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Abstract
Objectives
This study was undertaken to examine changes in lumbar isometric extensor strength after posterior lumbar interbody fusion (PLIF) surgery.
Summary of Literature Review
In most reports, the patients that have undergone PLIF surgery have been shown to have muscle weakness and atrophy. However, the research conducted regarding the changes in muscle strength throughout a follow up period is insufficient.
Materials and Methods
Forty-nine patients (mean age, 65 years (range, 45 to 77)), scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases, were enrolled. Preoperatively and 3, 6, and 12 month after surgery, lumbar isometric extensor strength was assessed using a MedX instrument in 7 angular positions (0-72°). The mean isometric strength and rate of increase were calculated. Isometric strengths were compared according to patients’ age (<60, 60-70, and ≥70 years) and fusion level (short: <3; and long: ≥3) and the respective relationships were analyzed.
Results
The mean isometric strength changed from 89.0 preoperatively to 85.3, 110.4, and 120.8 ft-lb at each followup, respectively. The rate of increase of strength was significantly greater at 0°(36.1 %) than at 72°(24.2 %) (p=0.019). Preoperative isometric strengths were similar in each age and fusion level group, but isometric strengths at the final followup were significantly lower in older patients and in the long level fusion group (p=0.002 and 0.043, respectively). Mean isometric strength at the last followup showed significant associations with age and fusion level (r=-0.431 and -0.317, p=0.002 and 0.030, respectively).
Conclusion
After lumbar fusion surgery, back muscle strength slightly decreased until 3 months and then significantly increased. However, postoperative strength increases were lower in older patients and those in the long level (>3) fusion group. These results could be basic data for a rehabilitation program after lumbar fusion.
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Figures and Tables%
Fig. 2.
After lumbar fusion surgery, the isometric strengths were maintained or slightly decreased without significance until 3 months and then increased until 12 months. In particular, significant increases were obseved between at postoperative 3 and 6 months* (p<0.001). The isometric strengths were stronger in higer flexion angular positions.
Fig. 3.
After lumbar fusion surgery, the mean isometric extension strength increased significantly and the mean ratio of 72°/0° isometric strength decreased significantly, particularly between postoperative 3 and 6 months* (p<0.001 and 0.007, respectively). The mean isometric strength showed a significant negative association with the ratio of 72°/0° isometric strength (r=-0.371, p<0.001).
Fig. 4.
In comparisons of the mean isometric strength according to patients’ age and fusion level groups, preoperative isometric strengths were not significantly different, but the increases of isometric strengths were lower in older patients and long level fusion group (*p<0.05).
Fig. 5.
After lumbar fusion sugery, the ODI and VAS for back decreased gradually until postoperative 12 months and significant decreases were obseved between preoperative and at postoperative 3 months* (p=0.045 and 0.022, respectively).
Table 1.
Baseline demographic and clinical data
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