The parapsinal muscular dysfunction was postulated to be due to injured paraspinal muscle inflicted by the surgery. Min, S. H., Kim, M. H., Seo, J. Phan K, Maharaj M, Assem Y, Mobbs RJ. reported less edema and atrophy of the multifidus muscle in patients that received MIS as compared to those that received COS at 6months postoperatively13. Therefore, OLIF has attracted considerable attention because OLIF uses the ante-psoas muscle approach, which theoretically avoids paraspinal muscle damage and decreases the risk of chronic low back pain. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). When this . Muscle damage can cause pain in the surgical site. Therefore, we believe that an increase in the fat percentage in the paravertebral muscle is another important factor in accelerating muscle atrophy after fusion. All authors read and approved the final manuscript. In conclusion, standalone OLIF can achieve better clinical outcomes compared with OLIF combined with PPSF for grade I spondylolisthesis, as shown by less back pain at 1week and 3months after operation. Chi-Chien Niu. Nevertheless, unilateral fixation has a lower incidence of degeneration than bilateral fixation in the proximal stage. The site is secure. This study was funded by Beijing Jishuitan Hospital Nova Program (#XKXX201808), Beijing Hospital Authority Youth Program (#QML20190403), Beijing Jishuitan Hospital Medical and Engineering Intersection Project (#YGQ-201924), and Beijing Ten, Hundred, Thousand Medical Talents Project: Application of computer navigation-assisted minimally invasive surgery and traditional surgery in lumbar degenerative disease. GUID:85763E8E-4F28-4EC7-8366-E9EF02D38F8D, Oblique lumbar interbody fusion, Percutaneous pedicle screw fixation, Paraspinal muscles atrophy, Functional cross-sectional area, Spondylolisthesis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Neurological examination showed a leg motor power of grade IV/III+(right/left), with knee flexion and ankle dorsi-/plantar-flexion power of grade IV/III . Spondylolisthesis is the displacement (usually anterior) of a vertebral body relative to the adjacent inferior vertebral body [1, 2]. Fortunately, your muscles provide a great deal of strength and energy during this process. 2023 Mar;47(3):819-830. doi: 10.1007/s00264-022-05658-w. Epub 2022 Dec 21. 2010 Dec 15;35(26 Suppl):S281-6. The long incisions, prolonged wide retraction, injury to the medial branch of posterior ramus of the spinal nerve, can result in ischemic necrosis and denervation of the paraspinal musculature. Acute lumbar disk pain: navigating evaluation and treatment choices. There was significantly increased fatty infiltration in the erector spinae muscle in the COS group. Introduction Comparison of open and minimally invasive techniques for posterior lumbar instrumentation and fusion after open anterior lumbar interbody fusion. VAS and JOA scores were analyzed using repeated measure ANOVA with the post hoc paired samplet-test. When comparing the preoperative and 1-year-postoperative images, multifidus muscle (MF) reduction was consistently observed in the MRI and CT groups, right and left (p = 0.003, p < 0.001, p = 0.005 and p < 0.001, respectively). Muscle Atrophy After Surgery - Mend Well Blog -, Tsutsumimoto T, Shimogata M, Ohta H, Misawa H. Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Muscle atrophy after COS occurs frequently, and can result in back pain and failed back surgery syndrome2. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. 27 Asymmetry appears to be associated with posterolateral disc herniation at the lower lumbar and upper sacral levels as well as with degenerative disc disease and radiculopathy. Surg. Regarding motion-preserving surgical treatment such as total disc replacement, a significantly lower ratio of adjacent-segment degeneration was reported compared with the fusion approach [38]. We sought to identify changes in back muscle atrophy between the two groups, with analysis of the impact of these changes on clinical outcomes. Objective: Paraspinal muscle atrophy (PMA) after posterior cervical fusion is a known complication that causes considerable morbidity. 