Ultrasonography of Paravertebral Muscles of Patients with Lumbar Spine Degenerative Diseases and Prognosis of their Surgical Treatment Results

The article deals with the issues of the establishment of ultrasonography criteria for assessing the status of paravertebral muscles of patients with degenerative diseases of the lumbar spine and predicting the results of their surgical treatment. Material and methods. We studied the results of a survey of 74 patients (31 men and 43 women) who were operated in the clinic of vertebrology for degenerative diseases of the lumbar spine. All patients were divided into four groups – N, G, S, and St. Group N consisted of 15 (20.27%) persons with unstable vertebral segments, a group of G had 25 patients (33.78 %) with diagnosis of an intervertebral disc hernia during the examination. Group S was represented by 15 (20.27 %) patients with spondylolisthesis, St group had 19 (25.68 %) patients with spinal stenosis. Fifth group was control and had 12 people in it. An ultrasonography study was conducted in real-time on the Toshiba Aplio, Japan. Linear ultrasound sensors with a frequency of 5.0-7.5 MHz were used to assess the state of skeletal muscle. Results and discussion. Among the patients selected for surgical treatment, 13 (17.6%) had severe disabilities, 30 (40.5%) were disabled, and 31 (41.9%) had ligament disturbances. After surgical treatment, minimal disabilities were observed in 24 patients (32.4%), moderate in 37 (50.0%), and 13 (17.6%) remained serious and invalidating disorders. Most results of the operations performed at the Institute of Vertebrology Clinic were evaluated as the best and most satisfactory. Therefore, for the selection of the necessary group with unsatisfactory results, it was necessary to search for a longer time. This group is of particular interest. It included 13 people (5 men and 8 women) aged 53.54 ± 2.54. That is, unsatisfactory results of surgical treatment are defined in patients older than 48 years. The diagnosis of "stenosis of the lumbar spine canal" was determined in 8 (61.54%) of them, hernia of the intervertebral disc was in 3 (23.08%) patients, spondylolisthesis was diagnosed in 2 (15.38%) of them. Patients of this group were performed surgical treatment that improved their condition: the significance of Osvetic disabilitative index changes (Wilcoxon Z = 3.179797, p <0.05) was found, but their condition remained difficult after surgery. In two patients, the degree of disability abilities after treatment has not changed. Prior to surgical treatment, serious violations (degree of severity III) were detected in 1 patient from this group. Disorders resulting in disability (gravity IV) were found in 4 patients; disorders of bedding (V degree) were noted in 8 patients. After treatment the disability in 9 patients was qualified as serious (degree of severity III), and 4 of them had the IV degree of severity. Conclusion. Thus, with the help of ultrasonography we observed stenosis in most degenerative diseases of the lumbar spine that increased echogenicity and violation of the structure of paravertebral muscles. The "Instability" group does not differ from the control one in any indicators. The hernias occupy an intermediate position (they are closer to stenosis and spondylolisthesis in thickness of muscle layer, and on indicators that take into account PZH, sometimes do not differ from control or from instability). We also proved the dependence between ultrasonography changes of paravertebral muscles and the results of surgical treatment of patients with degenerative lesions of the lumbar spine. The main factors of influence are the thickness of the muscular layer, increased echogenicity of the tissue and the significance of the ratio of the subcutaneous fat layer / muscle layer. We proposed the model which allows predicting the results of surgical treatment based on ultrasonography data of paravertebral muscles in patients with degenerative diseases of the lumbar spine with an accuracy of 84.4%.