different experimental studies have demonstrated the reliability of magnetic resonance &#40;MR&#41;&#44; and in particular the use of sequences T1 and T2 in estimating the percentage of paraspinal muscle and the extent of degeneration of fatty tissue in comparison with histological studies&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This paper uses MR and quantitative methodology to study the degree of paraspinal muscle atrophy which occurs after performing hemilaminectomy for radicular nerve decompression and after a laminectomy with pedicle screw fixation for decompression of the lumbar canal&#44; both procedures following the classic technique&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study sample</span><p id="par0030" class="elsevierStylePara elsevierViewall">Adult patients who had undergone lumbar spine surgery with a posterior approach were included and were divided into two groups depending on the degree of exposure of the paravertebral musculature&#44; with a limited approach in half of the cases and an approach with greater exposure in the other half&#46; The demographic characteristics and magnetic resonance imaging &#40;MRI&#41; results enhanced in T2 were retrospectively assessed&#44; prior and subsequent to the programmed lumbar spine interventions&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The first group of 21 patients &#40;non-fixation group&#41; underwent a hemilaminectomy&#44; foraminotomy&#44; partial facetectomy with or without diskectomy&#44; and finally without instrumentation&#46; Inclusion criteria in this group were patients with lumbar disc hernia and&#47;or radiologic foraminal stenosis associated with clinical signs of radiculopathy which was refractory to conservative treatment for at least 8 weeks&#46; All patients were required to have a pre and postoperative MRI&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the second group of 20 patients &#40;fixation group&#41; complete laminectomy with complete bilateral facetectomy was performed&#44; separating the paravertebral muscular masses past part of the transverse apophysis for bone graft insertion and in all cases pedicle screws were inserted due to the instability resulting from extensive decompression during surgery&#46; Inclusion criteria in this group were patients with radiologic stenosis of the degenerative or congenital lumbar canal associated with moderate to severe neurogenic claudication with or without symptoms of radicular compression&#46; All patients were required to have a pre and postoperative MRI&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">These operations were performed in the Neurosurgery Department of the University Hospital La Paz in Madrid &#8211; Spain between 2013 and 2015&#46; Patients who presented with recurrent symptoms of severe nerve compression and complications which may have compromised the oedema of the musculature and therefore altered the postoperative signal on the MR imaging were excluded&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Magnetic resonance</span><p id="par0050" class="elsevierStylePara elsevierViewall">The resonance used for this study was of 1&#46;5 T and the sequences used for analysis were T1 or T2 enhanced&#46; Axial slices at the level of the intervertebral space of the affected levels in both groups were recorded&#46; These measures were analysed with the Image J 1&#46;46 &#40;National Institutes of Health&#44; Bethesda&#44; MD&#44; EE&#46; UU&#46;&#44; <a id="intr0010" class="elsevierStyleInterRef" href="http://rsbweb.nih.gov/ij/download.html">http&#58;&#47;&#47;rsbweb&#46;nih&#46;gov&#47;ij&#47;download&#46;html</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a> programme by the grey scale intensity calculated as the percentage of muscle area and fatty tissue infiltrate&#46; The pixels compatible with musculature were marked in red&#44; and the pixels compatible with fatty tissue infiltrate or fibrosis were not marked &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In the non-fixation group the percentage of the ipsilateral paraspinal muscle area was calculated at the affected region level and in the fixation groups the bilateral muscle area and mean of all fixed levels was calculated&#46; Regional limits were drawn by hand&#44; with posterior limit reference being the thoracolumbar fascia and at the posterior side of the quadratus lumborum muscle&#44; the facets&#44; the vertebral laminas and the lateral vertebra as anterior limit&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Two observers assessed the axial images with the software and reliability was measured with the interclass interobserver correlation coefficient&#46; Final analysis of data was made with the mean of the two evaluations made by the two assessors&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Bivariate analysis was performed using the statistical tests for nonparametric tests&#46; The intraclass correlation coefficient and the Bland&#8211;Altman graph for measuring concordance between observers were used&#46; Dispersion graphs were made and the Spearman correlation coefficent was calculated for quantitative variables&#46; Multivariate analysis of multiple lineal regression was performed to predict postoperative atrophy&#46; <span class="elsevierStyleItalic">p</span> values of &#46;05 were considered statistically significant and statistical programmes used were Stata version 12&#46;0 and SPSS version 23&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">The mean age of the sample was 61&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;4 years&#44; in the fixation group it was 62&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;5 and in the non-fixation group it was 60&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;6 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;48&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The sample had a predominance of females &#40;63&#46;4&#37;&#41;&#44; in the fixation group this was 80&#37; compared with the non-fixation group where it was 47&#46;6&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The median of times in which control MR was performed for the non fixation group was 1&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#46;36 years&#44; and for the fixation group it was 2&#46;37 years<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#46;88 &#40;Logrank <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;079&#41;&#46; In the fixation group fixation at