Zavras Athan G, Sullivan T Barrett, Federico Vincent P, Nolte Michael T, Munim Mohammed A, Phillips Frank M, Colman Matthew W
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Global Spine J. 2024 Mar;14(2):647-656. doi: 10.1177/21925682221120400. Epub 2022 Aug 19.
Retrospective cohort.
Lateral lumbar interbody fusion (LLIF) commonly involves a transpsoas approach. Despite the association between LLIF, postoperative iliopsoas weakness, and iatrogenic neuropraxia, no study has yet examined the effect of psoas or multifidus muscle quality on patient-reported outcomes (PROs).
This study retrospectively reviewed patients who underwent LLIF with 1-year minimum follow-up. Psoas and multifidus muscle qualities were graded on preoperative magnetic resonance imaging using two validated classification systems for muscle atrophy. Average muscle quality was calculated as the mean score from all levels (L1-2 through L5-S1). Univariate and multivariate statistics were utilized to investigate the relationship between psoas/multifidus muscle quality and preoperative, 6-weeks postoperative, and final postoperative PROs.
74 patients (110 levels) with a mean follow-up of 18.71 ± 8.02 months were included for analysis. Greater multifidus atrophy was associated with less improvement on ODI, SF12, and VR12 ( < .05) on univariate analysis. On multivariate analysis, worse multifidus atrophy predicted less improvement on SF12 and VR12 ( < .05).
Despite the direct manipulation of the psoas muscle inherent to LLIF, preoperative psoas muscle quality did not affect postoperative outcomes. Rather, the extent of preoperative multifidus fatty infiltration and atrophy was more likely to predict postoperative pain and disability. These findings suggest that multifidus atrophy may be more pertinent than psoas atrophy in its association with patient-reported outcome measures after LLIF.
回顾性队列研究。
腰椎外侧椎间融合术（LLIF）通常采用经腰大肌入路。尽管LLIF与术后腰大肌无力和医源性神经失用症之间存在关联，但尚无研究探讨腰大肌或多裂肌质量对患者报告结局（PROs）的影响。
本研究回顾性分析了接受LLIF且至少随访1年的患者。使用两种经过验证的肌肉萎缩分类系统，在术前磁共振成像上对腰大肌和多裂肌质量进行分级。平均肌肉质量计算为所有节段（L1-2至L5-S1）的平均评分。采用单因素和多因素统计学方法研究腰大肌/多裂肌质量与术前、术后6周及术后最终PROs之间的关系。
纳入74例患者（110个节段）进行分析，平均随访时间为18.71±8.02个月。单因素分析显示，多裂肌萎缩程度越高，ODI、SF12和VR12的改善程度越低（P<0.05）。多因素分析显示，多裂肌萎缩越严重，SF12和VR12的改善程度越低（P<0.05）。
尽管LLIF本身对腰大肌有直接操作，但术前腰大肌质量并未影响术后结局。相反，术前多裂肌脂肪浸润和萎缩程度更有可能预测术后疼痛和功能障碍。这些发现表明，在LLIF后与患者报告结局指标的关联中，多裂肌萎缩可能比腰大肌萎缩更相关。
