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Archives of Physical Medicine and... Apr 1994
Topics: Bias; Electromyography; Humans; Lumbosacral Region; Meningitis
PubMed: 8172514
DOI: 10.1016/0003-9993(94)90181-3 -
World Neurosurgery May 2021Giant paraspinal thoracic schwannomas (GPTSs) are benign, slow-growing, encapsulated lesions. They can be intracanalicular, span more than 2 vertebral bodies, and/or...
BACKGROUND
Giant paraspinal thoracic schwannomas (GPTSs) are benign, slow-growing, encapsulated lesions. They can be intracanalicular, span more than 2 vertebral bodies, and/or have a foraminal component with extraspinal extension >2.5 cm. They pose surgical challenges because of the often unfamiliar complex regional anatomy. We report the largest series of GPTSs and discuss regional surgical strategies for tumors in the thoracic spine.
METHODS
We conducted a retrospective review of GPTSs operated at a national spinal referral center between December 2008 and October 2019. Inclusion criteria included World Health Organization grade 1 GPTS. Patient demographics, clinical features, radiology, and histopathology were assessed.
RESULTS
Seventeen patients (12 females, 5 males) had a mean age of 48.1 years (range 21-65 years). Five GPTS (29%) were located at T1-T3, 6 (35%) at T4-6, and 6 (35%) below T6. The mean maximum diameter was 58.5 ± 19.1 mm (range 30-91 mm). Mean volume was 90.9 cm (range 19.1-350.6 cm). Twelve (70%) had a fluorodeoxyglucose positron emission tomography scan showing low (25%) or moderate to high (75%) uptake. Six patients (35%) had preoperative computed tomography-guided biopsy. Surgical approaches included 1) manubriotomy and variations (4/17); 2) high lateral thoracotomy (4/17); 3) posterior parascapular (1/17); 4) standard lateral thoracotomy (3/16); 5) posterior/posterolateral (2/17); and 6) combined posterior and thoracotomy (3/17). All patients had gross total resection and were grade 1 cellular schwannomas. No recurrence at final follow-up (mean 36.1 months, range 8-130 months).
CONCLUSIONS
A number of approaches are available to resect GPST in specific locations in the thoracic spine. Total resection is achievable despite complex regional anatomy, location, and tumor extension but often requires anterior or combined approaches.
Topics: Adult; Aged; Female; Humans; Image-Guided Biopsy; Male; Middle Aged; Neoplasm Recurrence, Local; Neurilemmoma; Neurosurgical Procedures; Positron-Emission Tomography; Postoperative Complications; Retrospective Studies; Spinal Neoplasms; Sternotomy; Thoracic Vertebrae; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 33516861
DOI: 10.1016/j.wneu.2020.11.174 -
International Journal of Environmental... Jan 2023Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia... (Review)
Review
Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks.
Topics: Female; Humans; Cervix Uteri; Nerve Block; Pain Management; Anesthesia, Conduction; Ultrasonography, Interventional
PubMed: 36767465
DOI: 10.3390/ijerph20032098 -
Spine Dec 2010A case report and review of the literature. (Review)
Review
STUDY DESIGN
A case report and review of the literature.
OBJECTIVE
To report a rare case of paraspinal compartment syndrome that presented a diagnostic challenge.
SUMMARY OF BACKGROUND DATA
Paraspinal compartment syndrome is a rare condition defined as increased pressure within a closed fibro-osseous space, resulting in reduced blood flow and tissue perfusion in that space. The reduced perfusion causes ischemic pain and irreversible damage to the tissues of the compartment if unrecognized or left untreated.