level 65&#37; was the most common followed by two 20&#37; levels and 3 15&#37; levels &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The intraclass correlation coefficient between the measurements of both investigators was &#46;84 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; considered as a good correlation&#46; The existence of measurement bias was also evaluated by the Bland&#8211;Altman graph&#44; observing that there was no proportional bias in the differences of measurements of the two assessors &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;056&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Mean percentage of preoperative musculature in the fixation group was 59&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;67&#37; and in the non-fixation group it was 61&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;15&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;62&#41;&#46; Greater musculature was observed in the males at 62&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;69 than in the females at 58&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;44&#37;&#44; with no significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;10&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The mean of postoperative musculature in the non-fixation group was 56&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;19&#37;&#44; higher than in the fixation group at 50&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;48&#37; with these differences being statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;027&#41;&#46; The difference of pre and postoperative musculature &#40;postoperative atrophy&#41; in both groups was 6&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;02&#37;&#46; This atrophy was greater for the fixation group at 8&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;46&#37; than for the non-fixation group at 4&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;34&#37;&#46; The atrophy difference between both groups was not significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;077&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Correlation analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Age and preoperative musculature&#46;</span> Correlation between age and preoperative musculature had a negative lineal correlation&#44; which older patients being those who presented with less musculature &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;44 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;039&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; This correlation in the fixation group was higher and more significant &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;64 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#44; and was not significant in the non-fixation group&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Age and postoperative muscle atrophy&#46;</span> Correlation analysis between age and postoperative atrophy in both groups showed there was a low and negative correlation coefficient &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;21 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;18&#41; which was not significant in either of the two groups &#40;fixation group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;26 and non-fixation group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;34&#41;&#46; During analysis of subgroups a significant correlation was observed of &#8220;age<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>50 years&#8221; with a greater loss of muscle mass &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;37 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41;&#46; This was not significant in other cut off points&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Preoperative musculature and postoperative muscle atrophy</span>&#46; A positive and significant correlation was also observed between the preoperative musculature and postoperative atrophy&#44; i&#46;e&#46; a higher loss if the initial musculature was greater &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;32 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;041&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; The correlation in the subgroup of patients above 50 was higher in the non-fixation group &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;36 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;034&#41; and the fixation group &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;57 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Multivariate analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">A multiple lineal regression model was performed to predict the &#8220;postoperative atrophy&#8221; and correct the confusion and interaction between the variables&#44; noting that the residuals for each covariate were of normal distribution&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The following variables were included&#58; &#40;1&#41; age over 50 years &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41;&#44; &#40;2&#41; preoperative musculature &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;041&#41;&#44; &#40;3&#41; type of surgery which in vicariate analysis was not significant but we considered it appropriate to consider &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;077&#41;&#46; With the inclusion of age and gender variables&#44; the multivariate model was performed&#46; The preoperative musculature variable was subsequently classed into 3 subvariables to improve final prediction &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;313&#41;&#44; i&#46;e&#46; the model predicted 31&#37; of postoperative atrophy in the patients who were assessed&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Adjusted by age&#44; gender and type of surgery&#44; a musculature of over 70&#37; is associated with muscular atrophy of 13&#46;8&#37; compared with those who present a muscle mass<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37;&#46; When adjusted by preoperative musculature and age&#44; surgery with fixation is associated with loss of musculature of 5&#46;3&#37; compared with surgery without fixation&#46; Adjusted by previous musculature&#44; the type of surgery and gender&#44; age variable is not associated with greater postoperative atrophy &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;395&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">In general the number of lumbar spine