Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
Department of Radiology, National Health Insurance Service Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
Medicine (Baltimore). 2022 Jul 1;101(26):e29778. doi: 10.1097/MD.0000000000029778.
AbstractParaspinal (erector spinae and multifidus) and psoas muscles contribute to spinal stability, but no study has yet examined the relationship between muscle mass and recurrent lumbar disc herniation (rLDH). The purpose of this study was to investigate the effect of psoas and paraspinal muscle mass on recurrent Lumbar disc herniation (LDH). This retrospective study included 49 patients with LDH (22 men, 27 women; mean age: 59.9 years; range 32-80) who underwent discectomy and partial laminectomy without fusion and underwent both pre- and postoperative magnetic resonance imaging. The presence of rLDH was determined using medical records and postoperative magnetic resonance imagings. Patients were divided into an rLDH group (26 patients) and a without-rLDH group (23 patients). Clinical characteristics, segmental motion, and paraspinal and psoas muscle mass were compared between the groups. Using ImageJ software, the cross-sectional area (CSA), lean muscle mass (LMM), and skeletal muscle index (SMI) were measured on T2 axial preoperative magnetic resonance images at L2-L3, L3-L4, and L4-L5 disc levels to represent muscle mass. Univariate and multivariate logistic regression analyses were performed. In the rLDH group, patients were younger (52.6 years vs 68.2 years; P = .001), segmental instability was more common (50.0% vs 4.3%; P = .001), and the CSA, LMM, CSASMI, and LMMSMI of psoas muscles were larger (5851.59 mm2 vs 4264.93 mm2, 5456.59 mm2 vs 4044.77 mm2, 18.77 cm2/m2 vs 13.86 cm2/m2, and 17.52 cm2/m2 vs 12.98 cm2/m2; P < .01 for all 4 variables). On multivariate logistic regression, age and segmental instability were independent risk factors for rLDH (odds ratio 0.886 and 18.527; P = .01 and P = .02, respectively). In middle-aged and elderly patients with lumbar disc herniation, relatively younger age, segmental instability, and greater psoas muscle mass may be risk factors for recurrence.
脊柱旁（竖脊肌和多裂肌）和腰大肌有助于脊柱稳定，但目前尚无研究探讨肌肉质量与复发性腰椎间盘突出症（rLDH）之间的关系。本研究旨在探讨腰大肌和脊柱旁肌肉质量对复发性腰椎间盘突出症（LDH）的影响。这项回顾性研究纳入了 49 名接受椎间盘切除术和部分椎板切除术（未融合）的 LDH 患者（22 名男性，27 名女性；平均年龄 59.9 岁；年龄范围 32-80 岁），并在术前和术后均进行了磁共振成像。通过病历和术后磁共振成像确定 rLDH 的存在。患者分为 rLDH 组（26 例）和无 rLDH 组（23 例）。比较两组间的临床特征、节段运动以及脊柱旁和腰大肌肌肉质量。使用 ImageJ 软件，在 L2-L3、L3-L4 和 L4-L5 椎间盘水平的 T2 轴位术前磁共振图像上测量横截面积（CSA）、瘦肌肉质量（LMM）和骨骼肌指数（SMI），以代表肌肉质量。进行单变量和多变量逻辑回归分析。在 rLDH 组中，患者年龄较小（52.6 岁 vs 68.2 岁；P =.001），节段不稳定更为常见（50.0% vs 4.3%；P =.001），并且腰大肌的 CSA、LMM、CSASMI 和 LMMSMI 更大（5851.59mm2 vs 4264.93mm2，5456.59mm2 vs 4044.77mm2，18.77cm2/m2 vs 13.86cm2/m2，17.52cm2/m2 vs 12.98cm2/m2；所有 4 个变量的 P<.01）。多变量逻辑回归分析显示，年龄和节段不稳定是 rLDH 的独立危险因素（比值比 0.886 和 18.527；P=.01 和 P=.02）。在患有腰椎间盘突出症的中老年患者中，相对较年轻的年龄、节段不稳定和更大的腰大肌肌肉质量可能是复发的危险因素。
