Atrofia asimétrica de los músculos paraespinales en pacientes sometidos a neurotomía por radiofrecuencia unilateral de rama medial lumbar: Publicado originalmente en la Revista Pain 2024; 165(9): 2130-34.  Traducción: Eddy Gutiérrez Rojas

Ali E. Guven; Gisberto Evangelisti; Marco D. Burkhard; Paul Köhli; Jan Hambrecht; Jiaqi Zhu; Erika  Chiapparelli; Michael Kelly; Koki Tsuchiya; Krizia Amoroso; Arman Zadeh; Jennifer Shue; Ek Tsoon Tan; Andrew A. Sama; Federico P. Girardi; Frank P. Cammisa; Alexander P. Hughes

doi:10.47924/neurotarget2025477

Authors

Ali E. Guven Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0009-0004-7663-9043
Gisberto Evangelisti Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0002-5185-4482
Marco D. Burkhard Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY https://orcid.org/0000-0003-1501-1952
Paul Köhli Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0001-7473-6553
Jan Hambrecht Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0009-0007-4152-7465
Jiaqi Zhu Biostatistics Core, Hospital for Special Surgery, New York City, NY, United States
Erika Chiapparelli Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0001-9646-2397
Michael Kelly Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
Koki Tsuchiya Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0001-9105-6939
Krizia Amoroso Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0009-0004-9703-262X
Arman Zadeh Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0009-0005-2737-2327
Jennifer Shue Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0001-9885-3834
Ek Tsoon Tan Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0003-2847-9378
Andrew A. Sama Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
Federico P. Girardi Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0002-3269-7602
Frank P. Cammisa Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0002-5797-977X
Alexander P. Hughes Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States https://orcid.org/0000-0001-7293-9672

DOI:

https://doi.org/10.47924/neurotarget2025477

Keywords:

Back pain, Radiofrequency neurotomy, Medial branch, Multifidus, Facet joint

Abstract

Lumbar medial branch radiofrequency neurotomy (RFN), a common treatment for chronic low back pain due to facet joint osteoarthritis (FJOA), may amplify paraspinal muscle atrophy due to denervation. This study aimed to investigate the asymmetry of paraspinal muscle morphology change in patients undergoing unilateral lumbar medial branch RFN. Data from patients who underwent RFN between March 2016 and October 2021 were retrospectively analyzed. Lumbar foramina stenosis (LFS), FJOA, and fatty infiltration (FI) functional cross-sectional area (fCSA) of the paraspinal muscles were assessed on preinterventional and minimum 2-year postinterventional MRI. Wilcoxon signed-rank tests compared measurements between sides. A total of 51 levels of 24 patients were included in the analysis, with 102 sides compared. Baseline MRI measurements did not differ significantly between the RFN side and the contralateral side. The RFN side had a higher increase in multifidus FI (14.2% [0.3-7.8] vs12.0% [22.2 to 6.2], P 5 0.005) and a higher decrease in multifidus fCSA (260.9 mm2 [2116.0 to 10.8] vs 219.6 mm2 [280.3 to 44.8], P 5 0.003) compared with the contralateral side. The change in erector spinae FI and fCSA did not differ between sides. The RFN side had a higher increase in multifidus muscle atrophy compared with the contralateral side. The absence of significant preinterventional degenerative asymmetry and the specificity of the effect to the multifidus muscle suggest a link to RFN. These findings highlight the importance of considering the long-term effects of lumbar medial branch RFN on paraspinal muscle health.

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