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Han G, Fan Z, Yue L, Zou D, Zhou S, Qiu W, Sun Z, Li W. Paraspinal muscle endurance and morphology (PMEM) score: a new method for prediction of postoperative mechanical complications after lumbar fusion. Spine J 2024; 24:1900-1909. [PMID: 38843961 DOI: 10.1016/j.spinee.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND CONTEXT Although the relationships between paraspinal muscles and lumbar degenerative disorders have been acknowledged, paraspinal muscle evaluation has not been incorporated into clinical therapies. PURPOSE We aimed to establish a novel paraspinal muscle endurance and morphology (PMEM) score to better predict mechanical complications after lumbar fusion. STUDY DESIGN Prospective cohort study. PATIENT SAMPLE A total of 212 patients undergoing posterior lumbar interbody fusion with at least 1 year of follow-up were finally included. OUTCOME MEASURES Mechanical complications including screw loosening, pseudarthrosis and other complications like cage subsidence, and patient-reported outcomes were evaluated at last follow-up. METHODS The PMEM score comprised 1 functional muscular parameter (the performance time of the endurance test) and 2 imaging muscular parameters (relative functional cross-sectional area [rFCSA] of paraspinal extensor muscles [PEM] and psoas major [PS] on magnetic resonance imaging). The score was established based on a weighted scoring system created by rounding β regression coefficients to the nearest integer in univariate logistic regression. The diagnostic performance of the PMEM score was determined by binary logistic regression model and receiver operating characteristic (ROC) curve with the area under the curve (AUC). Additionally, pairwise comparisons of ROC curves were conducted to compare the diagnostic performance of the PMEM score with conventional methods based on a single muscular parameter. Moreover, differences of mechanical complications and patient-reported outcomes among the PMEM categories were analyzed using Chi-square test with Bonferroni correction. RESULTS The PMEM score, calculated by adding the scores for each parameter, ranges from 0 to 5 points. Patients with higher PMEM scores exhibited higher rates of mechanical complications (p<.001). Binary logistic regression revealed that the PMEM score was an independent factor of mechanical complications (p<.001, OR=2.002). Moreover, the AUC of the PMEM score (AUC=0.756) was significantly greater than those of the conventional methods including the endurance test (AUC=0.691, Z=2.036, p<.05), PEM rFCSA (AUC=.690, Z=2.016, p<.05) and PS rFCSA (AUC=0.640, Z=2.771, p<.01). In terms of the PMEM categories, a score of 0-1 was categorized as low-risk muscular state of mechanical complications; 2-3, as moderate; and 4-5, as high-risk state. Moving from the low-risk state to the high-risk state, there was a progressive increase in the rates of mechanical complications (13.8% vs 32.1% vs 72.7%; p<.001), and a decrease in the rates of clinically significant improvement of patient-reported outcomes (all p<.05). CONCLUSIONS The PMEM score might comprehensively evaluate paraspinal muscle degeneration and exhibit greater ability in predicting mechanical complications than the conventional evaluations after lumbar fusion. Surgeons might develop individualized treatment strategy tailored to different muscle degeneration statuses reflected by the PMEM score for decreasing the risk of mechanical complications.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Zheyu Fan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Lihao Yue
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Da Zou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Weipeng Qiu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.
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Wang Z, Zhao Z, Li Z, Gao J, Li Y. Fatty Infiltration in Paraspinal Muscles: Predicting the Outcome of Lumbar Surgery and Postoperative Complications. World Neurosurg 2024; 190:218-227. [PMID: 39019431 DOI: 10.1016/j.wneu.2024.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
Lumbar spine disorders often cause lower back pain, lower limb radiating pain, restricted movement, and neurological dysfunction, which seriously affect the quality of life of middle-aged and older people. It has been found that pathological changes in the spine often cause changes in the morphology and function of the paraspinal muscles (PSMs). Fatty infiltration (FI) in PSMs is closely associated with disc degeneration and Modic changes. And FI causes inflammatory responses that exacerbate the progression of lumbar spine disease and disrupt postoperative recovery. Magnetic resonance imaging can better distinguish between fat and muscle tissue with the threshold technique. Three-dimensional magnetic resonance imaging multi-echo imaging techniques such as water-fat separation and proton density are currently popular for studying FI. Muscle fat content obtained based on these imaging sequences has greater accuracy, visualization, acquisition speed, and utility. The proton density fat fraction calculated from these techniques has been shown to evaluate more subtle changes in PSMs. Magnetic resonance spectroscopy can accurately reflect the relationship between FI and the degeneration of PSMs by measuring intracellular and extracellular lipid values to quantify muscle fat. We have pooled and analyzed published studies and found that patients with spinal disorders often exhibit FI in PSMs. Some studies suggest an association between FI and adverse surgical outcomes, although conflicting results exist. These suggest that clinicians should consider FI when assessing surgical risks and outcomes. Future studies should focus on understanding the biological mechanisms underlying FI and its predictive value in spinal surgery, providing valuable insights for clinical decision-making.
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Affiliation(s)
- Zairan Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zijun Zhao
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhimin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Sun K, Liu J, Zhu H, Wang J, Wan H, Huang B, Zhang Q, Chen G. Lower psoas mass indicates worse prognosis in percutaneous vertebroplasty-treated osteoporotic vertebral compression fracture. Sci Rep 2024; 14:13880. [PMID: 38880790 PMCID: PMC11180649 DOI: 10.1038/s41598-024-64626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024] Open
Abstract
The correlation between lower psoas mass and the prognosis of osteoporotic vertebral compression fractures (OVCF) is still unclear. This study aims to investigate the impact of lower psoas mass on the prognosis of patients undergoing percutaneous vertebroplasty (PVP). One hundred and sixty-three elderly patients who underwent single-segment PVP from January 2018 to December 2021 were included. The psoas to L4 vertebral index (PLVI) via MRI were measured to assess psoas mass. Patients were divided into high PLVI (> 0.79) and low PLVI (≤ 0.79) groups based on the median PLVI in the cohort. The basic information (age, gender, body mass index (BMI) and bone mineral density (BMD)), surgical intervention-related elements (duration of operation, latency to ambulation, period of hospital stay, and surgical site), postoperative clinical outcomes (Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores), and incidence of secondary fractures) were compared. Patients showed no statistically significant differences in terms of age, gender, surgical sute, BMI, BMD and preoperative VAS, ODI, JOA scores (P > 0.05) between the two groups. However, there were significant differences in terms of latency to ambulation, period of hospital stay (P < 0.05). VAS, ODI, and JOA scores at 1, 6, and 12 months after surgery showed that the high PLVI group had significantly better outcomes than the low PLVI group (P < 0.05). Additionally, the low PLVI group had a significantly higher incidence of recurrent fracture (P < 0.05). Lower psoas mass can reduce the clinical effect of PVP in patients with osteoporotic vertebral compression fractures, and is a risk factor for recurrent vertebral fracture.
