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Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis.

Park DA, Kim SW, Lee SM, Ju CI, Kim CG, Jang SJ - Korean J Spine (2012)

Bottom Line: Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery.Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7.No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea.

ABSTRACT

Objective: Screw fixation via the paraspinal muscle sparing approach and by percutaneous screw fixation are known to diminish the risk of complications, such as, iatrogenic muscle injury as compared with the conventional midline approach. The purpose of this study was to evaluate tissue injury markers after these less traumatic screw fixation techniques for the treatment of L4-L5 spondylolisthesis.

Methods: Twenty-two patients scheduled for posterior lumbar interbody fusion (PLIF) at the L4-L5 segment for spondylolisthesis were prospectively studied. Patients were divided into two groups by screw fixation technique (Group I: paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery.

Results: Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7. No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3.

Conclusion: This study shows that percutaneous screw fixation procedure is the preferable minimally invasive technique in terms of minimizing muscle injury associated with L4-L5 spondylolisthesis.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photographs of screw fixation via paraspinal muscle sparing approach. (A) Through a midline skin incision, the spinal processes, laminae, and facet joints were exposed. (B) Following decompression and discectomy, two titanium cages are inserted into the intervertebral space. (C) Paramedian fascial incision are made in 2-3 cm lateral to midline and screws are inserted via the paraspinal muscle sparing approach between longissimus and multifidus muscle. (D) Postoperative skin incision shows single midline incision.
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Figure 1: Intraoperative photographs of screw fixation via paraspinal muscle sparing approach. (A) Through a midline skin incision, the spinal processes, laminae, and facet joints were exposed. (B) Following decompression and discectomy, two titanium cages are inserted into the intervertebral space. (C) Paramedian fascial incision are made in 2-3 cm lateral to midline and screws are inserted via the paraspinal muscle sparing approach between longissimus and multifidus muscle. (D) Postoperative skin incision shows single midline incision.

Mentions: Twenty-two patients who underwent single level PLIF for L4-L5 spondylolisthesis were included in this study. Patients with chronic illness, a history of malignancy or of infectious disease, or an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level in preoperation check were excluded from this study. Those on medications or with conditions that could have interfered with results, such as, cardiovascular disease or muscular disease, which can elevate serum enzymes, were also excluded. After receiving the written consent of this study, the 22 patients were allocated to one of two groups. Group I consisted of 11 patients (three males and eight females) treated by PLIF using interbody cages by the paraspinal muscle sparing approach for screw fixation. The paramedian fascial incisions were made in their correct place, which was usually located 2-3 cm lateral to the midline. After the natural cleavage plane of the anatomic intermuscular space between multifidus and longissimus muscles were identified for pedicle screw placement (Fig. 1). Group II also consisted of 11 patients (three males and eight females) treated by PLIF using interbody cages by percutaneous screw fixation. Peripheral venous blood samples were collected from all patients at 6 AM the day of the surgery and at 1, 3, and 7 days after the surgery. Samples were contained in a K3-EDTA-treated tube (Becton Dickinson, Ontario Canada) and two serum separation tubes (Becton Dickinson, Mississauga, Canada). Complete blood cell counts and ESR were determined using the Advia 2120 system(Siemens Healthcare Diagnostics GmbH, Eschborn, Germany) and the Test-1 analyzer (Alifax, Padova, Italy), respectively, in EDTA-treated whole blood. To separate serum, separation tubes were centrifuged immediately at 3,500 rpm for 10 minutes within one hour of blood sampling. The separated serum was stored at a -70℃ in a deep freezer for the four biomarker assays. The CK-MM and TNNC2 activities were determined using quantitative enzyme-linked immunosorbent assay (ELISA) kits (Uscn Life Science & Technology Co., Beijing, China), and the serum concentrations of IL-8 (a pro-inflammatory cytokine) and IL-1ra (an anti-inflammatory cytokine) were measured using quantitative ELISA kits (Invitrogen, Carlsbad, CA). The preoperative group differences were evaluated using the student's t-test for unpaired data. The Mann-Whitney U test in SPSS ver. 13 was used for the statistical analysis for the result. Results are presented as means and standard deviations. Statistical significance was accepted for p values of <0.05.


Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis.