operations are currently increasing due to degenerative pathology related to the greater longevity of the population&#44; and this has become a common cause of disability in older patients&#44; even in people of middle age&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> The European sarcopenia work group has estimated a 5&#8211;10&#37; rate of sarcopenia in people over 65 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;14</span></a> In this study we corroborated this negative correlation between age and paraspinal muscle atrophy which was even greater in more advanced ages&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The ways in which musculature and fatty tissue infiltrate are measured have been evaluated using different methods such as ultrasound&#44; computerised tomography and MR<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">15&#8211;17</span></a>&#59; MR is currently the most reliable technique compared with the histology gold standard and has therefore been the most used test during recent years in many studies on lumbar paraspinal muscle&#44;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11&#44;17&#44;18</span></a> with acceptable intraclass correlation coefficients having been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11&#44;19</span></a> In our study we observed that it is quite an objective test for analysing musculature and reproducing estimations&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In this study&#44; there were slightly fewer females in the non fixation group &#40;47&#46;6&#37;&#41;&#44; in keeping with the female&#47;male ratio of the degenerative disc pathology which&#44; according to epidemiological studies is around 1&#47;1&#46;5&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20&#44;21</span></a> However&#44; in the laminectomy group with fixation due to stenosis of the lumbar canal we observed a predominance of females &#40;80&#37;&#41;&#44; which we find striking due to the fact that other studies report a predominance of females around 60&#37;&#46; This high predominance could be due to the fact that the females had more control MR studies associated with less favourable outcomes also observed in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20&#44;22</span></a> and therefore were more prone to being included in our retrospective study&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The difference of the paraspinal musculature between the sexes has been assessed in several studies with the observation of a greater fatty tissue infiltrate and lower musculature in females&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> In the male group of our study a higher percentage of preoperative and postoperative muscle was observed&#44; in addition to lower postoperative atrophy compared with the females&#44; although differences were not significant&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Although age is clearly related to muscle atrophy in the population&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;8</span></a> it is unclear whether a greater age also influences the postoperative muscle atrophy&#46; We did not find any studies which assessed this relationship in postoperative studies and in our study no significant correlation was observed&#46; As a result we believe that atrophy is more related to other variables such as the severity of the nerve compression&#44; the type of surgical approach and the pattern of symptoms&#44; as has been reported in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">23&#8211;26</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">We also observed that surgery with fixation was associated with higher muscular atrophy than non-fixation surgery which has been corroborated in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9&#44;10</span></a> During the last decade this has led to an increase in alternative approaches and minimally invasive approaches due to association with a minor muscle tissue lesion according to different authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">27&#8211;29</span></a> However&#44; this is not the only parameter to be taken into account since other potential advantages such as lower blood loss&#44; less time spent in hospital&#44; less postoperative pain and other possible disadvantages such as the learning curve by the surgeon and the clinical efficacy of the intervention which could be lower than classic techniques also exist&#46; These facts have not yet been corroborated by high quality studies with patients with disc pathologies and lumbar canal stenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">30&#44;31</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Although it was not reported in previous studies&#44; in our series we observed a direct and proportional relationship to the fact that patients with higher preoperative musculature are those who finally develop greater atrophy after surgery&#44; especially in the group who present with a preoperative musculature of over 70&#37;&#46; Several studies have observed that minimally invasive approaches which do not include fixation&#44; are associated with lower muscular atrophy&#44;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">29&#44;32&#8211;34</span></a> but it is unclear whether this lower atrophy is associated with better long-term functional outcomes&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">This study has limitations due to its retrospective nature and that we only report a radiologic follow-up&#44; without correlating the long-term clinical data of follow-up&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">In patients with a degenerative lumbar pathology the paraspinal muscle measured by MR decreases with age&#46; Atrophy after lumbar surgery is greater if a more extensive approach is used&#44; such as that of complete laminectomy with bilateral facetectomy and pedicle screw fixation&#46; Greater previous musculature&#44; regardless of age&#44; gender and type of surgery&#44; may also lead to higher postoperative atrophy&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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              "identificador" => "abst0005"
              "titulo" => "Objectives"
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              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
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            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
