gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Electromyographic denervation and extent of atrophy of paraspinal muscles after PLIF correlate significantly with clinical outcome – a prospective clinical study of 30 patients

Meeting Abstract

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  • A. Waschke - Klinik für Neurochirurgie, Universitätsklinikum Jena
  • C. Hartmann - Klinik für Neurochirurgie, Universitätsklinikum Jena
  • R. Kalff - Klinik für Neurochirurgie, Universitätsklinikum Jena

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.08.10

doi: 10.3205/12dgnc361, urn:nbn:de:0183-12dgnc3613

Published: June 4, 2012

© 2012 Waschke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Denervation phenomena of paraspinal muscles after posterior approaches to lumbar spine are widely described. For some time now quantitative volumetric analysis of paraspinal muscles is available. There are some papers discussing paraspinal denervation and atrophy, as a substantial causal factor for an unsatisfactory outcome after surgery, however evidence so far could not be provided.

Methods: Prospective clinical, electromyographic and radiographic analysis of 30 patients operated on in a 20-months-period by three experienced surgeons performing a posterior lumbar intercorporal instrumented fusion (PLIF) in one or two segments. Exclusion criteria were: previous lumbar spine surgery, osteoporosis, infectious disease, polyneuropathy or myopathy. Clinical outcome was measured with SF36 questionnaire and VAS scale. Serial paraspinal EMG studies were performed before surgery as well as 3, 6 and 12 months after surgery. CT-volumetry was done before and 12 months after surgery. A multivariate analysis was carried out.

Results: There were 13 men and 17 women with a median age of 61 years (range 32–80) with 20 monosegmental fusions and 10 fusions over two segments. Serial EMG, SF36 data and CT volumetry of paraspinal muscles were available for every patient a final follow-up. The overall improvement was 3.5 on the VAS scale after one year and 1.6 points in SF36 general outcome subcategory both being statistically significant in t-test (p<0.05). We could demonstrate a strong and significant correlation of paraspinal denervation signs (PSW, fibrillations) combined with loss of function which persisted longer than 6 months in serial EMG studies on the one hand as well as atrophy of the paraspinal segmental muscles measured by CT volumetry with a worse SF36 general outcome and physical function after one year.

Conclusions: Our data underline the importance of maintenance of function of paraspinal muscles within the context of posterior lumbar spine surgery.