J Korean Med Sci.  2023 May;38(20):e151. 10.3346/jkms.2023.38.e151.

Effect of Muscularity and Fatty Infiltration of Paraspinal Muscles on Outcome of Lumbar Interbody Fusion

• You KH
• Cho M
• Lee JH

• KMID: 2542592
• DOI: http://doi.org/10.3346/jkms.2023.38.e151

Abstract

Background
Lumbar paraspinal muscles play an important role in maintaining global spinal alignment and are associated with lower back pain; however, only a few studies on the effect of the paraspinal muscles on the surgical outcome exist. Therefore, this study aimed to analyze the association of preoperative muscularity and fatty infiltration (FI) of paraspinal muscles with the outcome of lumbar interbody fusion.
Methods
Postoperative clinical and radiographic outcomes were analyzed in 206 patients who underwent surgery for a degenerative lumbar disease. The preoperative diagnosis was spinal stenosis or low-grade spondylolisthesis, and the surgery performed was posterior lumbar interbody fusion or minimally invasive transforaminal lumbar interbody fusion. Indications for surgery were a complaint of severe radiating pain that did not improve with conservative treatment and neurological symptoms accompanied by lower extremity motor weakness. Patients with fractures, infections, tumors, or a history of lumbar surgery were excluded from this study. Clinical outcome measures included functional status, measured using the Oswestry disability index (ODI) and visual analog scale (VAS) score for lower back and leg pain. Other radiographic parameters included measures of spinal alignment, including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, C7 sagittal vertical axis, and pelvic incidence-lumbar lordosis mismatch. Lumbar muscularity (LM) and FI were measured preoperatively using a lumbar magnetic resonance image (MRI).
Results
The high LM group showed more significant improvement in VAS score for lower back pain than the low LM group. In contrast, the VAS score for leg pain demonstrated no statistical significance. The high LM group showed more significant improvement in ODI postoperatively than the medium group. The severe FI group showed more significant improvement in ODI postoperatively, whereas the less severe FI group showed more significant improvement in the sagittal balance postoperatively.
Conclusion
Patients with high LM and mild FI ratio observed on preoperative MRI demonstrated more favorable clinical and radiographic outcomes after lumbar interbody fusion. Therefore, preoperative paraspinal muscle condition should be considered when planning lumbar interbody fusion.

Keyword

Paraspinal Muscle; Lumbar Muscularity; Fatty Infiltration; Posterior Lumbar Interbody Fusion; Minimally Invasive Transforaminal Lumbar Interbody Fusion

Figure

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  Fig. 1 Measurement of LM. LM was measured by dividing the CSA of bilateral multifidus and erector spinae muscle by the CSA of L3 lower endplate to correct for individual differences in body size.LM = lumbar muscularity, CSA = cross sectional area.

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  Fig. 2 Measurement of FI. FI was measured as the ratio of the fatty infiltration area among the total cross sectional areas of both multifidus and erector spinae muscle. (A, B) Mild FI (less than 30%). (C, D) Moderate FI (30% to 50%). (E, F) Severe FI group (more than 50%).FI = fatty infiltration.

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  Fig. 3 Clinical outcomes between each groups according to lumbar muscularity and fatty infiltration. (A, B) Visual analogue scale for back pain. (C, D) VAS for leg pain. (E, F) Oswestry disability index.LM = lumbar muscularity, FI = fatty infiltration, VAS = visual analogue scale.

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