METHODS
A 20-year-old African-American man presented with 2 days of new-onset progressive back pain after repetitive lifting of 235 lbs in a deadlift exercise. The patient had significantly tender lumbar paraspinal muscles, was unable rise from a supine position, and had severe pain with attempted active rolling or sitting. Findings of supine radiographs were normal. Findings of initial laboratory investigations were consistent with rhabdomyolysis and acute kidney injury. Despite aggressive hydration and narcotic analgesia, the patient's creatinine kinase and myoglobin continued to rise and his pain continued to worsen. Computed tomography of the spine revealed enlarged paraspinal musculature and decreased enhancement bilaterally. Gadolinium-enhanced magnetic resonance imaging of the spine showed increased T2 signal and paraspinal muscle edema with areas of decreased contrast uptake, consistent with ischemia and necrosis. Compartment pressures measured 78 mm Hg on the left and 26 mm Hg on the right.
RESULTS
Because hydration and analgesia had failed, the patient was taken urgently to the operating room for bilateral paraspinal fasciotomies with delayed closure. His symptoms and rhabdomyolysis then resolved during the next 2 days.
CONCLUSION
The diagnostic challenge presented by this case, especially considering the rarity of paraspinal compartment syndrome, indicates the need for a high index of suspicion in the appropriate setting.
Topics: Acute Disease; Back Pain; Compartment Syndromes; Decompression, Surgical; Humans; Lifting; Lumbosacral Region; Male; Treatment Outcome; Young Adult
PubMed: 21102286
DOI: 10.1097/BRS.0b013e3181ec4023 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Apr 2023To characterize the paraspinal muscles of adolescent idiopathic scoliosis (AIS) patients, and to further explore its etiology.
OBJECTIVE
To characterize the paraspinal muscles of adolescent idiopathic scoliosis (AIS) patients, and to further explore its etiology.
METHODS
Clinical records and paraspinal muscle biopsies at the apex vertebra region during posterior scoliosis correction surgery of 18 AIS were collected from November 2018 to August 2019. Following standardized processing of fresh muscle tissue biopsy, serial sections with conventional hematoxylin-eosin (HE) and histochemical and immunohistochemical (IHC) with antibody Dystrophin-1 (R-domain), Dystrophin-2 (C-terminal), Dystrophin-3 (N-terminal), Dystrophin-total, Myosin (fast), major histocompatibility complex 1 (MHC-1), CD4, CD8, CD20, and CD68 staining were obtained. Biopsy samples were grouped according to the subjects' median Cobb angle (Cobb angle ≥ 55° as severe AIS group and Cobb angle < 55° as mild AIS group) and Nash-Moe's classification respectively, and the corresponding pathological changes were compared between the groups statistically.
RESULTS
Among the 18 AIS patients, 8 were in the severe AIS group (Cobb angle ≥55°) and 10 in the mild AIS group (Cobb angle < 55°). Both severe and mild AIS groups presented various of atrophy and degeneration of paraspinal muscles, varying degrees and staining patterns of immune-expression of Dystrophin-3 loss, especially Dystrophin-2 loss in severe AIS group with significant differences, as well as among the Nash-Moe classification subgroups. Besides, infiltration of CD4 and CD8 cells in the paraspinal muscles and tendons was observed in all the patients while CD20 cells were null. The expression of MHC-1 on myolemma was present in some muscle fibers.
CONCLUSION
The histologic of paraspinal muscle biopsy in AIS had similar characteristic changes, the expression of Dystrophin protein was significantly reduced and correlated with the severity of scoliosis, suggesting that Dystrophin protein dysfunctions might contribute to the development of scoliosis. Meanwhile, the inflammatory changes of AIS were mainly manifested by T cell infiltration, and there seemed to be a certain correlation between inflammatory cell infiltration, MHC-1 expression and abnormal expression of Dystrophin. Further research along the lines of this result may open up new ideas for the diagnosis of scoliosis and the treatment of paraspinal myopathy.
Topics: Humans; Adolescent; Scoliosis; Paraspinal Muscles; Dystrophin; Non-alcoholic Fatty Liver Disease; Kyphosis; Biopsy
PubMed: 37042139
DOI: 10.19723/j.issn.1671-167X.2023.02.012 -
Spine Aug 2020
Topics: Gene Expression; Humans; Lumbar Vertebrae; Lumbosacral Region; Paraspinal Muscles
PubMed: 32675621
DOI: 10.1097/BRS.0000000000003576 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2022The aim: To study the structural features of the lumbar m. multifidus and the m. psoas after keeping rats on a high-fat diet (obesity) or compressing their lumbar...
