Chiapparelli Erika, Caffard Thomas, Medina Samuel J, Amoroso Krizia, Zhu Jiaqi, Guven Ali E, Evangelisti Gisberto, Hambrecht Jan, Kohli Paul, Tsuchiya Koki, Tripathi Vidushi, Verna Bruno, Shue Jennifer, Sama Andrew, Girardi Federico P, Cammisa Frank P, Hughes Alexander P
Spine Care Institute, Hospital for Special Surgery, New York City, USA.
Department of Orthopedic Surgery, University of Ulm, Ulm, Germany.
Eur Spine J. 2025 Jun 13. doi: 10.1007/s00586-025-09030-5.
Spinal stenosis, a common degenerative condition causing back pain and neurogenic claudication, often requires decompression surgery when conservative treatments fail. This study investigates the relationship between posterior paraspinal muscle (PPM) measurements and early conversion to lumbar fusion in patients following decompression surgery. Understanding this relationship is crucial, as prior research suggests paraspinal fat infiltration impacts spinal alignment and surgical outcomes, potentially necessitating revision lumbar fusion surgery.
An institutional database of posterior lumbar fusion patients was reviewed, excluding those with prior fusion history and missing pre-decompression MRIs. Conversions within two years post-decompression were "early conversion," those between 2 and 5 years "intermediate conversion," and those 5 years or later "late conversion." Muscle segmentations were performed using ITK-SNAP, with ROI set in the bilateral psoas muscle and PPM on preoperative T2-weighted axial MRI at the superior endplate of L4. Muscle metrics were calculated using Matlab™, and sagittal alignment was assessed on sagittal standing spinal radiographs.
The final analysis included 50 patients, with early conversion to fusion observed in 21 patients (42%), intermediate in 14 patients (28%), and late in 15 patients (30%). Patients with early conversion showed significantly higher total PPM FI compared to those with late conversion (p = 0.03). No differences were noted in sagittal alignment measurements among groups.
Higher PPM FI may estimate early conversion to lumbar fusion post-decompression surgery, emphasizing the importance of muscle health in surgical planning and patient management for spinal stenosis. Further research is needed to refine risk stratification and optimize treatment strategies.
椎管狭窄是一种常见的退行性疾病，可导致背痛和神经源性间歇性跛行，保守治疗失败时通常需要进行减压手术。本研究调查了减压手术后患者椎旁肌（PPM）测量值与早期转为腰椎融合术之间的关系。了解这种关系至关重要，因为先前的研究表明椎旁脂肪浸润会影响脊柱排列和手术效果，可能需要进行翻修腰椎融合手术。
回顾了一个机构的腰椎融合患者数据库，排除有既往融合病史和术前MRI缺失的患者。减压后两年内的转为“早期转换”，2至5年之间的为“中期转换”，5年或更晚的为“晚期转换”。使用ITK-SNAP进行肌肉分割，在术前L4上终板的T2加权轴向MRI上，在双侧腰大肌和PPM中设置感兴趣区域（ROI）。使用Matlab™计算肌肉指标，并在矢状位站立脊柱X线片上评估矢状位排列。
最终分析纳入50例患者，其中21例（42%）早期转为融合术，14例（28%）中期转换，15例（30%）晚期转换。早期转换的患者与晚期转换的患者相比，PPM总脂肪浸润（FI）显著更高（p = 0.03）。各组间矢状位排列测量值无差异。
较高的PPM FI可能预示减压手术后早期转为腰椎融合术，强调了肌肉健康在椎管狭窄手术规划和患者管理中的重要性。需要进一步研究以完善风险分层并优化治疗策略。
