腰椎多裂肌肌内脂肪浓度与腰椎管狭窄减压术后的恢复相关。一项为期5年随访的纵向队列研究。
Lumbar Multifidus Intramuscular fat Concentrations are Associated With Recovery Following Decompressive Surgery for Lumbar Spinal Stenosis. A Longitudinal Cohort Study With 5-year Follow-up.
作者信息
Wesselink Evert Onno, Verheijen Eduard, Djuric Niek, Coppieters Michel, Elliott James, Weber Kenneth Arnold, Wouter Moojen, Vleggeert-Lankamp Carmen, Pool-Goudzwaard Annelies
机构信息
Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA.
出版信息
Spine (Phila Pa 1976). 2025 May 27. doi: 10.1097/BRS.0000000000005408.
STUDY DESIGN
Longitudinal cohort study.
OBJECTIVE
To explore the association between pre-operative lumbar paraspinal intramuscular fat (IMF) and recovery over a 5-year period following surgical decompression for lumbar spinal stenosis (LSS)-related intermittent neurogenic claudication.
SUMMARY OF BACKGROUND DATA
The literature is inconclusive whether higher IMF concentrations on MRI are related to unfavorable outcomes following lumbar decompressive surgery for intermittent neurogenic claudication due to LSS.
METHODS
Patients(N=149) with LSS-related intermittent neurogenic claudication (52% male; mean (SD) age: 65.5 (9.1) years; BMI: 27.9 (4.3)) were included for this study. Pre-operative lumbar paraspinal IMF was quantified and categorized as non-severe (<50%) and severe (≥50%) IMF for each muscle (left and right lumbar multifidus and erector spinae) from axial T2-weighted MRI scans using automated computer-vision models. Logistic regression was used to investigate the association between IMF and global perceived effect as well as surgical success. Linear mixed-effects models were used to assess the difference in the clinical course of leg and back pain and disability between the IMF groups. The models were corrected for potential confounders.
RESULTS
Overall, participants with non-severe IMF in the lumbar multifidus reported a higher percentage of successful recovery (53.7% versus 37.5%) and surgical success (76.5% versus 59.9%) compared to the severe IMF group. This association was not present for erector spinae IMF. After adjusting for the potential confounders, the associations between lumbar multifidus IMF and successful recovery and surgical success remained significant for most timepoints across the 5-year follow-up (Odds ratios: 2.26-7.32, p≤0.049). Patients with non-severe IMF in the right lumbar multifidus experienced less disability (P=0.035). No between-group differences were found for the clinical course of leg and back pain (p≥0.143).
CONCLUSIONS
Pre-operative levels of IMF in the lumbar multifidus, but not the erector spinae, were associated with 5-year recovery and success following surgery for LSS-related intermittent neurogenic claudication.
研究设计
纵向队列研究。
目的
探讨术前腰椎旁肌内脂肪（IMF）与腰椎管狭窄症（LSS）相关间歇性神经源性跛行手术减压后5年恢复情况之间的关联。
背景数据总结
关于MRI上较高的IMF浓度是否与LSS所致间歇性神经源性跛行的腰椎减压手术后不良结局相关，文献尚无定论。
方法
本研究纳入149例LSS相关间歇性神经源性跛行患者（52%为男性；平均（标准差）年龄：65.5（9.1）岁；体重指数：27.9（4.3））。使用自动计算机视觉模型，通过轴向T2加权MRI扫描对术前腰椎旁IMF进行量化，并将每块肌肉（左右腰大肌和竖脊肌）的IMF分为非严重（<50%）和严重（≥50%）两类。采用逻辑回归研究IMF与总体感知效果以及手术成功率之间的关联。使用线性混合效应模型评估IMF组之间腿部和背部疼痛及残疾临床过程的差异。对模型进行潜在混杂因素校正。
结果
总体而言，与严重IMF组相比，腰大肌中IMF非严重的参与者报告的成功恢复百分比更高（53.7%对37.5%），手术成功率也更高（76.5%对59.9%）。竖脊肌IMF不存在这种关联。在调整潜在混杂因素后，腰大肌IMF与成功恢复和手术成功率之间的关联在5年随访的大多数时间点仍具有显著性（优势比：2.26 - 7.32，p≤0.049）。右侧腰大肌中IMF非严重的患者残疾程度较轻（P = 0.035）。在腿部和背部疼痛的临床过程中未发现组间差异（p≥0.143）。
结论
术前腰大肌而非竖脊肌的IMF水平与LSS相关间歇性神经源性跛行手术后5年的恢复和成功相关。
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