Hambrecht Jan, Köhli Paul, Duculan Roland, Lan Ranqing, Chiapparelli Erika, Guven Ali E, Evangelisti Gisberto, Burkhard Marco D, Tsuchiya Koki, Shue Jennifer, Sama Andrew A, Cammisa Frank P, Girardi Federico P, Mancuso Carol A, Hughes Alexander P
Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Spine (Phila Pa 1976). 2024 Oct 16. doi: 10.1097/BRS.0000000000005192.
Secondary analysis of prospective study.
To investigate the impact of fatty infiltration (FI) in the paraspinal muscles (PM) on postoperative Oswestry Disability Index (ODI) subsection-scores in patients undergoing elective lumbar surgery for degenerative lumbar spondylolisthesis (DLS).
DLS can increase FI in the PM like the multifidus (MF), erector spinae (ES), and psoas (PS), leading to greater spinal disability and higher ODI-scores. It is unclear if increased PM FI affects all ODI subsections equally.
This study reviewed data from a single-center cohort of DLS-patients who underwent elective lumbar surgery. Overall ODI and the subsection scores were prospectively assessed before and 2 years post-surgery. FI of the PS, MF, and ES was measured using T2-weighted MRI images. The relationship between PM FI and postoperative ODI subsections were analyzed, using multivariable linear regression analysis.
Overall, 229 patients (59% female, mean age of 67±8 y) were included with an overall baseline ODI of 50[40-62] and a postoperative ODI of 16.[2-34] The highest preoperative subsection-scores were seen in pain intensity (4[2-4]), changing degree of pain (4[3-4]), lifting (4[1-5]), and standing (4[3-4]). PM-measurements showed a mean FI of 41±10% for ES, 58±15% for MF, and 6±5% for PS. Patients with increased ES FI were more likely to show higher postoperative scores in all ODI subsections and in the overall ODI (Est=0.45, 95%CI 0.20-0.71, P=0.004). Increased MF FI was significantly associated with higher postoperative ODI subsection scores in standing (Est=0.02, 95%CI 0.01-0.03, P=0.033) and walking (Est=0.02, 95%CI 0.01-0.03, P=0.017).
Increased erector spinae fatty infiltration is significantly associated with higher ODI scores across all subsections 2 years after lumbar surgery, while higher multifidus fatty infiltration is linked to greater disability in standing and walking. These findings underscore the need to maintain paraspinal muscle health to improve surgical planning, improve rehabilitation outcomes, and reduce postoperative disability.
前瞻性研究的二次分析。
探讨退行性腰椎滑脱症（DLS）择期腰椎手术患者椎旁肌（PM）脂肪浸润（FI）对术后Oswestry功能障碍指数（ODI）各亚组评分的影响。
DLS可增加多裂肌（MF）、竖脊肌（ES）和腰大肌（PS）等椎旁肌的脂肪浸润，导致更严重的脊柱功能障碍和更高的ODI评分。目前尚不清楚椎旁肌脂肪浸润增加是否对所有ODI亚组有同等影响。
本研究回顾了接受择期腰椎手术的DLS患者的单中心队列数据。术前和术后2年对总体ODI及其亚组评分进行前瞻性评估。使用T2加权MRI图像测量腰大肌、多裂肌和竖脊肌的脂肪浸润情况。采用多变量线性回归分析方法分析椎旁肌脂肪浸润与术后ODI亚组之间的关系。
共纳入229例患者（59%为女性，平均年龄67±8岁），总体基线ODI为50[40 - 62]，术后ODI为16[2 - 34]。术前亚组评分最高的是疼痛强度（4[2 - 4]）、疼痛变化程度（4[3 - 4]）、提举（4[1 - 5]）和站立（4[3 - 4]）。椎旁肌测量结果显示，竖脊肌平均脂肪浸润为41±10%，多裂肌为58±15%，腰大肌为6±5%。竖脊肌脂肪浸润增加的患者在所有ODI亚组和总体ODI中的术后评分更有可能更高（估计值=0.45，95%置信区间0.20 - 0.71，P = 0.004）。多裂肌脂肪浸润增加与术后站立（估计值=0.02，95%置信区间0.01 - 0.03，P =