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        1 => array:2 [
          "identificador" => "xpalclavsec1083187"
          "titulo" => "Keywords"
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        2 => array:3 [
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          "titulo" => "Resumen"
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              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
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              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1083186"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "titulo" => "Material and methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study sample"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Magnetic resonance"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
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          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Correlation analysis"
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        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Multivariate analysis"
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          "titulo" => "Discussion"
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          "identificador" => "sec0050"
          "titulo" => "Conclusions"
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          "identificador" => "sec0055"
          "titulo" => "Conflict of interests"
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          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-02-14"
    "fechaAceptado" => "2018-11-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1083187"
          "palabras" => array:6 [
            0 => "Paraspinal muscle atrophy"
            1 => "Posterior lumbar fusion"
            2 => "Pedicle screw fixation"
            3 => "Lumbar laminectomy"
            4 => "Lumbar stenosis"
            5 => "Lumbar disc herniation"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1083186"
          "palabras" => array:6 [
            0 => "Atrofia muscular paraespinal"
            1 => "Fusi&#243;n lumbar posterior"
            2 => "Fijaci&#243;n transpedicular"
            3 => "Laminectom&#237;a lumbar"
            4 => "Estenosis lumbar"
            5 => "Hernia discal lumbar"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lumbar spine surgery causes a muscular injury during its approach that could worsen long-term postoperative functional results&#46; This study aims to analyse the postoperative paraspinal atrophy associated with two types of intervention&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical records and lumbar magnetic resonance imaging were collected from a group of 41 patients&#44; 20 underwent laminectomy with lumbar fixation due to lumbar spinal stenosis &#40;fixation group&#41; and another group of 21 underwent hemilaminectomy without fixation due to lumbar disc disease &#40;non-fixation group&#41;&#46; In which muscle atrophy was analysed quantitatively&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We found a negative correlation between age and preoperative muscle&#44; which was higher in those who underwent lumbar fixation &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;64 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; We also found a positive correlation between preoperative muscle and postoperative atrophy &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;32 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;041&#41;&#46; In the age&#44; sex and fixation adjusted multivariate linear regression model &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;31&#41;&#44; laminectomy with fixation is attributed to 5&#46;3&#37; atrophy &#40;IC95 1&#46;4&#8211;9&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#59; preoperative musculature<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>70&#37; is attributed to atrophy of 13&#46;8&#37; &#40;95&#37; <span class="elsevierStyleSmallCaps">C</span>I 5&#46;5&#8211;22&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; Age did not correlate with postoperative atrophy&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Paraspinal muscle atrophy after lumbar spinal surgery is greater if an extensive approach is performed such as complete laminectomy with bilateral facetectomy and transpedicular fixation&#46; A greater previous musculature regardless of age&#44; sex and type of surgery also predicts greater postoperative atrophy&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a de columna lumbar produce una lesi&#243;n muscular durante su abordaje que podr&#237;a empeorar los resultados funcionales postoperatorios a largo plazo&#46; Este estudio pretende analizar la atrofia paraespinal postoperatoria asociada a dos tipos de intervenciones&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se recogieron historias cl&#237;nicas y resonancias magn&#233;ticas lumbares pre- y postoperatorias de un grupo de 41 pacientes&#44; 20 se sometieron a laminectom&#237;a con fijaci&#243;n lumbar por estenosis de canal &#40;Grupo fijaci&#243;n&#41; y otro grupo de 21 se sometieron a una hemilaminectom&#237;a sin fijaci&#243;n por enfermedad discal &#40;Grupo no fijaci&#243;n&#41;&#46; En los que se analiz&#243; la atrofia muscular de manera cuantitativa&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se hall&#243; una correlaci&#243;n negativa entre la edad y la musculatura preoperatoria&#44; siendo mayor en el grupo laminectom&#237;a con fijaci&#243;n &#40;rho &#61; &#8722;0&#44;64 p &#61; 0&#44;002&#41;&#46; Observamos tambi&#233;n una correlaci&#243;n positiva entre la musculatura preoperatoria y la atrofia postoperatoria &#40;rho &#61; 0&#44;32 p &#61; 0&#44;041&#41;&#46; En el modelo de regresi&#243;n lineal multivariado ajustado por la edad&#44; sexo y tipo de intervenci&#243;n&#44; observamos que la predicci&#243;n de la atrofia postoperatoria fue del 31&#37; &#40;R<span class="elsevierStyleSup">2</span> &#61; 0&#44;31&#41;&#59; a la laminectom&#237;a con fijaci&#243;n se le atribuye una atrofia del 5&#44;3&#37; &#40;IC95 1&#44;4-9&#44;5&#37;&#44; p &#61; 0&#44;017&#41;&#59; a la musculatura preoperatoria &#62; 70&#37; se le atribuye una atrofia del 13&#44;8&#37; &#40;IC95 5&#44;5-22&#37;&#44; p &#61; 0&#44;002&#41;&#46; La edad no se correlacion&#243; con la atrofia postoperatoria&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La atrofia muscular paraespinal que se produce despu&#233;s