Lumbar paravertebral muscle [Neurosurgery Wiki]

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=====Lumbar paravertebral muscle=====
The association between [[chronic low back pain]] and morphologic, structural changes of the [[paravertebral muscle]]s has been widely acknowledged
((Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM R. 2010;2:142–146. quiz 1 p following 167.))
((Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5:2.))
((Mengiardi B, Schmid MR, Boos N, Pfirrmann CW, Brunner F, Elfering A, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240:786–792.))
((Mannion AF. Fibre type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain. J Electromyogr Kinesiol. 1999;9:363–377.)).

Considerable research effort has been directed at investigating the fatty infiltration of the paravertebral muscle, as well as the reduction of muscle volume, as a clinical predictor of post-surgical outcome
((Hebert JJ, Marcus RL, Koppenhaver SL, Fritz JM. Postoperative rehabilitation following lumbar discectomy with quantification of trunk muscle morphology and function: a case report and review of the literature. J Orthop Sports Phys Ther. 2010;40:402–412.))
and spinal stability
((Chan ST, Fung PK, Ng NY, Ngan TL, Chong MY, Tang CN, et al. Dynamic changes of elasticity, cross-sectional area, and fat infiltration of multifidus at different postures in men with chronic low back pain. Spine J. 2012;12:381–388.)).

Additionally, fatty infiltration of the muscle can also be caused by chronic conditions such as age-related sarcopenia
((Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–423. ))
, which is the generalized gradual loss of skeletal muscle mass and strength; it is associated to functional limitation, physical disability, and muscle strength
((Dufour AB, Hannan MT, Murabito JM, Kiel DP, McLean RR. Sarcopenia definitions considering body size and fat mass are associated with mobility limitations: the Framingham Study. J Gerontol A Biol Sci Med Sci. 2013;68:168–174.))
((Pineda-Alonso N, Xu Q, Sharma P, Martin D, Hu X. High speed multiple echo acquisition (HISTO): a rapid and simultaneous assessment of fat and iron content in liver by 1HMRS. Proc Intl Soc Mag Reson Med. 2008;16:3699.)).

In the conventional posterior approach to the [[lumbar spine]], the [[lamina]] is exposed by stripping the [[paravertebral muscle]]s from the [[spinous process]], and the resulting paravertebral muscle damage can produce muscle atrophy and decreased muscle strength.



Chatani developed a novel surgical approach to the lumbar spine in which the attachment of the paravertebral muscles to the spinous process is preserved. In the novel approach, the spinous process is split on the midline without stripping the attached muscles, and a hemilateral half of the spinous process is then resected at the base, exposing only the ipsilateral lamina. Before closing, the resected half is sutured and reattached to the remaining half of the spinous process. Thirty-eight patients with lumbar spinal canal stenosis (LSCS) undergoing unilateral partial laminectomy and bilateral decompression using this novel approach were analyzed. Postoperative changes in the multifidus muscle were evaluated by T2 signal intensity on MR images. MRI performed 1 year after the operation revealed no significant difference in the T2 signal intensity of the multifidus muscle between the approach and nonapproach sides. This result indicated that postoperative changes of the multifidus muscle on the approach side were slight. The clinical outcomes of unilateral partial laminectomy and bilateral decompression using this approach for LSCS were satisfactory. The novel approach can be a useful alternative to the conventional posterior lumbar approach
((Chatani K. A novel surgical approach to the lumbar spine involving hemilateral
split-off of the spinous process to preserve the multifidus muscle: technical
note. J Neurosurg Spine. 2015 Nov 6:1-6. [Epub ahead of print] PubMed PMID:
26544596.
)).