Department of Neurosurgery and Neurotraumatology, Regional Specialized Hospital, No. 4, al. Legionów 10, 41-902, Bytom, Poland.
Department of Medical Radiology and Roentgenodiagnostics, Clinical Hospital in Zabrze, Silesian Medical University in Katowice, ul. 3-go Maja 13-15, 41-800, Zabrze, Poland.
Arch Orthop Trauma Surg. 2022 Jul;142(7):1375-1384. doi: 10.1007/s00402-021-03754-x. Epub 2021 Jan 23.
There is a growing number of publications highlighting sarcopenia and myosteatosis as poor prognosic factors for treatment results in oncological patients. The decrease in the cross-sectional area (CSA) of the multifidus muscle and muscle steatosis is associated with lumbar disc herniation and low back/limb pain. Nevertheless, no studies have analyzed the influence of the above parameters on patient satisfaction, pain decrease and return to daily activities. The aim of the study was to verify whether decreased preoperative CSA of the paraspinal and psoas major muscles and their fatty degeneration (myosteatosis) may influence the outcome of surgical treatment of lumbar disc disease (LDD).
One hundred and one patients with LDD undergoing open microdiscectomy were enrolled in the analysis. Relative cross-sectional areas (rCSA) of the paraspinal and psoas major muscles as well as their fatty degeneration were measured. Patients were assessed according to the validated Polish versions of the EURO EQ-5D, Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) 1 and 6 months postoperatively. The association between the variables was calculated using Pearson r and Spearman rank correlation. The Kruskal-Wallis test was used to compare the results between the groups with different rCSA of paraspinal and psoas major muscles and a different degree of paraspinal muscle myosteatosis.
Fatty degeneration of the paraspinal muscles correlated with better outcomes 1 and 6 months postoperatively according to ODI (P = 0.003 and P = 0.027, respectively). Patients with higher rCSA of the paraspinal and psoas major muscles achieved better results on the EURO EQ-5D scale (P = 0.0289 and P = 0.0089, respectively). Higher rCSA of the paraspinal and psoas major muscles did not correlate with better outcomes measured using ODI, COMI and VAS scales (P ≥ 0.072).
The degree of fatty degeneration of the paraspinal muscles correlates with better outcomes 1 and 6 months after microdiscectomy.
越来越多的出版物强调肌少症和肌肉脂肪变性是肿瘤患者治疗结果不良的预后因素。多裂肌的横截面积 (CSA) 减少和肌肉脂肪变性与腰椎间盘突出症和腰背/肢体疼痛有关。然而，尚无研究分析上述参数对患者满意度、疼痛减轻和恢复日常活动的影响。本研究旨在验证脊柱旁和腰大肌的术前 CSA 减少及其脂肪变性（肌少症）是否会影响腰椎间盘疾病（LDD）的手术治疗结果。
分析了 101 例接受开放式微创手术的 LDD 患者。测量了脊柱旁和腰大肌的相对 CSA 及其脂肪变性。根据经过验证的波兰版 EURO EQ-5D、核心结局测量指数（COMI）、Oswestry 残疾指数（ODI）和视觉模拟量表（VAS），在术后 1 和 6 个月对患者进行评估。使用 Pearson r 和 Spearman 秩相关计算变量之间的关联。使用 Kruskal-Wallis 检验比较具有不同脊柱旁和腰大肌 rCSA 以及不同程度脊柱旁肌少肌症的组之间的结果。
根据 ODI，脊柱旁肌肉的脂肪变性与术后 1 和 6 个月更好的结果相关（分别为 P=0.003 和 P=0.027）。脊柱旁和腰大肌 rCSA 较高的患者在 EURO EQ-5D 量表上的结果更好（分别为 P=0.0289 和 P=0.0089）。较高的脊柱旁和腰大肌 rCSA 与 ODI、COMI 和 VAS 量表测量的更好结果无关（P≥0.072）。
脊柱旁肌肉的脂肪变性程度与微创手术后 1 和 6 个月的结果相关。
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