de la cirug&#237;a lumbar es mayor si se realiza un abordaje m&#225;s amplio como la laminectom&#237;a completa con facetectom&#237;a bilateral y fijaci&#243;n transpedicular&#46; Una mayor musculatura previa independientemente de la edad&#44; el sexo y el tipo de cirug&#237;a tambi&#233;n predice una mayor atrofia postoperatoria&#46;</p></span>"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Palpan Flores A&#44; Garc&#237;a Feijoo P&#44; Isla Guerrero A&#46; Atrofia de la musculatura paraespinal despu&#233;s de cirug&#237;a lumbar posterior con y sin fijaci&#243;n transpedicular por la t&#233;cnica cl&#225;sica&#46; Neurocirugia&#46; 2019&#59;30&#58;69&#8211;76&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">MR axial slice &#40;T2&#41; of the lumbar paraspinal muscle&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Pre and postoperative MR in a case of laminectomy and pedicle screw fixation at L5-S1 level&#46; &#40;B&#41; RM Pre and postoperative MR in a case where hemilaminectomy and diskectomy of left L4&#8211;L5 was performed&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Age distribution in both groups&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Dispersion graph between preoperative musculature and age in the fixation group &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;64 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Dispersion graph between preoperative musculature and postoperative atrophy &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;32 <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;041&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The central tendency measurements of the variables are expressed as means and the time is expressed as median&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Fixation group<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Non-fixation group<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;480&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Women &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time to control MR &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;079&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative musculature &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;620&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative musculature &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative atrophy &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;34&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Predictors of postoperative atrophy&#58; multivariate analysis&#46;</p>"
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      "titulo" => "References"
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              "identificador" => "bib0175"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
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                          "etal" => false
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                            0 => "G&#46;L&#46; Moseley"
                            1 => "P&#46;W&#46; Hodges"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                      "autores" => array:1 [
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                            0 => "A&#46; Indahl"
                            1 => "A&#46;M&#46; Kaigle"
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                  "host" => array:1 [
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              "identificador" => "bib0190"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease"
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                        0 => array:2 [
                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1259/bjr/58136533"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21081573"
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                0 => array:2 [
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                      "titulo" => "Sarcopenia&#58; European consensus on definition and diagnosis&#58; Report of the European Working Group on Sarcopenia in Older People"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Cruz-Jentoft"
                            1 => "J&#46;P&#46; Baeyens"
                            2 => "J&#46;M&#46; Bauer"
                            3 => "Y&#46; Boirie"
                            4 => "T&#46; Cederholm"
                            5 => "F&#46; Landi"
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1093/ageing/afq034"
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                        "tituloSerie" => "Age Ageing"
                        "fecha" => "2010"
                        "volumen" => "39"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20392703"
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              "identificador" => "bib0200"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of spinal stabilization exercise on the cross-sectional areas of the lumbar multifidus and psoas major muscles&#44; Pain Intensity&#44; and Lumbar Muscle Strength of Patients with Degenerative Disc Disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Kim"
                            1 => "H&#46; Kim"
                            2 => "J&#46; Chung"
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                        ]
                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1589/jpts.26.579"
                      "Revista" => array:6 [
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                        "fecha" => "2014"
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                    0 => array:2 [
                      "titulo" => "Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling"
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                          "etal" => true
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                            0 => "L&#46; Hansen"
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                            2 => "J&#46; Rasmussen"
                            3 => "T&#46;B&#46; Andersen"
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                    0 => array:2 [
                      "titulo" => "New predictive index for lumbar paraspinal muscle degeneration associated with aging"
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Article information

ISSN: 25298496
Original language: English

DOI:10.1016/j.neucie.2018.11.001

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