The Use of Curare During Anesthesia to Prevent Iatrogenic Muscle Damage Caused by Lumbar Spinal Surgery Through a Posterior Approach

Abstract

STUDY DESIGN: Prospective randomized study of patients undergoing lumbar arthrodesis. OBJECTIVES: To evaluate the use of curare during anesthesia to limit muscle lesions caused by surgery. SUMMARY OF BACKGROUND DATA: It has been shown that lumbar spine surgery through a posterior approach can induce iatrogenic lesions in the erector spinae. The prevention of these lesions by intraoperative cholinergic blockade has never been evaluated. METHODS: Twenty patients scheduled to undergo pedicle-screw enhanced L4-L5 arthrodesis were enrolled in this study. The average age was 48.9 years. Ten patients received curare during anesthesia and 10 patients did not. Postoperative pain was assessed using a visual analog scale (VAS) and the consumption of morphine by patient-controlled analgesia during the first 24 hours. Intramuscular pressure (IMP) in the multifidus was monitored during the intervention. A biopsy of the multifidus muscle was performed at the end of the intervention for histologic study. Serum activity of the MM iso-enzyme of the creatine phosphokinase (CPK-MM) was measured 24 hours after surgery. RESULTS: The average consumption of morphine and the mean value of the VAS at 24 hours were not statistically different between these 2 groups. The use of a self-retaining retractor during lumbar surgery resulted in a substantial increase in IMP, resulting in histologic muscle lesions and an increase in serum CPK-MM activity. There was no significant difference between the 2 groups of patients. CONCLUSIONS: The use of curare during anesthesia did not limit the muscle damage caused by surgery.