5). Lumbar muscle atrophy and increased muscle tissue fat have negative effects on the patient's recovery. The regions of interest (ROI) of individual muscles (multifidus muscle and rector spinae muscle) were measured on axial T1-weighted images by placing polygon points around the outer margins of the muscles to avoid metallic artifacts at each disc level from L23 to L5S1, first on postoperative images and then on corresponding preoperative images (Fig. Quantitative analysis of paraspinal muscle atrophy after oblique As a library, NLM provides access to scientific literature. We believe that strong fixation results in a long-term disuse paraspinal muscle atrophy and further accelerate the degeneration of adjacent segments. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Hamrick, M. W., McGee-Lawrence, M. E. & Frechette, D. M. Fatty infiltration of skeletal muscle: Mechanisms and comparisons with bone marrow adiposity. 8600 Rockville Pike This study adheres to STROBE statement guidelines (Supplementary Appendix 1). The site is secure. found alteration of the contractile component of the cross-section area in the erector muscle mainly occurs distal to the lumbar operated segment20. Hyun, S. J. et al. a =, Histograms of the sum of right and left paraspinal muscles on MRI and, MeSH In the OLIF combined group, the mean multifidus and erector spinae FCSA decreased after surgery (multifidus: from 7.722.69 to 5.671.71cm2, P<0.001; erector spinae: from 12.602.04 to 10.151.82cm2, P<0.001). The .gov means its official. Waschke A, Hartmann C, Walter J, Dunisch P, Wahnschaff F, Kalff R, et al. The orange arrow indicates the intervertebral cage. Postoperative lumbar MRI studies were obtained a mean of 12.5months after surgery in the COS group and 14.7months after surgery in the MIS group. The two groups showed significant improvement in all clinical outcome scores at all time points after surgery compared to preoperative data. Imaging of muscle and adipose tissue in the spine: A narrative review. These better clinical outcomes were probably associated with the better FCSA, and FIP found in the standalone OLIF group compared with the OLIF combined group. The number of patients was small. 2016 Jul;16(7):867-75. doi: 10.1016/j.spinee.2016.03.010. Accessibility Spine Surg. 2022 Dec 9;101(49):e32051. Patients with degenerative lumbar spinal stenosis who underwent posterior interbody fusion (PLIF) at the L4/5 level in the period from May 2010 to June 2017 were enrolled in this study. History of osteoporosis (defined as T-score<2.5) was verified from the medical charts. Paraspinal muscle atrophy (PMA) after posterior cervical fusion is a known complication that causes considerable morbidity. Article The multifidus and erector spinae were measured in selected axial images at the lower third of the vertebral body(L3) above the operation level(L4/5) to avoid the artifact produced by the screws. Muscle atrophy can involve a single muscle or can involve all of the musculature of a single extremity. Asian Spine J. This observation is probably due to no invasion of the paraspinal muscles with standalone OLIF. The surgery is done to help stabilize your spine, reduce pain, or address spine issues, such as scoliosis. Zhong D, Ke ZY, Chen Q, Liu Y, Lin L, Wang Y. Int Orthop. CAS In COS, the paraspinal muscles need to be deflected from the spinous processes, and this can cause muscle denervation, ischemic, and progressive muscle atrophy2,7,8,9. Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach. Eur. The inclusion criteria were:1) underwent standalone OLIF or OLIF combined with PPSF at the L45 or L5-S1level for grade I spondylolisthesis [15] with symptoms of radicular pain, intermittent neurogenic claudication, and mechanical low back pain; 2) failure to >6months of conservative treatment;3) no previous history of lumbar surgical intervention at the L45or L5-S1 level; and 4) available24months of follow-up. OLIF may not result in paraspinal muscle atrophy at 24months after surgery. Minimally invasive surgery (MIS)can cause lessmuscle injury than conventional open surgery (COS). Burke CJ, Shah D, Saha S, Houghton R. Spondylolisthesis: a pictorial review. https://doi.org/10.3346/jkms.2007.22.4.646 (2007). Article Spine. https://doi.org/10.1016/j.spinee.2016.08.001 (2017). This was a single-center study with a small sample size, and only 1-year follow-up. https://doi.org/10.1097/BRS.0b013e3181a9d28e (2009). Ghiasi MS, Arjmand N, Shirazi-Adl A, Farahmand F, Hashemi H, Bagheri S, et al. Contemporary management of isthmic spondylolisthesis: pediatric and adult. The results suggest that standalone OLIF may result in less important paraspinal muscle atrophy than OLIF combined with PPSF in patients with spondylolisthesis. For MFI evaluation, the preoperative ROI corresponding to the postoperative ROI was drawn manually by visualization. Spine (Phila Pa 1976). Frontiers | Changes in paraspinal muscles and facet joints after A written informed consent was obtained from every participant. Technique to minimize paraspinal muscle atrophy after posterior Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches. Initially there were 50 patients enrolled in this study. 