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Affiliation(s)
- Kai Sun
- Department of Orthopedic Surgery, Jiujiang University Affiliated Hospital, Jiujiang, 332006, China
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Jinan University (Heyuan Shenhe People's Hospital), Heyuan, 517000, China
| | - Jianjun Liu
- Department of Orthopedic Surgery, Jiujiang University Affiliated Hospital, Jiujiang, 332006, China
| | - Haoran Zhu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Jinan University (Heyuan Shenhe People's Hospital), Heyuan, 517000, China
| | - Jiajia Wang
- Department of Orthopedic Surgery, Jiujiang University Affiliated Hospital, Jiujiang, 332006, China
| | - Haiwu Wan
- Department of Orthopedic Surgery, Jiujiang University Affiliated Hospital, Jiujiang, 332006, China
| | - Bo Huang
- Department of Orthopedic Surgery, Jiujiang University Affiliated Hospital, Jiujiang, 332006, China.
| | - Qinglin Zhang
- Department of Orthopedic Surgery, Dongguan Qiaotou Hospital, Dongguan, 523539, China.
| | - Guoliang Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
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Hou X, Hu H, Cui P, Kong C, Wang W, Lu S. Predictors of achieving minimal clinically important difference in functional status for elderly patients with degenerative lumbar spinal stenosis undergoing lumbar decompression and fusion surgery. BMC Surg 2024; 24:59. [PMID: 38365668 PMCID: PMC10873985 DOI: 10.1186/s12893-024-02356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/10/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE To identify the predictors for the achievement of minimal clinically important difference (MCID) in functional status among elderly patients with degenerative lumbar spinal stenosis (DLSS) undergoing lumbar decompression and fusion surgery. METHODS Patients who underwent lumbar surgery for DLSS and had a minimum of 1-year follow-up were included. The MCID achievement threshold for the Oswestry Disability Index (ODI) was set at 12.8. General patient information and the morphology of lumbar paraspinal muscles were evaluated using comparative analysis to identify influencing factors. Multiple regression models were employed to identify predictors associated with MCID achievement. A receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal cut-off values for predicting functional recovery. RESULTS A total of 126 patients (46 males, 80 females; mean age 73.0 ± 5.9 years) were included. The overall rate of MCID achievement was 74.6%. Patients who achieved MCID had significantly higher psoas major muscle attenuation (43.55 vs. 39.23, p < 0.001) and preoperative ODI (51.5 vs. 41.6, p < 0.001). Logistic regression showed that elevated psoas major muscle attenuation (p = 0.001) and high preoperative ODI scores (p = 0.001) were independent MCID predictors. The optimal cut-off values for predicting MCID achievement were found to be 40.46 Hounsfield Units for psoas major muscle attenuation and 48.14% for preoperative ODI. CONCLUSION Preoperative psoas major muscle attenuation and preoperative ODI were reliable predictors of achieving MCID in geriatric patients undergoing lumbar decompression and fusion surgery. These findings offer valuable insights for predicting surgical outcomes and guiding clinical decision-making in elderly patients.
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Affiliation(s)
- Xiaofei Hou
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, China
- Department of Orthopaedics, China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Hailiang Hu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, China
| | - Peng Cui
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, China
| | - Chao Kong
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, China
- Department of Orthopaedics, China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, China.
- Department of Orthopaedics, China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
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Han G, Wang W, Yue L, Fan Z, Li Z, Li J, Sun Z, Li W. Age-Dependent Differences of Paraspinal Muscle Endurance and Morphology in Chinese Community Population Without Chronic Low Back Pain. Global Spine J 2024; 14:235-243. [PMID: 35584688 PMCID: PMC10676164 DOI: 10.1177/21925682221103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES Our aim was to describe age-dependent changes of lumbar paraspinal muscle endurance and morphology in Chinese healthy population. We also explored the relationship between paraspinals endurance and morphology. METHODS A total of 181 participants from Chinese community population without chronic low back pain were included. The participants were divided into three groups: young (20-39 years old, n = 29), middle (40-59 years old, n = 93), and elderly (≥ 60 years old, n = 59). The Ito test was performed to evaluate the isometric endurance of paraspinal muscles. The total cross-sectional area (TCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES) were measured at L1-L5 levels on magnetic resonance imaging. Physical activity level was evaluated using the physical activity index and comorbidities were assessed by the modified 5-item frailty index. RESULTS The elderly group had a shorter performance time of endurance test than the young group and middle-aged group. Correlation analysis showed that age had a significant correlation with endurance test, the average MF TCSA, MF FI, ES TCSA and ES FI of L1-5. In addition, PAI had a significant correlation with endurance test and MF FI. In multiple linear regression analysis, paraspinals endurance was associated with MF FI, ES FI, physical activity level and comorbidities. CONCLUSION Age-related decreases in paraspinals endurance and TCSA, and an increase in FI were revealed. Besides, paraspinal muscles FI, but not TCSA, was negatively associated with the endurance of paraspinals.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Tianjin Hospital, Beijing, China
| | - Lihao Yue
- Peking University Health Science Center, Beijing, China
| | - Zheyu Fan
- Peking University Health Science Center, Beijing, China
| | - Zonglin Li
- Peking University Health Science Center, Beijing, China
| | - Jiaming Li
