PMID- 37796163 OWN - NLM STAT- Publisher LR - 20231005 IS - 1528-1159 (Electronic) IS - 0362-2436 (Linking) DP - 2023 Oct 5 TI - Examining the Role of Paraspinal Musculature in Post-Operative Disability after Lumbar Fusion Surgery for Degenerative Spondylolisthesis. LID - 10.1097/BRS.0000000000004840 [doi] AB - STUDY DESIGN: Retrospective analysis of prospectively enrolled patients. OBJECTIVE: To evaluate the relationship between paraspinal muscle (PM) atrophy and Oswestry Disability Index (ODI) improvement after spinal fusion surgery for degenerative lumbar spondylolisthesis (DLS). BACKGROUND: Atrophy of the PM is linked to multiple spinal conditions, sagittal malalignment, and increased postoperative complications. However, only limited evidence for the effect on patient-reported outcomes exists. METHODS: Patients with DLS undergoing decompression and fusion surgery were analyzed. Patients with missing follow-up, no imaging, or inadequate image quality were excluded. The Oswestry Disability Index (ODI) was assessed preoperatively and two years postoperatively. A cross-sectional area of the PM was measured on a T2-weighted Magnetic Resonance Imaging (MRI) sequence at the upper endplate of L4. Based on the literature, a 10-point improvement cut-off was defined as the minimum clinically important difference (MCID). Patients with a baseline ODI below the MCID were excluded. Logistic regression was used to calculate the association between fatty infiltration (FI) of the PM and improvement in ODI, adjusted for age, sex, and body mass index (BMI). RESULTS: 133 patients were included in the final analysis, with only two lost to follow-up. The median age was 68 years (IQR 62 - 73). The median preoperative ODI was 23 (IQR 17 - 28), and 76.7% of patients showed improvement in their ODI score by at least 10 points. In the multivariable regression, FI of the erector spinae and multifidus increased the risk of not achieving clinically relevant ODI improvement (P=0.01 and P<0.001, respectively). No significant association was found for the psoas muscle (P=0.158). CONCLUSIONS: This study demonstrates that FI of the erector spinae and multifidus, is significantly associated with less likelihood of clinically relevant ODI improvement following decompression and fusion. Further research is needed to assess the effect of interventions. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Schonnagel, Lukas AU - Schonnagel L AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. AD - Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin, Berlin, Germany. FAU - Guven, Ali E AU - Guven AE AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. AD - Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin, Berlin, Germany. FAU - Camino-Willhuber, Gaston AU - Camino-Willhuber G AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. FAU - Caffard, Thomas AU - Caffard T AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. AD - Universitatsklinikum Ulm, Klinik fur Orthopadie, Ulm, Germany. FAU - Tani, Soji AU - Tani S AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. AD - Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan. FAU - Zhu, Jiaqi AU - Zhu J AD - Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA. FAU - Haffer, Henryk AU - Haffer H AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. AD - Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin, Berlin, Germany. FAU - Muellner, Maximilian AU - Muellner M AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. AD - Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin, Berlin, Germany. FAU - Zadeh, Arman AU - Zadeh A AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. FAU - Sanchez, Leonardo Albertine AU - Sanchez LA AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. FAU - Shue, Jennifer AU - Shue J AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. FAU - Duculan, Roland AU - Duculan R AD - Hospital for Special Surgery, New York City, NY, USA. FAU - Schomig, Friederike AU - Schomig F AD - Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin, Berlin, Germany. FAU - Sama, Andrew A AU - Sama AA AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. FAU - Cammisa, Frank P AU - Cammisa FP AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. FAU - Girardi, Federico P AU - Girardi FP AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. FAU - Mancuso, Carol A AU - Mancuso CA AD - Hospital for Special Surgery, New York City, NY, USA. AD - Weill Cornell Medical College, New York, NY. FAU - Hughes, Alexander P AU - Hughes AP AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA. LA - eng PT - Journal Article DEP - 20231005 PL - United States TA - Spine (Phila Pa 1976) JT - Spine JID - 7610646 SB - IM COIS- Declaration of conflicting interest: The Authors declare that there is no conflict of interest concerning materials or methods used in this study or the findings specified in this paper. EDAT- 2023/10/05 12:42 MHDA- 2023/10/05 12:42 CRDT- 2023/10/05 10:33 PHST- 2023/08/02 00:00 [received] PHST- 2023/09/23 00:00 [accepted] PHST- 2023/10/05 12:42 [medline] PHST- 2023/10/05 12:42 [pubmed] PHST- 2023/10/05 10:33 [entrez] AID - 00007632-990000000-00482 [pii] AID - 10.1097/BRS.0000000000004840 [doi] PST - aheadofprint SO - Spine (Phila Pa 1976). 2023 Oct 5. doi: 10.1097/BRS.0000000000004840.