Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
North Shore University Hospital, 300 Community Dr, Manhasset, NY, USA.
Eur Spine J. 2023 Jul;32(7):2326-2335. doi: 10.1007/s00586-023-07533-7. Epub 2023 Apr 3.
To determine the optimal level for the measurement of psoas cross-sectional area and examine the correlation with short-term functional outcomes of posterior lumbar surgery.
Patients who underwent minimally invasive posterior lumbar surgery were included in this study. The cross-sectional area of psoas muscle was measured at each intervertebral level on T2-weighted axial images of preoperative MRI. Normalized total psoas area (NTPA) (mm/m) was calculated as total psoas area normalized to patient height. Intraclass Correlation Coefficient (ICC) was calculated for the analysis of inter-rater reliability. Patient reported outcome measures including Oswestry disability index (ODI), visual analog scale (VAS), short form health survey (SF-12) and patient-reported outcomes measurement information system were collected. A multivariate analysis was performed to elucidate independent predictors associated with failure to reach minimal clinically important difference (MCID) in each functional outcome at 6 months.
The total of 212 patients were included in this study. ICC was highest at L3/4 [0.992 (95% CI: 0.987-0.994)] compared to the other levels [L1/2 0.983 (0.973-0.989), L2/3 0.991 (0.986-0.994), L4/5 0.928 (0.893-0.952)]. Postoperative PROMs were significantly worse in patients with low NTPA. Low NTPA was an independent predictor of failure to reach MCID in ODI (OR = 2.68; 95% CI: 1.26-5.67; p = 0.010) and VAS leg (OR = 2.43; 95% CI: 1.13-5.20; p = 0.022).
Decreased psoas cross-sectional area on preoperative MRI correlated with functional outcomes after posterior lumbar surgery. NTPA was highly reliable, especially at L3/4.
确定测量竖脊肌横截面积的最佳水平，并研究其与后路腰椎手术后短期功能结果的相关性。
本研究纳入了接受微创后路腰椎手术的患者。在术前 MRI 的 T2 加权轴位图像上测量每个椎间水平的竖脊肌横截面积。将竖脊肌总面积归一化为患者身高，得到标准化总竖脊肌面积（NTPA）（mm/m）。计算组内相关系数（ICC）以分析组内可靠性。收集患者报告的结果测量指标，包括 Oswestry 残疾指数（ODI）、视觉模拟量表（VAS）、简明健康调查量表（SF-12）和患者报告结局测量信息系统。进行多元分析以阐明与 6 个月时每个功能结局未达到最小临床重要差异（MCID）相关的独立预测因素。
本研究共纳入 212 例患者。与其他水平相比，L3/4 处的 ICC 最高[0.992（95% CI：0.987-0.994）] [L1/2 0.983（0.973-0.989），L2/3 0.991（0.986-0.994），L4/5 0.928（0.893-0.952）]。NTPA 较低的患者术后 PROM 明显较差。低 NTPA 是 ODI 未达到 MCID 的独立预测因素（OR=2.68；95% CI：1.26-5.67；p=0.010）和 VAS 腿部（OR=2.43；95% CI：1.13-5.20；p=0.022）。
术前 MRI 上竖脊肌横截面积的减少与后路腰椎手术后的功能结果相关。NTPA 高度可靠，尤其是在 L3/4。