- Peking University Health Science Center, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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Han G, Zhou S, Qiu W, Fan Z, Yue L, Li W, Wang W, Sun Z, Li W. Role of the Paraspinal Muscles in the Sagittal Imbalance Cascade: The Effects of Their Endurance and of Their Morphology on Sagittal Spinopelvic Alignment. J Bone Joint Surg Am 2023; 105:1954-1961. [PMID: 37856573 DOI: 10.2106/jbjs.22.01175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND The role of paraspinal muscle degeneration in the cascade of sagittal imbalance is still unclear. This study aimed to compare paraspinal muscle degeneration in the 4 stages of sagittal imbalance: sagittal balance (SB), compensated sagittal balance (CSB), decompensated sagittal imbalance (DSI), and sagittal imbalance with failure of pelvic compensation (SI-FPC). In addition, it aimed to compare the effects paraspinal muscle endurance and morphology on sagittal spinopelvic alignment in patients with lumbar spinal stenosis. METHODS A cross-sectional study of 219 patients hospitalized with lumbar spinal stenosis was performed. The isometric paraspinal extensor endurance test and evaluation of atrophy and fat infiltration of the paraspinal extensor muscles and psoas major on magnetic resonance imaging were performed at baseline. Spinopelvic parameters including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and the sagittal vertical axis were measured. RESULTS The patients with lumbar spinal stenosis were divided into 67 with SB, 85 with CSB, 49 with DSI, and 17 with SI-FPC. There were significant differences in paraspinal muscle endurance and morphology among the 4 groups. Furthermore, the SI-FPC group had poorer paraspinal muscle endurance than either the SB or the CSB group. In multiple linear regression analysis, paraspinal muscle endurance and the relative functional cross-sectional area of the paraspinal extensor muscles were the independent predictors of the sagittal vertical axis, and the relative functional cross-sectional area of the psoas major was the independent predictor of relative pelvic version. CONCLUSIONS This study indicated that paraspinal muscle degeneration is not only an initiating factor in pelvic retroversion but also a risk factor for progression from a compensated to a decompensated stage. Specifically, the impairment of muscle endurance in the CSB stage may be the reason why patients experience failure of pelvic compensation. In addition, paraspinal muscle endurance and muscle morphology (relative functional cross-sectional area of the paraspinal extensor muscles and psoas major) had different clinical consequences. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Weipeng Qiu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Zheyu Fan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Lihao Yue
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wei Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wei Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, People's Republic of China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
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Liu Y, Yuan L, Zeng Y, Ni J, Yan S. The Difference in Paraspinal Muscle Parameters and the Correlation with Health-Related Quality of Life among Healthy Individuals, Patients with Degenerative Lumbar Scoliosis and Lumbar Spinal Stenosis. J Pers Med 2023; 13:1438. [PMID: 37888049 PMCID: PMC10608224 DOI: 10.3390/jpm13101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Paraspinal muscle degeneration affects the quality of life in patients with degenerative lumbar scoliosis (DLS) and lumbar spinal stenosis (LSS). We aimed to describe the characteristics and differences in the paraspinal muscle parameters between patients with DLS and LSS and investigate their correlation with health-related quality of life (HRQOL). (2) Methods: There were forty-four participants in each group, namely the DLS, LSS, and healthy groups, who were matched at a ratio of 1:1 according to age, sex, and BMI. Differences in paraspinal muscle parameters among the three groups were compared using analysis of variance or the Mann-Whitney U test, and paraspinal muscle degeneration and HRQOL were analyzed using Spearman's correlation analysis. (3) Results: In the upper lumbar, the psoas (PS), quadratus lumborum (QL), and multifidus (MF) cross-sectional area (CSA) in the DLS group were smaller than those in the other groups. In the lower lumbar region, the CSA of the PS, QL, erector spinae (ES), and gross CSA (GCSA) of the MF in the DLS group were not significantly different from those in the LSS group. These values were lower than those observed in the healthy group. The lean muscle fat index (LMFI) of the MF and ES groups was higher than those of the other groups. Regarding HRQOL, we found that PS and MF CSA were strongly associated with HRQOL in healthy individuals; however, only MF was associated with HRQOL in the LSS group. (4): Conclusion: PS in the upper lumbar region and MF degeneration were more severe in patients with DLS than in those with LSS. ES degeneration was similar between the LSS and DLS groups. MF muscle atrophy in patients with LSS and asymmetric changes in the MF in DLS are associated with quality of life.
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Affiliation(s)
- Yinhao Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Peking University Third Clinical College, Peking University Health Science Center, Haidian District, No. 38 Xueyuan Road, Beijing 100191, China
| | - Lei Yuan
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
| | - Jiajun Ni
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Peking University Third Clinical College, Peking University Health Science Center, Haidian District, No. 38 Xueyuan Road, Beijing 100191, China
| | - Shi Yan
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China; (Y.L.); (L.Y.); (J.N.); (S.Y.)
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing 100191, China
- Peking University Third Clinical College, Peking University Health Science Center, Haidian District, No. 38 Xueyuan Road, Beijing 100191, China
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Suo M, Zhang J, Sun T, Wang J, Liu X, Huang H, Li Z. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med 2023; 55:2258922. [PMID: 37722876 PMCID: PMC10512810 DOI: 10.1080/07853890.2023.2258922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration. OBJECTIVES The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research. METHODS We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions. RESULTS The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice. CONCLUSION The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.