21, 745753. Correlation between surgical segment mobility and paravertebral muscle fatty infiltration of upper adjacent segment in single-segment LDD patients: retrospective study at a minimum 2 years' follow-up. In another group of patients with lumbar spinal stenosis, more asymmetric paraspinal muscle atrophy was noted in individuals with degenerative lumbar scoliosis than in those without. We found increased postoperative fatty infiltration in the multifidus and erector spinae muscles in both groups, but a significant MFI change between the two operative methods was only found in the erector spinae muscle. Paraspinal muscle atrophy after lumbar spine surgery. Its primary surgical goal is to preserve the posterior column structure, thereby reducing paraspinal muscle trauma. [7] reported that there were significant differences not only in back pain VAS but also in the Oswestry disability index when they used the paramedian interfascial approach compared to the midline approach. MF, multifidus; ES, erector spinae; P, psoas. All statistical comparisons were 2-tailed, and the threshold for statistical significance was set at P<0.05. Please enable it to take advantage of the complete set of features! Urrutia, J. et al. Finally, factors such as general condition, comorbidities, and neurological conditions were not considered. and C.C.N. Spinal muscular atrophy (SMA) is a genetic disease that affects the nervous system and, mostly, the muscles it controls. Please enable it to take advantage of the complete set of features! The mean SI in the ROI of the multifidus muscles (M), erector spinae muscle (E), and subcutaneous fat (F) were obtained from postoperative (a) and preoperative (b) T1WI MRI images using the picture archiving and communication system software tools. Taylor H, McGregor AH, Medhi-Zadeh S, Richards S, Kahn N, Zadeh JA, et al. Technique to minimize paraspinal muscle atrophy after posterior Background: Posterior lumbar fusion is a widely accepted surgical technique; however, it has been related to the possibility of paraspinal muscle atrophy after surgery. Indications for and Outcomes of Three Unilateral Biportal Endoscopic Approaches for the Decompression of Degenerative Lumbar Spinal Stenosis: A Systematic Review. Regev et al. Spondylolisthesis is caused by the malfunction of the locking mechanism of the vertebral process between adjacent vertebrae [1]. Olivier et al. Gejo, R., Matsui, H., Kawaguchi, Y., Ishihara, H. & Tsuji, H. Serial changes in trunk muscle performance after posterior lumbar surgery. Postoperative muscle edema and swelling can be present for up to 6months after surgery, before it begins to subside13,17. Imaging of muscle and adipose tissue in the spine: A narrative review. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. The study was approved by the ethical committee of the Beijing Jishuitan Hospital (approval number: 20181103) and the ethical committee of Shanghai Changzheng Hospital (approval number: 20181201). The mean global postoperative MFI change in the multifidus and erector spinae muscles from L2S1. https://doi.org/10.3174/ajnr.A4596 (2016). The replacement of lean muscle by a fatty component suggests a decreased contractile muscle component and fatty degeneration of the muscle. What Is the Ideal HGH Dosage For Injury Recovery? During spinal fusion, a surgeon places bone or a bonelike material in the space between two spinal bones. Key word~: Spinal muscular atrophy, scoliosis, surgery. This was a retrospective cohort study of patients who underwent OLIF or OLIF+PPSF at Beijing Jishuitan Hospital and Shanghai ChangZheng Hospital between 07/2014 and 10/2017. Results: Fitness and wellness. The operative time was significantly shorter in the standalone OLIF group than in the OLIF combined group (9814 vs. 18232min, P<0.001). [32] demonstrated that the atrophy of multifidus muscles appeared less important and trunk extension muscle strength was better preserved in