The Immediately Postoperative Changes of Creatine Phosphokinase After Microendoscopic Discectomy

Young-Yul Kim; Hae Seok Koh; Kee-Won Rhyu

doi:10.4184/jkss.2007.14.4.229

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Kim, Koh, and Rhyu: The Immediately Postoperative Changes of Creatine Phosphokinase After Microendoscopic Discectomy

Original Article

Journal of Korean Spine Surg 2007;14(4):229-234.

Published online: 21 February 2007

DOI: https://doi.org/10.4184/jkss.2007.14.4.229

The Immediately Postoperative Changes of Creatine Phosphokinase After Microendoscopic Discectomy

Young-Yul Kim, M.D., Hae Seok Koh, M.D., Kee-Won Rhyu, M.D.

Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea

Address reprint requests to Kee-Won Rhyu, M.D. Department of Orthopedic Surgery, St. Vincent's Hospital 93-6 Ji-dong, Paldal-gu, Suwon, Gyeonggi-Do, Korea 442-723 Tel: 82-31-249-7114, Fax: 82-31-254-7186, E-mail: kwrhyu@catholic.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study

Objectives

To evaluate postoperative muscle damage after microendoscopic discectomy (MED) and open discectomy (OD), using analysis of serum creatine phosphokinase (CPK) levels.

Summary of Literature Review

Paravertebral muscle damage after retraction during posterior lumbar surgery can cause postoperative back pain. Serum CPK level is elevated in these patients and may indicate postoperative muscle damage.

Materials and Methods

We examined 35 cases with MED (group 1) and 11 cases with OD (group 2). Serum CPK levels were checked preoperatively and postoperatively at day 1 and day 3. We analyzed intra-group and intergroup differences in CPK levels according to sex, age, and operation time. Surgical outcomes were evaluated with a visual analog scale (VAS) preoperatively and 1 year postoperatively.

Results

CPK levels at postoperative 1 day were increased significantly and decreased significantly at postoperative 3 day in both groups (p<0.05), with levels in group 1 significantly lower than in group 2 (p<0.05). There were no differences in CPK levels according to sex, age, or operation time, except between the 3rd and 5th decades of age at postoperative 1 day in group 2. VAS was significantly different in intra-group analysis (p<0.05) with no significant differences in intergroup analysis.

Conclusions

MED induced a lower increase in serum CPK than OD with similar VAS outcomes. MED results in less postoperative muscle damage than OD, with similar surgical outcomes.

Keywords: Microendoscopic discectomy (MED), Creatine phosphokinase, Postoperative muscle damage

REFERENCES

1). Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine. 1997; 22:1018–1023.

2). Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spinal surgery, A Histological and serological analysis. Spine. 1996; 21:941–944.

3). Kawaguchi Y, Yabuki S, Styf J, et al. Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine. 1996; 21:2683–2688.

4). Kotil K, Tunckale T, Tatar Z, Koldas M, Kural A, Bilge T. Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine. 2007; 6:121–125.

5). Sasaoka R, Nakamura H, Konishi S, et al. Objective assessment of reduced invasiveness in MED. Compared with conventional one-level laminotomy. Eur Spine J. 2006; 15:577–582.

6). Huang TJ, Hsu RW, Li YY, Cheng CC. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res. 2005; 23:406–411.

7). Chiu D, Wang HH, Blumenthal MR. Creatine phosphokinase release as a measure of tourniquet effect on skeletal muscle. Arch Surg. 1976; 111:71–74.

8). Healey JH, Kagen LJ, Velis KP, Levine DB. Creatine kinase MB in skeletal muscle and serum of spinal fusion patient. Clin Orthop. 1985; 195:282–288.

9). Jackson RK. The long term effect of wide laminectomy for lumbar disc excision. A review of 130 patients. J Bone Joint Surg. 1971; 53B:609–616.

10). Mayer TG, Vanharanta H, Gatche RJ. Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patient. Spine. 1989; 14:33–36.

11). Weber BR, Grob D, Dvorak J, Muntener M. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine. 1997; 22:1765–1772.

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Figures and Tables%

Fig. 1.

The changes of the serum level of CPK in group 1 and group 2

Table 1.

Summary of datas

		Group 1	Group 2
Sex	Male	19	8
	Female	16	3
Age (years)		37.5±9.6	37.0±8.6
	20~29	8	3
	30~39	13	4
	40~49	14	4
Operation level	L3-4	1	1
	L4-5	22	7
	L5-S1	12	3
Operation time (min)		61.1±16.7	67.1±23.1
	< 60 min	18	4
	≥60 min	17	7
CPK (IU/L)	Preop.	33.3±5.5	31.6±2.6
	POD 1 day	35.1±4.8*	43.0±5.7*
	POD 3 day	34.3±5.0**	38.8±5.3**
VAS	Preop.	7.4±0.7***	7.3±0.7^$
	POD 1 year	1.1±0.9***	1.0±1.2^$

^∗ : p=0.000,

^∗ : p=0.024,

^*** : p=0.000,

^$ : p=0.000

Table 2.

The changes of serum level of CPK according to the sex, age, and operation time at operation in group 1

			Creatine phosphokinase (IU/L)
		Preop.	POD 1 day	POD 3 day
Sex	Male	33.6±5.9	35.1±5.4	34.6±5.7
	Female	32.9±5.3	35.1±4.2	33.9±4.2
Age (years)	20~29	31.4±5.3	35.0±3.8	34.5±4.9
	30~39	33.5±6.1	34.2±5.6	34.0±5.6
	40~49	34.1±5.3	35.9±4.8	34.4±4.9
Operation time (min)	<60	33.2±5.3	34.8±4.1	34.7±4.2
	≥60	33.4±6.0	35.4±5.6	33.8±5.8

Table 3.

Table 3. The changes of serum level of CPK according to the sex, age, and operation time at operation in group 2

			Creatine phosphokinase (IU/L)
		Preop.	POD 1 day	POD 3 day
Sex	Male	31.6±2.9	43.6±6.6*	39.1±5.6*
	Female	31.7±2.3	41.3±1.2*	38.0±5.3
Age (years)	20~29	32.0±1.7	39.3±3.1*	37.0±6.6
	30~39	30.5±2.9	42.0±5.4*	38.5±5.4
	40~49	32.5±3.1	46.8±6.2*	40.5±5.3
Operation time (min)	<60	31.3±3.1	41.0±5.3*	37.8±5.6
	≥60	31.9±2.5	44.1±1.0*	39.4±5.5

^∗ : p=0.01

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