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Affiliation(s)
- Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
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Muellner M, Haffer H, Moser M, Amoroso K, Wang Z, Arzani A, Tan ET, Chiapparelli E, Dodo Y, Shue J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Changes of the posterior paraspinal and psoas muscle in patients with low back pain: a 3-year longitudinal study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3290-3299. [PMID: 37378708 DOI: 10.1007/s00586-023-07814-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time. METHODS Patients with LBP who had a repeat lumbar MRI with a minimum of 3-years apart at a tertiary referral center were analyzed. MRI-based quantitative assessments of the PPM and the psoas muscle were conducted for the baseline and follow-up MRI. The cross sectional area (CSA), the functional cross sectional area (fCSA) and the fat area (FAT) were calculated using a dedicated software program. The fatty infiltration (FI,%) of the regions of interest was calculated. Differences between the 1st and 2nd MRI were calculated for all assessed muscular parameters. RESULTS A total of 353 patients (54.4%female) with a median age of 60.1 years and BMI of 25.8 kg/m2 at baseline were analyzed. The mean time between the 1st and 2nd MRI was 3.6 years. The fCSAPPM declined in both sexes significantly from the 1st to the 2nd MRI, whereas the FATPPM increased. In line with this result, the FIPPM increased in both males (29.9%) and females (19.4%). Females had a higher FIPPM and FIPsoas than males in both MRIs. In females, no significant changes were found for the psoas muscle. The CSAPsoas and fCSAPsoas in males were significantly smaller in the 2nd MRI. With increasing age, a significant trend in a decrease in ∆FIPPM was observed for both sexes. CONCLUSION The study revealed significant quantitatively muscular changes in males and females, especially in the posterior paraspinal muscles in only three years' time.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Zhaorui Wang
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Artine Arzani
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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10
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Han G, Wu H, Dai J, Li X, Yue L, Fan Z, Li Q, Shao Q, Jiang Y, Li W. Does paraspinal muscle morphometry predict functional status and re-operation after lumbar spinal surgery? A systematic review and meta-analysis. Eur Radiol 2023; 33:5269-5281. [PMID: 36977852 PMCID: PMC10326143 DOI: 10.1007/s00330-023-09548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Whether paraspinal muscle degeneration is related to poor clinical outcomes after lumbar surgery is still indistinct, which limits its clinical application. This study aimed to evaluate the predictive value of paraspinal muscle morphology on functional status and re-operation after lumbar spinal surgery. METHODS A review of the literature was conducted using a total of 6917 articles identified from a search of PubMed, EMBASE, and Web of Science databases through September 2022. A full-text review of 140 studies was conducted based on criteria including an objective assessment of preoperative paraspinal muscle morphology including multifidus (MF), erector spinae (ES), and psoas major (PS) in addition to measuring its relationship to clinical outcomes including Oswestry disability index (ODI), pain and revision surgery. Meta-analysis was performed when required metrics could be calculated in ≥ three studies, otherwise vote counting model was a good alternative to show the effect direction of evidence. The standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. RESULTS A total of 10 studies were included in this review. Of them, five studies with required metrics were included in the meta-analysis. The meta-analysis suggested that higher preoperative fat infiltration (FI) of MF could predict higher postoperative ODI scores (SMD = 0.33, 95% CI 0.16-0.50, p = 0.0001). For postoperative pain, MF FI could also be an effective predictor for persistent low back pain after surgery (SMD = 0.17, 95% CI 0.02-0.31, p = 0.03). However, in the vote count model, limited evidence was presented for the prognostic effects of ES and PS on postoperative functional status and symptoms. In terms of revision surgery, there was conflicting evidence that FI of MF and ES could predict the incidence of revision surgery in the vote count model. CONCLUSION The assessment of MF FI could be a viable method to stratify patients with lumbar surgery by the risk of severe functional disability and low back pain. KEY POINTS • The fat infiltration of multifidus can predict postoperative functional status and low back pain after lumbar spinal surgery. • The preoperative evaluation of paraspinal muscle morphology is conducive for surgeons.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Haotian Wu
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Jinyue Dai
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xinhang Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Lihao Yue
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zheyu Fan
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Qiaoyu Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Qirui Shao
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Yu Jiang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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11
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Han G, Wang W, Zhou S, Li W, Zhang B, Sun Z, Li W. Paraspinal Muscle Degeneration as an Independent Risk for Loss of Local Alignment in Degenerative Lumbar Scoliosis Patients After Corrective Surgery. Global Spine J 2023; 13:1186-1193. [PMID: 34404242 PMCID: PMC10416586 DOI: 10.1177/21925682211022284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES To investigate the effect of paraspinal muscle degeneration on the maintenance of local and global alignment among degenerative lumbar scoliosis (DLS) patients after corrective surgery. METHODS 98 DLS patients with a mean follow-up period of 38.3 months after corrective surgery were included. The T1 pelvic angle (TPA), lumbar lordosis (LL), pelvic incidence were measured preoperatively, immediate postoperatively and at last follow-up. All patients were divided into LL maintenance group (n = 21) and LL loss group (n = 77). For patients with well-aligned correction (immediate postoperative TPA ≤ 20°, n = 73), they were divided into TPA maintenance group (last follow-up TPA ≤ 20°) and TPA loss group (last follow-up TPA > 20°). The relative gross cross-sectional area (rGCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured at L3, L4 and L5 on preoperative magnetic resonance imaging. RESULTS MF rGCSA were significantly smaller in LL loss group than in LL maintenance group. Both MF rGCSA and PS rFCSA were significantly smaller and MF FI was significantly higher in TPA loss group than in TPA maintenance group. Binary logistic regression revealed that the MF rGCSA was an independent factor of LL loss; Large immediate postoperative TPA was an independent risk factor of TPA loss, but not the parameters of paraspinal muscles. CONCLUSION The effect of paraspinal muscles in lower lumbar segments might be mainly focused on the maintenance of local alignment rather than the global alignment.
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Affiliation(s)
- Gengyu Han
- Orthopedics Department, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research and Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University, Beijing, China
| | - Wei Wang
- Orthopedics Department, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research and Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University, Beijing, China
| | - Siyu Zhou
- Orthopedics Department, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research and Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University, Beijing, China
| | - Wei Li
- Orthopedics Department, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research and Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University, Beijing, China
| | - Bo Zhang
- Orthopedics Department, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research and Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University, Beijing, China
| | - Zhuoran Sun
- Orthopedics Department, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research and Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University, Beijing, China
| | - Weishi Li
- Orthopedics Department, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research and Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University, Beijing, China
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12
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A clinical nomogram for predicting the residual low back pain after percutaneous endoscopic surgery for lumbar disc herniation. INTERNATIONAL ORTHOPAEDICS 2023; 47:819-830. [PMID: 36542140 DOI: 10.1007/s00264-022-05658-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Current findings suggest that minimally percutaneous endoscopic lumbar discectomy (PELD) is a practical therapeutic approach for lumbar disc herniation (LDH). However, some patients still end up with residual low back pain, even after surgery. Our study aims to construct and validate a nomogram to predict residual low back pain after PELD. METHODS The medical records of 355 LDH patients admitted to the author's hospital were retrospectively analyzed between January 2019 and December 2021. The patients were randomly divided into two groups with a ratio of 7:3, namely a modelling group and a validation group. The univariable logistics and multivariable regression methods were used to screen the independent risk factors. A nomogram was then drawn using independent risk factors selected from the univariable and multivariable regression analyses. The concordance index (C-index), the receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis were used to evaluate the nomogram's performance. Finally, the accuracy of the nomogram was verified by a validation cohort. RESULTS 36.6% (130/355) of patients showed low back pain after percutaneous endoscopic lumbar discectomy, while 63.4% (225/355) showed no symptoms. Multivariable logistical regression analysis showed that Modic change (p < 0.05, OR = 1.813), fatty infiltration of the paravertebral muscle (p < 0.05, OR = 2.935), and edema of lumbodorsal fascia (p = 0.049, OR = 1.611) were significant risk factors for post-operative residual back pain. Moreover, the C-index of the predictive nomogram was 0.743 (0.681-0.805), the area under the receiver operating characteristic curve (AUC) value was 0.739, and the DCA results exhibit a net benefit between 0.16 and 0.66. The above internal validation methods demonstrate the nomogram's good predictive capability. CONCLUSION Each variable in the model had a quantitatively corresponding risk score, which can be used in predicting residual low back pain after PELD.