patients who underwent PPSF compared to patients who received open surgery. Provided by the Springer Nature SharedIt content-sharing initiative, Journal of Materials Science: Materials in Medicine (2022). government site. Images were stored in a digital imaging and communications in medicine (DICOM) format and analyzed on a personal computer using the Tissue Composition Module of the software (Mindways, Austin, TX, USA). Bilateral posterolateral fusion (inter-transverse fusion) was performed in addition to TLIF in the COS group. . Chir. Supplementary information accompanies this paper at 10.1186/s12891-020-3051-9. FCSA and fat infiltration percentage (FIP) of multifidus and erector spinae on the right side before surgery and 24months after surgery were measured automatically by the software (Additionalfile1: Figure S1). The psoas muscle showed no significant change after 1 year. and JavaScript. The improvement of spinal stenosis was defined as DSCSA change from before to after surgery. Fritzell, P., Hagg, O., Wessberg, P., Nordwall, A. Google Scholar. PDF Denervation and atrophy of paraspinal muscles after open lumbar Paraspinal muscles are commonly affected during spine surgery. Tech. 1, Table2). Of these, 365 patients had lumbar fusions and 164 had lumbar decompressions. But all functional scores (VAS, ODI, and JOA) 1year postoperatively were not different between the two groups. Wong, A. P., Smith, Z. PMC Careers. Mao L, Zhao J, Dai KR, Hua L, Sun XJ. The study was approved by the ethical committee of the Beijing Jishuitan Hospital (approval number: 20181103) and the ethical committee of Shanghai Changzheng Hospital (approval number: 20181201). doi: 10.1097/01.brs.0000202533.05906.ea. The average MFI change at L2S1 erector spinae muscle was significantly greater in the COS group (27.3721.37% vs. 14.1319.19%, P=0.044). Spine J. [37] also reported atrophy of the back muscle due to denervation of the paraspinal muscle, based on the results of a small animal study. 2023 Mar;47(3):819-830. doi: 10.1007/s00264-022-05658-w. Epub 2022 Dec 21. Yuan B, Tang YF, Xu Z, Wang JC, Zhou SY, Chen XS. There is no available literature for comparison on muscle atrophy between the "stand-alone" oblique lateral interbody fusion (OLIF) and regular OLIF (i.e., combined with percutaneous pedicle screws fixation (PPSF) in patients with spondylolisthesis). Kim et al. Symptoms include a decrease in muscle mass, one limb being smaller than the other, and numbness, weakness and tingling in your limbs. Quantitative analysis of paraspinal muscle atrophy after oblique It typically affects children but is more symptomatic in adults [3]. Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3-4 fixation. Minimally Invasive Spinal Fusion | Johns Hopkins Medicine Stevens et al. Functional cross-sectional area of the multifidus and erector spinae before and 24months after surgery, b Comparison between pre- and post-operation, Iatrogenic paravertebral muscle injury at fusion cage level (a); pedicle screw level (b) and adjacent segment level (c). Improvement of DSCSA after operation was more prominent in the COS group than in MIS group (P=0.0005). Therefore, assessing muscle atrophy after spine surgery could help predict the outcomes. Symptoms vary, and treatment may include physical therapy, functional electric stimulation, or surgery. Spine. PubMedGoogle Scholar. There was a trend of more severe fatty infiltration in the COS group. Spinal muscular atrophy (SMA) refers to a group of hereditary diseases that can damage and kill specialized nerve cells in the brain and spinal cord (motor neurons). Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. Consequence of paraspinal muscle after spinal fusion: an - PubMed After the posterior lumbar fusion, the volume of the MF muscles was markedly decreased, and the degree of decrease was apparent in the MRI. The effect of spinal implant rigidity on vertebral bone density. 