Park DA, Kim SW, Lee SM, Ju CI, Kim CG, Jang SJ - Korean J Spine (2012)

Intraoperative photographs of screw fixation via paraspinal muscle sparing approach. (A) Through a midline skin incision, the spinal processes, laminae, and facet joints were exposed. (B) Following decompression and discectomy, two titanium cages are inserted into the intervertebral space. (C) Paramedian fascial incision are made in 2-3 cm lateral to midline and screws are inserted via the paraspinal muscle sparing approach between longissimus and multifidus muscle. (D) Postoperative skin incision shows single midline incision.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430557&req=5

Figure 1: Intraoperative photographs of screw fixation via paraspinal muscle sparing approach. (A) Through a midline skin incision, the spinal processes, laminae, and facet joints were exposed. (B) Following decompression and discectomy, two titanium cages are inserted into the intervertebral space. (C) Paramedian fascial incision are made in 2-3 cm lateral to midline and screws are inserted via the paraspinal muscle sparing approach between longissimus and multifidus muscle. (D) Postoperative skin incision shows single midline incision.
Mentions: Twenty-two patients who underwent single level PLIF for L4-L5 spondylolisthesis were included in this study. Patients with chronic illness, a history of malignancy or of infectious disease, or an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level in preoperation check were excluded from this study. Those on medications or with conditions that could have interfered with results, such as, cardiovascular disease or muscular disease, which can elevate serum enzymes, were also excluded. After receiving the written consent of this study, the 22 patients were allocated to one of two groups. Group I consisted of 11 patients (three males and eight females) treated by PLIF using interbody cages by the paraspinal muscle sparing approach for screw fixation. The paramedian fascial incisions were made in their correct place, which was usually located 2-3 cm lateral to the midline. After the natural cleavage plane of the anatomic intermuscular space between multifidus and longissimus muscles were identified for pedicle screw placement (Fig. 1). Group II also consisted of 11 patients (three males and eight females) treated by PLIF using interbody cages by percutaneous screw fixation. Peripheral venous blood samples were collected from all patients at 6 AM the day of the surgery and at 1, 3, and 7 days after the surgery. Samples were contained in a K3-EDTA-treated tube (Becton Dickinson, Ontario Canada) and two serum separation tubes (Becton Dickinson, Mississauga, Canada). Complete blood cell counts and ESR were determined using the Advia 2120 system(Siemens Healthcare Diagnostics GmbH, Eschborn, Germany) and the Test-1 analyzer (Alifax, Padova, Italy), respectively, in EDTA-treated whole blood. To separate serum, separation tubes were centrifuged immediately at 3,500 rpm for 10 minutes within one hour of blood sampling. The separated serum was stored at a -70℃ in a deep freezer for the four biomarker assays. The CK-MM and TNNC2 activities were determined using quantitative enzyme-linked immunosorbent assay (ELISA) kits (Uscn Life Science & Technology Co., Beijing, China), and the serum concentrations of IL-8 (a pro-inflammatory cytokine) and IL-1ra (an anti-inflammatory cytokine) were measured using quantitative ELISA kits (Invitrogen, Carlsbad, CA). The preoperative group differences were evaluated using the student's t-test for unpaired data. The Mann-Whitney U test in SPSS ver. 13 was used for the statistical analysis for the result. Results are presented as means and standard deviations. Statistical significance was accepted for p values of <0.05.

Bottom Line: Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery.Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7.No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea.

ABSTRACT

Objective: Screw fixation via the paraspinal muscle sparing approach and by percutaneous screw fixation are known to diminish the risk of complications, such as, iatrogenic muscle injury as compared with the conventional midline approach. The purpose of this study was to evaluate tissue injury markers after these less traumatic screw fixation techniques for the treatment of L4-L5 spondylolisthesis.

Methods: Twenty-two patients scheduled for posterior lumbar interbody fusion (PLIF) at the L4-L5 segment for spondylolisthesis were prospectively studied. Patients were divided into two groups by screw fixation technique (Group I: paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery.

Results: Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7. No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3.

Conclusion: This study shows that percutaneous screw fixation procedure is the preferable minimally invasive technique in terms of minimizing muscle injury associated with L4-L5 spondylolisthesis.

No MeSH data available.


Related in: MedlinePlus