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.
BMC Musculoskelet Disord. 2022 Mar 9;23(1):232. doi: 10.1186/s12891-022-05178-z.
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).
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.
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).
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.
脊柱旁肌退变对临床结果的预后价值已被揭示。然而，尚无研究探讨脊柱旁肌脂肪浸润（FI）对后路腰椎体间融合（PLIF）后骨不连的影响。
回顾性分析了 351 例接受 PLIF 治疗腰椎管狭窄症并随访 1 年的患者。根据术后 1 年的动态 X 线检查，将患者分为骨融合（n=301）和骨不连（n=50）两组。在术前磁共振成像上测量多裂肌（MF）和竖脊肌（ES）的相对总横截面积（rTCSA）和 FI，以及腰大肌（PS）的相对功能横截面积（rFCSA）。
不连组 MF 的 FI 和 ES 的 FI 明显高于融合组，而 MF 的 rTCSA 明显小于融合组（p=0.001，0.038，0.026）。二元逻辑回归显示，MF FI（p=0.029，比值比[OR] =1.04）、腰骶融合（p=0.026，OR=2193）和融合长度（p=0.001，OR=1.99）是骨不连的独立因素。在亚组分析中，在 1 或 2 个节段融合组中，不连组的患者 MF FI 和 ES FI 均高于融合组（均 p<0.05）。同样，在腰骶融合组中，不连组的患者 MF FI 和 ES FI 均高于融合组（均 p<0.05）。逻辑回归显示，在 1 或 2 个节段融合的患者（p=0.003，OR=1.074）和腰骶融合的患者（p=0.006，OR=1.073）中，MF FI 仍然是骨不连的独立因素。
较高的脂肪变性与 PLIF 后骨不连密切相关。当对患者进行后路手术时，外科医生应注意脊柱旁肌的 FI，尤其是那些需要短节段融合或将融合延伸至 S1 的患者。