OBJECTIVE
The aim: To study the structural features of the lumbar m. multifidus and the m. psoas after keeping rats on a high-fat diet (obesity) or compressing their lumbar paraspinal muscles by binding the muscles using non-absorbable sutures.
PATIENTS AND METHODS
Materials and methods: The study was performed on 2-month-old male rats (n=15) into three groups of 5: control group (normal diet without any surgical interventions), high-fat diet (model I: 40-45% kcal fat), and paraspinal muscles compression (model II: paraspinal muscles were tied from L2 to S1 with non-absorbable sutures Nurolon® 3). The experiment lasted for 90 days, after those fragments of the lumbar m. multifidus and m. psoas removed and histomorphometry analysis performed.
RESULTS
Results: 12 weeks from the beginning of the experiment, the high-fat diet rats weighed, on average, 22% (p=0.001) more than the control group rats. Similar degenerative changes such as uneven muscle fibre width and sarcoplasm colouring, 'wavy' and swollen fibres, loss of striation, karyopyknosis were observed in the lumbar paraspinal muscles in both models. In high-fat diet group the fat area (%) in the m. multifidus was 1.8 times larger (р<0.001) and in the m. psoas was greater by 2.2 times (р<0.001) than in the control. Fibrous tissue replaced muscle fibres in m. multifidus in model II and was 12.66%.
CONCLUSION
Conclusions: The relevance of the models is proven: after 3 months, it is possible to obtain degenerative changes in the muscle tissue that are extremely similar to those observed in the muscles of patients with degenerative spine diseases.
Topics: Male; Animals; Paraspinal Muscles; Diet, High-Fat; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging
PubMed: 36378709
DOI: 10.36740/WLek202209218 -
ANZ Journal of Surgery Sep 2018While still a rare entity, acute lumbar paraspinal compartment syndrome has an increasing incidence. Similar to other compartment syndromes, acute lumbar paraspinal...
While still a rare entity, acute lumbar paraspinal compartment syndrome has an increasing incidence. Similar to other compartment syndromes, acute lumbar paraspinal compartment syndrome is defined by raised pressure within a closed fibro-osseous space, limiting tissue perfusion within that space. The resultant tissue ischaemia presents as acute pain, and if left untreated, it may result in permanent tissue damage. A literature search of 'paraspinal compartment syndrome' revealed 21 articles. The details from a case encountered by the authors are also included. A common data set was extracted, focusing on demographics, aetiology, clinical features, management and outcomes. There are 23 reported cases of acute compartment syndrome. These are typically caused by weight-lifting exercises, but may also result from other exercises, direct trauma or non-spinal surgery. Pain, tenderness and paraspinal paraesthesia are key clinical findings. Serum creatine kinase, magnetic resonance imaging and intracompartment pressure measurement confirm the diagnosis. Half of the reported cases have been managed with surgical fasciotomy, and these patients have all had good outcomes relative to those managed with conservative measures with or without hyperbaric oxygen therapy. These good outcomes were despite significant delays to operative intervention. The diagnostic uncertainty and subsequent delay to fasciotomy result from the rarity of this disease entity, and a high level of suspicion is recommended in the appropriate setting. This is particularly true in light of the current popularity of extreme weight lifting in non-professional athletes. Operative intervention is strongly recommended in all cases based on the available evidence.
Topics: Acute Disease; Acute Kidney Injury; Adolescent; Adult; Aged; Compartment Syndromes; Creatine Kinase; Fasciotomy; Female; Humans; Incidence; Ischemia; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Myoglobin; Rhabdomyolysis; Treatment Outcome; Young Adult
PubMed: 29316189
DOI: 10.1111/ans.14342 -
European Spine Journal : Official... Mar 2022A retrospective study.