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13
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Guan J, Zhao D, Liu T, Yu X, Feng N, Jiang G, Li W, Yang K, Zhao H, Yang Y. Correlation between surgical segment mobility and paravertebral muscle fatty infiltration of upper adjacent segment in single-segment LDD patients: retrospective study at a minimum 2 years' follow-up. BMC Musculoskelet Disord 2023; 24:28. [PMID: 36635673 PMCID: PMC9835309 DOI: 10.1186/s12891-023-06137-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between surgical segment mobility and fatty infiltration of the adjacent segment paravertebral muscles in patients with single-segment lumbar degenerative disease (LDD) who underwent decompression with fusion or dynamic stabilization. METHODS Retrospective analysis of patients who underwent lumbar decompression combined with titanium rod fixation intertransverse fusion (PITF group), Isobar TTL dynamic stabilization (TTL group) or Isobar EVO dynamic stabilization (EVO group) for single-segment lumbar degenerative disease, from March 2012 to July 2018. The preoperative and final follow-up clinical indexes C-LDSI and the measured imaging indexes (range of motion of the surgical segment and the upper adjacent segment, and Goutallier grade of the upper adjacent segment) were counted, and the differences between the preoperative and final follow-up indexes were compared. RESULTS According to the inclusion and exclusion criteria, 68 patients were included in this study, 21 in the PITF group, 24 in the TTL group, and 23 in the EVO group. At the final follow-up, the C-LSDI score had significantly higher in the PITF group than the TTL and EVO groups, and the C-LSDI score was a very strongly negatively correlated with ROM of surgical segment (r=-0.7968, p < 0.001). There was a strong negative correlation between surgical segment and upper adjacent segment mobility (r = -0.6959, p < 0.001). And there was a very strong negative correlation between ROM of surgical segment and upper adjacent segment paravertebral muscle Goutallier classification (r = -0.8092, p < 0.001), whereas the ROM of the upper adjacent segment was strong positive correlated with the Goutallier classification (r = 0.6703, P < 0.001). CONCLUSION Compared with decompression combined with rigid fusion, decompression combined with dynamic fixation for single-segment lumbar degenerative disease can significantly reduce postoperative low back stiffness. And a certain range of increased mobility of the dynamic stabilization device can effectively reduce the compensatory mobility of the upper adjacent segment and slow down the fatty infiltration of the paravertebral muscle in the adjacent segment.
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Affiliation(s)
- Jianbin Guan
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - Dingyan Zhao
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - Tao Liu
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - Xing Yu
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - Ningning Feng
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - Guozheng Jiang
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - Wenhao Li
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - Kaitan Yang
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - He Zhao
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
| | - Yongdong Yang
- grid.24695.3c0000 0001 1431 9176Dongzhimen Hospital Beijing University of Chinese Medicine, Haiyuncang No.5, Dongcheng District 100700 Beijing, China
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14
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Chua M, Salame K, Khashan M, Ofir D, Hochberg U, Ankory R, Lidar Z, Regev GJ. Facet overhang: A novel parameter in the pathophysiology of multifidus muscle atrophy. Clin Anat 2022; 35:1123-1129. [PMID: 35701879 PMCID: PMC9795881 DOI: 10.1002/ca.23923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
The relationship between degenerative zygapophysial joint (facet) arthropathy and multifidus muscle atrophy has not been rigorously evaluated. The purpose of this study was to determine if specific morphological features of degenerative facet arthropathy are correlated with multifidus muscle atrophy. We retrospectively reviewed medical records and imaging studies of patients with lumbar spinal stenosis. Facet overhang, bridging osteophyte formation, facet effusion, and facet angles were evaluated by univariable and multivariable regression to identify independent associations with deep and superficial parts of the multifidus total cross-sectional area (tCSA), functional cross-sectional area (fnCSA), and fatty infiltration (FI). Facet overhang was classified as severe in 50 females (53.2%) versus 56 males (36.9%) (p = 0.030). Severity of facet overhang and female sex were independently associated with smaller deep part of the multifidus tCSA and fnCSA as well as higher FI, reflecting greater atrophy of the deep region compared to total muscle mass. In comparison, severe facet overhang (p < 0.001; OR = 3.47, 95% CI = 2.13-5.66) and female sex (p < 0.001; OR = 4.19, 95% CI = 2.58-6.79) were independently associated only with higher superficial part of the multifidus FI, reflecting muscle steatosis without significant lean muscle atrophy. In patients with degenerative lumbar spinal stenosis, facet overhang is an independent risk factor for deep part of the multifidus atrophy. Bridging osteophyte formation, facet effusion, and facet angles were not independently associated with deep part of the multifidus atrophy.
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Affiliation(s)
- Michelle Chua
- Department of NeurosurgeryTel‐Aviv Sourasky Medical CenterTel‐Aviv,Sackler Faculty of MedicineTel Aviv UniversityTel‐Aviv
| | - Khalil Salame
- Department of NeurosurgeryTel‐Aviv Sourasky Medical CenterTel‐Aviv,Sackler Faculty of MedicineTel Aviv UniversityTel‐Aviv
| | - Morsi Khashan
- Department of NeurosurgeryTel‐Aviv Sourasky Medical CenterTel‐Aviv,Sackler Faculty of MedicineTel Aviv UniversityTel‐Aviv
| | - Dror Ofir
- Department of NeurosurgeryTel‐Aviv Sourasky Medical CenterTel‐Aviv,Sackler Faculty of MedicineTel Aviv UniversityTel‐Aviv
| | - Uri Hochberg
- Department of NeurosurgeryTel‐Aviv Sourasky Medical CenterTel‐Aviv,Sackler Faculty of MedicineTel Aviv UniversityTel‐Aviv
| | - Ran Ankory
- Department of NeurosurgeryTel‐Aviv Sourasky Medical CenterTel‐Aviv,Sackler Faculty of MedicineTel Aviv UniversityTel‐Aviv
| | - Zvi Lidar
- Department of NeurosurgeryTel‐Aviv Sourasky Medical CenterTel‐Aviv,Sackler Faculty of MedicineTel Aviv UniversityTel‐Aviv
| | - Gilad J. Regev
- Department of NeurosurgeryTel‐Aviv Sourasky Medical CenterTel‐Aviv,Sackler Faculty of MedicineTel Aviv UniversityTel‐Aviv
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15
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Chen Q, Lei C, Zhao T, Dai Z, Zhang J, Jin Y, Xia C. Relationship between sarcopenia/paravertebral muscles and the incidence of vertebral refractures following percutaneous kyphoplasty: a retrospective study. BMC Musculoskelet Disord 2022; 23:879. [PMID: 36138369 PMCID: PMC9494877 DOI: 10.1186/s12891-022-05832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to reveal the associations of osteoporotic vertebral compression refracture (OVCRF) incidence with sarcopenia and paravertebral muscles (PVM). METHODS A total of 214 elderly patients who underwent percutaneous kyphoplasty in our hospital between January 2017 and December 2019 were analyzed. Data on possible risk factors, including sex, age, weight, height, diabetes, treated vertebral levels (thoracolumbar junction [(T10-L2]), vacuum clefts, and body mass index (BMI), were collected. Preoperative bone mineral density (BMD) and appendicular muscle mass were evaluated using dual-energy X-ray absorptiometry. Nutritional status was evaluated using the Mini Nutritional Assessment. Magnetic resonance imaging was performed to evaluate the physiological cross-sectional area of the PVM. RESULTS Overall, 74 (15 men and 59 women) and 60 (55 women and 14 men) patients developed OVCRF and sarcopenia, respectively. Sarcopenia is related to advanced age, ower BMD and BMI values. Sarcopenia-related indicators (PVM fat rate, appendicular muscle mass index, grip strength) were significantly lower in the sarcopenia group. Univariate analysis showed a correlation between OVCRF and BMD, BMI, diabetes, sarcopenia, and age. Multivariate analysis suggested that fatty infiltration of the PVM, BMD, sarcopenia, diabetes, BMI, and treated vertebral level remained as the independent predictors of OVCRF (p < 0.05). CONCLUSIONS The association between sarcopenia and PVM as independent risk factors for OVCRF was established in this study; therefore, sarcopenia should be greatly considered in OVCRF prevention.
