Ghimire Niraj, Lakhe Prashant, Kumar Anil, Ghimire Nisha, Kutum Chayanika, Choudhary Deepak, Singh Chauhan Bhanu Pratap, Narang Poonam, Singh Hukum, Singh Daljit
Department of Neurosurgery, Nepalgunj Medical College, Nepal.
Department of Neurosurgery, All India Institute of Medical Sciences, Nagpur, India.
Brain Spine. 2024 Nov 17;4:104141. doi: 10.1016/j.bas.2024.104141. eCollection 2024.
Paraspinal muscle atrophy has been implicated in low back pain (LBP) as well as degenerative disc disease, lumbar spinal stenosis, and disc herniation. The objective of the study was to determine the association of paraspinal muscle morphology with functional outcomes in patients undergoing spine surgery in degenerative spine diseases.
Can the degree of paraspinal muscle atrophy be a reliable prognostic indicator of post-operative functional outcome in patients undergoing surgery for degenerative lumbar spine disease?
Forty-one patients with degenerative lumbar spine disease planned for surgery were included. Pre-operative and postoperative MRI-based muscle morphology including total cross-sectional area (TCSA) and muscle atrophy were recorded. Association between muscle parameters and functional status as indicated from the visual analogue scale (VAS), and Oswestry Disability Index (ODI) were assessed, and compared between prior and after surgery.
The MF and ES cross-sectional area on MRI was in proportion to the functional status. (higher ODI and VAS). Preoperative MF TCSA was positively correlated with preoperative ODI ((r = -0.441, p = = 0.032), preoperative VAS (r = -0.338, p = 0.048) and was negatively correlated with change in ODI (r = -0.268, p = 0.016) while preoperative ES TCSA was negatively correlated with preoperative ODI (r = -0.420, p = 0.003). Preoperative ODI, change in ODI and preoperative VAS had significant correlation with muscle atrophy ( < 0.05). There was a positive correlation between preoperative ODI with Grade 2 ( = 0.332, = 0.016) and Grade 3 ( = 0.299, = 0.048) MF muscle; and Grade 2 ( = 0.308, = 0.067) and Grade 3 ( = 0.202, = 0.018) ES muscles atrophy. The change in ODI, negatively correlated with Grade 3 MF and ES atrophy (r = -0.332, p = 0.018 and r = -0.286, P = 0.011 respectively). Linear regression analysis showed duration of symptom (p = 0.005) was positively associated with preoperative ODI. Age and BMI were negatively associated with improvement in ODI. (p = 0.073, 0.098 respectively).
Preoperative paraspinal muscle area is an independent variable that affects preoperative functional status. The grade of paraspinal muscle atrophy is a good predictor of preoperative, postoperative and improvement in functional status.
椎旁肌萎缩与腰痛、椎间盘退变疾病、腰椎管狭窄症及椎间盘突出症有关。本研究的目的是确定在退行性脊柱疾病患者接受脊柱手术时，椎旁肌形态与功能结局之间的关联。
对于接受退行性腰椎疾病手术的患者，椎旁肌萎缩程度能否作为术后功能结局的可靠预后指标？
纳入41例计划接受手术的退行性腰椎疾病患者。记录基于术前和术后MRI的肌肉形态，包括总横截面积（TCSA）和肌肉萎缩情况。评估肌肉参数与视觉模拟量表（VAS）及奥斯威斯功能障碍指数（ODI）所显示的功能状态之间的关联，并比较手术前后的情况。
MRI上的多裂肌（MF）和竖脊肌（ES）横截面积与功能状态成比例（ODI和VAS较高）。术前MF的TCSA与术前ODI呈正相关（r = -0.441，p = 0.032）、术前VAS呈正相关（r = -0.338, p = 0.048），与ODI的变化呈负相关（r = -0.268, p = 0.016），而术前ES的TCSA与术前ODI呈负相关（r = -0.420, p = 0.003）。术前ODI、ODI的变化及术前VAS与肌肉萎缩有显著相关性（p < 0.05）。术前ODI与2级（r = 0.332, p = 0.016）和3级（r = 0.299, p = 0.048）的MF肌肉；以及2级（r = 0.308, p = 0.067）和3级（r = 0.202, p = 0.018）的ES肌肉萎缩呈正相关。ODI的变化与3级MF和ES萎缩呈负相关（分别为r = -0.332, p = 0.018和r = -0.286, p = 0.011）。线性回归分析显示症状持续时间（p = 0.005）与术前ODI呈正相关。年龄和体重指数与ODI的改善呈负相关（分别为p = 0.073, 0.098）。
术前椎旁肌面积是影响术前功能状态的一个独立变量。椎旁肌萎缩程度是术前、术后及功能状态改善的良好预测指标。
