Changes in the Flexion-Relaxation Response Following Percutaneous Endoscopic Lumbar Discectomy in Patients with Disc Herniation.

Changes in the Flexion-Relaxation Response Following Percutaneous Endoscopic Lumbar Discectomy in Patients with Disc Herniation.

World Neurosurg. 2019 Feb 15;:

Authors: Li Y, Zhang X, Dai J, Wang J, Wu H, Liu J, Chen J, Zhu Y, Zhao F

Abstract
BACKGROUND: Previous studies of percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation (LDH) have shown good clinical results. However, there is limited information about the post-operative improvement in back muscle function. We aimed to determine whether changes in neuromuscular patterns, assessed using the flexion-relaxation phenomenon (FRP), could be observed following PELD surgery.
METHODS: Thirty patients participated in the study. The patients' muscle functions were evaluated before and after PELD using surface electromyography (EMG) and self-report measures. The evaluated action included three repetitions of a trunk flexion and extension movement. The association between FRP measures and patient-reported outcomes was evaluated.
RESULTS: Four weeks after PELD, the patients had significantly lower visual analogue scale (VAS) and Québec Back Pain Disability Scale (QBPDS) scores and a significant increase in gross range of motion (ROM). Also, we observed a reduction in erector spinae (ES) muscle activation at L3 in the maximum voluntary flexion (MVF) phase. Normalized EMG root-mean-square values were significantly reduced in the MVF phase and significantly increased in the extension phase. Postoperatively, 60% of the patients successfully achieved flexion-relaxation compared to 7% of the patients preoperatively. There was a significant correlation between FRP measures and patient-reported outcomes, except for the Fear-Avoidance Beliefs Questionnaire scale.
CONCLUSION: PELD for individuals with LDH appears to normalize paraspinal muscle activation during lumbar flexion-extension movements. Gross ROM and disability-related limitations of physical activity are also improved.

PMID: 30776518 [PubMed - as supplied by publisher]

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