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Affiliation(s)
- Qi Chen
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Chenyang Lei
- Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Tingxiao Zhao
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Zhanqiu Dai
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Jun Zhang
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China.
| | - Yongming Jin
- Spine Lab, Department of Orthopedic Surgery, The First Affifiliated Hospital, Medical College of Zhejiang University, Hangzhou, China.
| | - Chen Xia
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China.
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16
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Han G, Zhou S, Wang W, Li W, Qiu W, Li X, Fan X, Li W. Correlations between paraspinal extensor muscle endurance and clinical outcomes in preoperative LSS patients and clinical value of an endurance classification. J Orthop Translat 2022; 35:81-86. [PMID: 36196076 PMCID: PMC9494036 DOI: 10.1016/j.jot.2022.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022] Open
Abstract
Background Few study has investigated how paraspinal muscle endurance deteriorates in lumbar spinal stenosis (LSS) patients. In addition, little information is available on the relationship between clinical outcomes and the endurance of paraspinal muscles. Objective To explore the correlation between paraspinal extensor muscle endurance, quality of life (QOL) and sagittal spinopelvic alignment. Besides, we attempted to propose a paraspinal extensor muscle endurance test (PEMET) classification for identifying the severity of clinical symptoms and sagittal imbalance in LSS patients. Methods 171 hospitalized LSS patients and 100 healthy controls from the community were prospectively enrolled in this study. The paraspinal extensor endurance test was performed at baseline according to Ito test. The LSS patients were stratified into three groups based on the performance time of endurance test: grade I (<10s); grade II (10–60s); and grade III (>60s). Clinical measures of QOL included the visual analog scale scores (VAS) for back pain and leg pain and the Oswestry Disability Index (ODI). Sagittal alignment was analysed by standing posteroanterior and lateral whole spine X-ray in LSS patients. Results The LSS group had a significantly shorter performance time of the endurance test than the control group. The paraspinal muscle endurance significantly correlated with VAS-back, VAS-leg, ODI, pelvic tilt, lumbar lordosis and sagittal vertical axis (SVA; all p < 0.05). In binary logistic regression, the performance time of the endurance test was an independent factor of both poor functional status (ODI >40; p = 0.005, OR = 0.985) and global sagittal imbalance (SVA >50 mm; p = 0.019, OR = 0.985). Based on PEMET classification, moving from the grade III group to the grade I group, there was progressive worsening in VAS-back and ODI (all adjusted p < 0.05). Moreover, the grade I group had significantly greater VAS- leg, less LL and greater SVA than the other two groups (all adjusted p < 0.05). Conclusion Paraspinal muscle endurance was associated with QOL and sagittal spinopelvic alignment in LSS patients. A PEMET classification system has been constructed and has shown a correlation with QOL and sagittal imbalance. Translational potential statement The PEMET classification system proposed in this study could be available for identifying the severity of clinical symptoms and sagittal imbalance during preoperative evaluation in LSS patients.
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Han G, Zou D, Li X, Zhang S, Li Z, Zhou S, Li W, Sun Z, Li W. Can fat infiltration in the multifidus muscle be a predictor of postoperative symptoms and complications in patients undergoing lumbar fusion for degenerative lumbar spinal stenosis? A case-control study. J Orthop Surg Res 2022; 17:289. [PMID: 35619169 PMCID: PMC9137055 DOI: 10.1186/s13018-022-03186-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose This study aimed to explore whether 25% as the cutoff value of fat infiltration (FI) in multifidus (MF) could be a predictor of clinical outcomes of lumbar spinal stenosis (LSS) patients.