19, 316324. None of the patients in both groups underwent additional laminectomy at the index level. Unable to load your collection due to an error, Unable to load your delegates due to an error, Measurements of paraspinal muscles. COS produces a greater area of decompression on follow up MRI than MIS with no statistical significance on clinical grounds. https://doi.org/10.1007/s00586-009-1191-6 (2010). Fan SW, Hu ZJ, Fang XQ, Zhao FD, Huang Y, Yu HJ. Denervation and atrophy of paraspinal muscles after open lumbar Due to the compression of the percutaneous pedicle screw channel to the midline during the operation, the multifidus is sandwiched between the spinous process and the channel, so the internal part of the fissure muscle is more prone to edema. Stevens, K. J. et al. Datta et al. Medicine (Baltimore). How Can HGH Be Helpful For Surgery? Yonggang Xing, Email: moc.361@211_0002_uil. 2) of adjacent segment degeneration in the OLIF combined group, while there was no case in the OLIF alone group. The distribution and extent of muscle atrophy . The global MFI change of the erector spinae muscle at L2S1 was significantly greater in the COS group (27.3821.37% vs. 14.1419.19%, P=0.044) (Fig. Spine J. Spinal Muscular Atrophy | National Institute of Neurological Disorders 47, 939945. Conversely, regression analysis showed a negative correlation between MF muscle volume loss and age in the MRI group (right and left, p = 0.002 and p = 0.015, respectively), that is, the younger the age, the greater loss of muscle mass. Careers, Unable to load your collection due to an error. Introduction Conventional posterior lumbar interbody fusion (PLIF) techniques are associated with approach-related morbidities resulting from iatrogenic muscle and soft tissue injury. Muscle atrophy can have a few different causes. 2005;30(1):123129. Before Your body needs a lot of energy for a full recovery after surgery. Federal government websites often end in .gov or .mil. Assessment of paraspinal muscle cross-sectional area after lumbar decompression: Minimally invasive versus open approaches. There were significant differences between the two groups at 24months (all P<0.001). Rhee JM, Schaufele M, Abdu WA. Methods contributed to interpret and analyse data for the work. Keywords: OLIF: oblique lateral interbody fusion; PPSF: percutaneous pedicle screws fixation. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spinous process-splitting open pedicle screw fusion provides favorable results in patients with low back discomfort and pain compared to conventional open pedicle screw fixation over 1 year after surgery. There were no differences between the two groups before surgery. Comparison of multifidus muscle atrophy after posterior lumbar This work was kindly supported by Grants CRRPG3H0061-2 from Chang Gung Memorial Hospital, Bone and Joint Research Center. However, the only significant MFI change difference between the COS and MIS groups was found at the caudal adjacent level of the erector spinae muscle (54.4837.95% vs. 23.6131.59%, P=0.016). The MFI changes at the operated and the cranial and caudal adjacent levels were compared between the two groups (Fig. ISSN 2045-2322 (online). 4). The Effect of Paraspinal Muscle Degeneration on Distal Pedicle Screw Loosening Following Corrective Surgery for Degenerative Lumbar Scoliosis. OLIF addresses these issues because of the anterior approach [10], but PPSF can still be associated with muscle injury. Considering the emerging interest for these techniques, we conducted a retrospective study on the degree of paravertebral lumbar muscle atrophy of standalone OLIF vs. OLIF combined with percutaneous pedicle screws fixation (PPSF) in patients with degenerative spondylolisthesis of grade I operated at one of two hospitals. Posterior surgical postoperative atrophy of paraspinal muscles quantified using CSA has been . Asian Spine J. The differences of FCSA and FIP between the two groups at 24months were significant (all P<0.001). Patients with previous spine surgery, spine trauma, infection, ankylosing spondylitis, cancer, and congenital spinal deformities were excluded. There is no available literature for comparison on muscle atrophy between the "stand-alone" oblique lateral interbody fusion (OLIF) and regular OLIF (i.e., combined with percutaneous pedicle screws fixation (PPSF) in patients with spondylolisthesis). The purpose of this study was to assess the potential factors that contribute to paraspinal muscle atrophy (PMA) after lumbar spine surgery. Nerve injury to the posterior rami medial branch during the insertion of pedicle screws: comparison of mini-open versus percutaneous pedicle screw insertion techniques. Figure3 shows an iatrogenic muscle injury. One side of the intervertebral height space at L3/4 is significantly smaller than on the other side (yellow arrow). This site needs JavaScript to work properly. J. Spinal Disord. 