STUDY DESIGN
A retrospective study.
OBJECTIVE
To evaluate the different degeneration patterns of paraspinal muscles in degenerative lumbar diseases and their correlation with lumbar spine degeneration severity. The degeneration characteristics of different paraspinal muscles in degenerative lumbar diseases remain unclear.
METHODS
78 patients diagnosed with single-level degenerative lumbar spondylolisthesis (DLS) and 76 patients with degenerative lumbar kyphosis (DLK) were included as DLS and DLK groups. Paraspinal muscle parameters of psoas major (PS), erector spinae (ES) and multifidus muscle (MF) were measured, including fatty infiltration (FI) and relative cross-sectional area (rCSA), namely the ratio of the paraspinal muscle CSA to the CSA of the vertebrae of the same segment. Sagittal parameters including lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. The paraspinal muscle parameters and ES/MF rCSA ratio were compared between the two groups. Paraspinal muscles parameters including rCSA and FI were also compared between each segments from L1 to L5 in both DLS and DLK groups. In order to determine the influence of sagittal spinal alignment on paraspinal muscle parameters, correlation analysis was conducted between the MF, ES, PS rCSA and FI and the LL in DLS and DLK group.
RESULT
MF atrophy is more significant in DLS patients compared with DLK. Also, MF fatty infiltration in the lower lumbar spine of DLS patients was greater compared to DLK patients. DLK patients showed more significant atrophy of ES and heavier ES fatty infiltration. MF FI was significantly different between all adjacent segments in both DLS and DLK groups. In DLS group, ES FI was significantly different between L2/L3 to L3/L4 and L4/L5 to L5/S1, while in DLK group, the difference of ES FI between all adjacent segments was not significant, and ES FI was found negatively correlated with LL.
CONCLUSIONS
Paraspinal muscles show different degeneration patterns in degenerative lumbar diseases. MF degeneration is segmental in both DLS and DLK patients, while ES degenerated diffusely in DLK patients and correlated with the severity of kyphosis. MF degeneration is more significant in the DLS group, while ES degeneration is more significant in DLK patients. MF is the stabilizer of the lumbar spine segments, while the ES tends to maintain the spinal sagittal balance.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Paraspinal Muscles; Retrospective Studies
PubMed: 34978601
DOI: 10.1007/s00586-021-07053-2 -
PM & R : the Journal of Injury,... Feb 2024Paraspinal electromyography has proven to be the most sensitive component of the electrodiagnostic examination for lumbar spinal disorders. However, no standardized,... (Review)
Review
Paraspinal electromyography has proven to be the most sensitive component of the electrodiagnostic examination for lumbar spinal disorders. However, no standardized, anatomically validated technique has been proposed for the cervical region. This study reviewed the published textbooks on cervical paraspinal anatomy to develop a standardized electromyography technique and scoring system. A library search found 32 anatomy texts published between 2000 and 2021. Of these 11 were unique and appropriate. Most texts described the basic muscle anatomy similarly, but only one cited original research. When the spinous process is defined as the origin, the multifidus and deeper rotatores appear innervated by the posterior primary rami of single cervical roots. However, texts differ in the number of pennae, between two and five, traveling to transverse process regions below. These are crowded into a small area between the spinous processes and transverse processes. Based on this understanding, a proposed cervical paraspinal mapping technique involves skin insertions from 1 to 2 cm lateral to the C5, C7, and T2 spinous processes. The needle samples transversely and deep toward midline, contacts bone, then is withdrawn and redirected to sample medial and caudally to midline to bone, creating two scores of 0-4 at three levels, theoretically resulting in scores of 0-24. This technique must be validated by clinical research to determine the range of normal, reproducibility, and the spectrum of findings in various disorders.
Topics: Humans; Paraspinal Muscles; Reproducibility of Results; Electromyography; Neck
PubMed: 37515513
DOI: 10.1002/pmrj.13046