Methods A total of 461 patients undergoing posterior lumbar interbody fusion for LSS with 1-year follow-up were identified. After sex- and age-match, 160 pairs of patients were divided into a FI < 25% group and a FI ≥ 25% group according to FI of MF at L4 on preoperative magnetic resonance imaging. Patient-reported outcomes including the visual analog scale scores (VAS) for back pain and leg pain and the Oswestry disability index (ODI) scores were evaluated. Bone nonunion and screw loosening were evaluated by dynamic X-ray. Results After matching, there was no significant difference in age, sex, body mass index, fusion to S1, number of fusion levels, osteoporosis, spondylolisthesis, smoking and diabetes. FI ≥ 25% group had significantly higher VAS for back pain, VAS for leg pain and ODI than FI < 25% group at 1-year follow-up. However, there was no significant difference in the change of them from baseline to 1-year follow-up between the two groups. In light of complications, FI ≥ 25% group had a significantly higher rate of bone nonunion than FI < 25% group, whereas there was no significant difference of screw loosening rates between the two groups. Conclusion MF FI might be a pragmatic cutoff value to predict bone nonunion in LSS patients, but it has little predictive value on screw loosening and postoperative improvement of symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03186-2.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Da Zou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xinhang Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Shuquan Zhang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Zhenxu Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Wei Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China. .,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China. .,Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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Han G, Zou D, Liu Z, Zhang B, Gong C, Zhou S, Li W, Sun Z, Li W. Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion. BMC Musculoskelet Disord 2022; 23:232. [PMID: 35264133 PMCID: PMC8908625 DOI: 10.1186/s12891-022-05178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/02/2022] [Indexed: 12/15/2022] Open
Abstract
Background The prognosis value of paraspinal muscle degeneration on clinical outcomes has been revealed. However no study has investigated the effect of the fat infiltration (FI) of paraspinal muscles on bone nonunion after posterior lumbar interbody fusion (PLIF). Methods Three hundred fifty-one patients undergoing PLIF for lumbar spinal stenosis with 1-year follow-up were retrospectively identified. Patients were categorized into bone union (n = 301) and bone nonunion (n = 50) groups based on dynamic X-ray at 1-year follow-up. The relative total cross-sectional area (rTCSA) and FI of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured on preoperative magnetic resonance imaging. Results The nonunion group had a significantly higher MF FI and a higher ES FI and a smaller MF rTCSA than the union group (p = 0.001, 0.038, 0.026, respectively). Binary logistic regression revealed that MF FI (p = 0.029, odds ratio [OR] = 1.04), lumbosacral fusion (p = 0.026, OR = 2193) and length of fusion (p = 0.001, OR = 1.99) were independent factors of bone nonunion. In subgroup analysis, in one or two-level fusion group, the patients with nonunion had a higher MF FI and a higher ES FI than those of the patients with union (all p < 0.05). Similarly, in lumbosacral fusion group, the patients with nonunion had a higher MF FI and a higher ES FI than those of the patients with union (all p < 0.05). The logistic regressions showed that MF FI remained an independent factor of bone nonunion both in the patients with one or two-level fusion (p = 0.003, OR = 1.074) and in the patients with lumbosacral fusion (p = 0.006, OR = 1.073). Conclusions Higher fatty degeneration was strongly associated with bone nonunion after PLIF. Surgeons should pay attention to the FI of paraspinal muscles when performing posterior surgery for patients, especially those who need short-segment fusion or to extend fusion to S1. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05178-z.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Da Zou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zexiang Liu
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Bo Zhang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Chunjie Gong
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Wei Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China. .,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China. .,Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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19
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Han G, Zou D, Liu Z, Zhou S, Li W, Gong C, Sun Z, Li W. Paraspinal muscle characteristics on MRI in degenerative lumbar spine with normal bone density, osteopenia and osteoporosis: a case-control study. BMC Musculoskelet Disord 2022; 23:73. [PMID: 35057764 PMCID: PMC8780389 DOI: 10.1186/s12891-022-05036-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background To investigate the difference of paraspinal muscles in patients with normal bone density, osteopenia and osteoporosis. Methods Patients undergoing surgery for lumbar spinal stenosis were included. Thirty-eight patients with osteoporosis were matched to patients with osteopenia and patients with normal bone density in a 1:1 manner according to WHO criteria. Dual-energy X-ray absorptiometry (DXA) scans and lumbar CT were performed preoperatively to measure the BMD of lumbar, femur and hip and HU values of L1-L4 respectively. The relative total cross-sectional area (rTCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured at L4–5 and L5-S level on preoperative MRI. Results Osteoporotic patients showed lower BMI, higher MF FI and higher ES FI when compared with normal bone density group (25.57 ± 3.71 vs 27.46 ± 3.11; 0.38 ± 0.1 vs 0.32 ± 0.08; 0.33 ± 0.1 vs 0.28 ± 0.08; all adjusted p < 0.05). Both the MF FI and ES FI were significantly correlated with lumbar T-score (r = − 0.223, p < 0.05; r = − 0.208, p < 0.05) and the averaged lumbar HU value (r = − 0.305, p < 0.01; r = − 0.239, p < 0.05). Conclusions Osteoporosis and paraspinal muscle degeneration might interact with each other and coexist in patients with degenerative lumbar diseases. It is recommended that the paraspinal muscle degeneration should be considered simultaneously when finding a patient with low bone mass before surgery.
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Chua M, Hochberg U, Regev G, Ophir D, Salame K, Lidar Z, Khashan M. Gender differences in multifidus fatty infiltration, sarcopenia and association with preoperative pain and functional disability in patients with lumbar spinal stenosis. Spine J 2022; 22:58-63. [PMID: 34111552 DOI: 10.1016/j.spinee.2021.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In patients with lumbar spinal stenosis, female gender has been associated with higher pain and functional disability. Sarcopenia and multifidus atrophy have also been associated with symptomatic severity. PURPOSE The purpose of this study was to determine if gender differences in sarcopenia and multifidus atrophy are associated with gender disparities in disease symptomatology. STUDY DESIGN Prospectively collected medical records and imaging studies were retrospectively reviewed. PATIENT SAMPLE We retrospectively reviewed medical records and imaging studies for 63 patients with clinically and radiologically defined lumbar spinal stenosis at L3/4 or L4/5 who underwent minimally invasive decompression. OUTCOME MEASURES Pain and functional disability were measured using the Oswestry Disability Index (ODI) and visual analogue scores for back pain (VASB) and leg pain (VASL). METHODS Multifidus total cross sectional area (tCSA), multifidus functional cross sectional area (fnCSA), multifidus fatty infiltration (FI), psoas tCSA, and psoas relative cross sectional area (rCSA) were evaluated by univariable and multivariable regression to identify gender linked and gender independent predictors of higher ODI, VASB, and VASL. RESULTS Female gender was significantly associated with lower multifidus fnCSA (p < .001), higher multifidus FI (p < .001), lower psoas tCSA (p < .001), lower psoas rCSA (p = .002), and higher preoperative ODI (p = .008). Lower psoas rCSA (p = .044) and psoas tCSA in the lowest sex specific quartile (p = .034) were significantly associated with higher preoperative VASB and psoas rCSA less than the sex specific median (p = .050) was significantly associated with higher preoperative VASL after controlling for age and gender. Multifidus FI was significantly associated with preoperative ODI after adjusting for age (p = .048) but not after controlling additionally for gender (p = .651). CONCLUSIONS Female patients with lumbar spinal stenosis may develop more severe and functionally significant multifidus atrophy, resulting in a more severe clinical course with higher functional disability. Sarcopenia was significantly associated with higher preoperative back pain and leg pain in both male and female patients with lumbar spinal stenosis.