1). Lumbar spinal fusion with conventional open surgery (COS) is an effective method to relieve the symptoms of spinal stenosis and instability. McAfee PC, Farey ID, Sutterlin CE, Gurr KR, Warden KE, Cunningham BW. Spine J. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Comparison of paraspinal muscle degeneration and decompression effect between conventional open and minimal invasive approaches for posterior lumbar spine surgery. A comprehensive review of the available English literature, including relevant abstracts and references of articles selected for review, was conducted to identify studies that reported PMA after spinal surgery. evaluated muscle damage from COS using the spinous process-splitting approach for decompression, and found significant postoperative multifidus muscle atrophy at the operated and caudal adjacent levels15. The axial images were obtained at intervertebral disc levels horizontal to the endplate of the vertebral bodies from L23 to L5S1. doi: 10.1097/01.brs.0000148999.21492.53. https://doi.org/10.1007/s00586-009-1191-6, https://doi.org/10.1016/j.spinee.2016.05.008, https://doi.org/10.1016/j.math.2012.06.007, https://doi.org/10.1016/j.crad.2004.08.013, https://doi.org/10.3928/01477447-20160129-07, https://doi.org/10.1097/BSD.0000000000000038, https://doi.org/10.1016/j.surneu.2007.04.021, https://doi.org/10.1097/01.bsd.0000193820.42522.d9, https://doi.org/10.3346/jkms.2007.22.4.646, https://doi.org/10.1007/s00586-011-2146-2, https://doi.org/10.1097/BRS.0b013e3181a9d28e, https://doi.org/10.1016/j.spinee.2016.08.001, https://doi.org/10.1097/BRS.0b013e31805471fe, https://doi.org/10.1007/s00256-018-2902-z, https://doi.org/10.3171/2014.4.SPINE13420, https://doi.org/10.1007/s00586-017-5280-7, http://creativecommons.org/licenses/by/4.0/, Correlation between surgical segment mobility and paravertebral muscle fatty infiltration of upper adjacent segment in single-segment LDD patients: retrospective study at a minimum 2 years follow-up, Oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative disease of the lumbar spine: a systematic review and meta-analysis, Lyophilized bovine acellular tendon linear fiber material for the reconstruction of attachment structure of paraspinous muscles: an animal in vivo study, The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles. 26, 25522564. 60, 355363. Among the 41 cages inserted, 37 (90.2%) were located at the L45 level and four (9.8%) at L5-S1 level. Spinal Muscular Atrophy Causes. Eur. To obtain Wei He and Da He contributed equally to this work. In this study, standalone OLIF achieved better clinical outcomes (VAS and JOA scores) over the first 24months after surgery compared with OLIF combined with PPSF. However, few studies have examined the differences of postoperative paraspinal muscle changes and outcomes between COS and MIS. There were no differences in FCSA and FIP between OLIF (n=32) and OLIF+PPSF (n=41) groups before surgery. Clin. Conversely, regression analysis showed a negative correlation between MF muscle volume loss and age in the MRI group (right and left, p = 0.002 and p = 0.015, respectively), that is, the younger the age, the greater loss of muscle mass. Med. a=semi-major axis (cm). h=vertical height (cm). Nerve damage can also lead to atrophy. To avoid strong susceptibility artifacts around the postoperative metallic instruments, the MRI examinations were performed with a 1.5-T MR scanner (GE, Optima MR 450W). National Library of Medicine -, Kim DY, Lee SH, Chung SK, Lee HY. Preoperative MRI (a) showed dural sac compression due to a bulging disc and ligamentum flavum hypertrophy. A number of MIS methods have been developed to avoid extensive muscle dissection, and have become popular. 201702031B0). If your child has SMA, it's because they have two copies of a broken gene, one from each parent. Both techniques require extensive dissection of the paraspinal muscles as well as prolonged soft tissue retraction [7]. An official website of the United States government. Nevertheless, CT is not appropriate to estimate the muscles at the fusion level on account of the interference by the metal artifacts [31, 32]. While fatty infiltration of the erector spinae muscle at the operated level and the cranial adjacent level, and of the multifidus muscle at the operated, cranial, and caudal adjacent levels were all greater in the COS group, differences between the COS and MIS group were not significant.
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