Reattachment of the Multifidus Tendon in Lumbar Surgery to Decrease Postoperative Back Pain: A Technical Note.

Cureus. 2019 Dec 12;11(12):e6366. doi: 10.7759/cureus.6366.

Klinger N, Yilmaz E, Halalmeh DR, Tubbs RS, Moisi MD.

---

Abstract

The posterior midline approach to the lumbar spine requires significant manipulation of the paraspinal muscles. Muscle detachment and retraction results in iatrogenic damage such as crush injury, devascularization, and denervation, all of which have been associated with postoperative pain. The muscle most directly affected by the posterior approach is the lumbar multifidus (LM), the largest and most medial of the deep lumbar paraspinal muscles. The effects of the posterior approach on the integrity of the LM is concerning, as multiple studies have demonstrated that intraoperative injuries sustained by the LM lead to postoperative muscle atrophy and potentially worsening low back pain. Given the inevitability of intraoperative paraspinal muscle manipulation when using the posterior approach, this technical note describes methods by which surgeons may minimize LM tissue disruption and restore the anatomical position of the LM to ultimately expedite recovery, minimize postoperative pain, and improve patient satisfaction.

Copyright © 2019, Klinger et al.

KEYWORDS:

back pain; lumbar surgery; multifidus muscle; postoperative; reattachment

Figure 1

Multifidus muscle identification and detachment

(A) Cadaveric dissection using wide retraction to display the LM in natural anatomical position, with the LM inserting rostrally into the spinous processes of the lumbar vertebrae in a fanning pattern (small white arrows). (B) Tendon insertion of the LM sharply divided with a residual cuff on the spinous process.

LM, lumbar multifidus

Figure 2

Multifidus muscle reattachment

Cadaveric dissection using wide retraction to display reattachment of the LM to the tendon insertion at the spinous process. (A) Suture needle through the residual tendon cuff of the LM attached to the spinous process. (B) Residual tendon cuff of the LM is re-approximated to the body of the LM. (C) Suture placed to reattach the tendon insertion of the LM to the body of the LM.

LM, lumbar multifidus