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Affiliation(s)
- Michelle Chua
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv, Israel. Sackler faculty of medicine, Tel-Aviv University
| | - Uri Hochberg
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv, Israel. Sackler faculty of medicine, Tel-Aviv University
| | - Gilad Regev
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv, Israel. Sackler faculty of medicine, Tel-Aviv University
| | - Dror Ophir
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv, Israel. Sackler faculty of medicine, Tel-Aviv University
| | - Khalil Salame
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv, Israel. Sackler faculty of medicine, Tel-Aviv University
| | - Zvi Lidar
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv, Israel. Sackler faculty of medicine, Tel-Aviv University
| | - Morsi Khashan
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv, Israel. Sackler faculty of medicine, Tel-Aviv University.
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21
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Li Q, Shi L, Wang Y, Guan T, Jiang X, Guo D, Lv J, Cai L. A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. Pain Res Manag 2021; 2021:3624614. [PMID: 34760032 PMCID: PMC8575618 DOI: 10.1155/2021/3624614] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Current findings suggest that percutaneous vertebroplasty (PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). However, a significant minority of patients still experience residual back pain after PVP. The present retrospective study was designed to determine the risk factors for residual back pain after PVP and provides a nomogram for predicting the residual back pain after PVP. METHODS We retrospectively reviewed the medical records of patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into group N and group R according to the postoperative VAS score. Group R is described as the VAS score of residual back pain ≥ 4. Pre- and postoperative factors that may affect back pain relief were evaluated between two groups. Univariate and multivariate logistic regression analysis were performed to identify risk factors affecting residual back pain after PVP. We provided a nomogram for predicting the residual back pain and used the receiver operating characteristic curve (ROC), concordance index (C-index), calibration curve, and decision curve analyses (DCA) to evaluate the prognostic performance. RESULTS Among 268 patients treated with PVP, 37 (13.81%) patients were classified postoperative residual back pain. The results of the multivariate logistical regression analysis showed that the presence of an intravertebral vacuum cleft (IVC) (OR 3.790, P=0.026), posterior fascia oedema (OR 3.965, P=0.022), severe paraspinal muscle degeneration (OR 5.804, P=0.01; OR 13.767, P < 0.001), and blocky cement distribution (OR 2.225, P=0.041) were independent risk factors for residual back pain after PVP. The AUC value was 0.780, suggesting that the predictive ability was excellent. The prediction nomogram presented good discrimination, with a C-index of 0.774 (0.696∼0.852) and was validated to be 0.752 through bootstrapping validation. The calibration curve of the nomogram demonstrated a good consistency between the probabilities predicted by the nomogram and the actual probabilities. The nomogram showed net benefits in the range from 0.06 to 0.66 in DCA. CONCLUSIONS The presence of IVC, posterior fascia oedema, blocky cement distribution, and severe paraspinal muscle degeneration were significant risk factors for residual back pain after PVP for OVCFs. Patients with OVCFs after PVP who have these risk factors should be carefully monitored for the possible development of residual back pain. We provide a nomogram for predicting the residual back pain after PVP.
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Affiliation(s)
- Qiujiang Li
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lin Shi
- Traditional Chinese Medicine Hospital Dianjiang Chongqing, Chongqing, China
| | - Yinbin Wang
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Tao Guan
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Xiaocheng Jiang
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Donggeng Guo
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Jinhan Lv
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lijun Cai
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
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22
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Mandelli F, Nüesch C, Zhang Y, Halbeisen F, Schären S, Mündermann A, Netzer C. Assessing Fatty Infiltration of Paraspinal Muscles in Patients With Lumbar Spinal Stenosis: Goutallier Classification and Quantitative MRI Measurements. Front Neurol 2021; 12:656487. [PMID: 34539538 PMCID: PMC8446197 DOI: 10.3389/fneur.2021.656487] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/23/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: Fatty infiltration of paraspinal muscle is associated with spinal disorders. It can be assessed qualitatively (i.e., Goutallier classification) and quantitatively using image processing software. The aims of this study were to compare paraspinal muscle fatty infiltration as assessed using the Goutallier classification vs. quantitative magnetic resonance images (MRI) measurements and to investigate the association between anthropometric parameters and paraspinal muscle morphology and fatty infiltration in patients with symptomatic lumbar spinal stenosis (LSS). Methods: Patients affected by symptomatic LSS scheduled for surgery with available MRI of the lumbar spine were included in this retrospective cross-sectional study. Fatty infiltration at each lumbar level was rated qualitatively according to the Goutallier classification and quantified based on the cross-sectional area (CSA) of the paraspinal muscle, of its lean fraction (LeanCSA), and the ratio between LeanCSA and CSA and the CSA relative to the CSA of vertebral body (RCSA). Considering the muscle as a single unit, overall fatty infiltration according to Goutallier, overall CSA, LeanCSA, LeanCSA/CSA, and RCSA were computed as averages (aGoutallier, aCSA, aLeanCSA, aLeanCSA/aCSA, and aRCSA). Associations among parameters were assessed using Spearman's respective Pearson's correlation coefficients. Results: Eighteen patients, with a mean age of 71.3 years, were included. aGoutallier correlated strongly with aLeanCSA and aLeanCSA/aCSA (R = −0.673 and R = −0.754, both P < 0.001). There was a very strong correlation between values of the left and right sides for CSA (R = 0.956, P < 0.001), LeanCSA (R = 0.900, P < 0.001), and LeanCSA/CSA (R = 0.827, P < 0.001) at all levels. Among all anthropometric measurements, paraspinal muscle CSA correlated the most with height (left: R = 0.737, P < 0.001; right: R = 0.700, P < 0.001), while there was a moderate correlation between vertebral body CSA and paraspinal muscle CSA (left: R = 0.448, P < 0.001; right: R = 0.454, P < 0.001). Paraspinal muscle CSA correlated moderately with body mass index (BMI; left: R = 0.423, P < 0.001; right: R = 0.436, P < 0.001), and there was no significant correlation between aLeanCSA or aLeanCSA/CSA and BMI. Conclusions: The Goutallier classification is a reliable yet efficient tool for assessing fatty infiltration of paraspinal muscles in patients with symptomatic LSS. We suggest taking body height as a reference for normalization in future studies assessing paraspinal muscle atrophy and fatty infiltration.
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Affiliation(s)
- Filippo Mandelli
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Orthopaedics, University Children's Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Yuancheng Zhang
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Florian Halbeisen
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
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