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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2025, Number 2

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Cir Columna 2025; 3 (2)

Impact of paravertebral muscle atrophy on surgical results of degenerative lumbar stenosis

Verde BJC, González MA, Sotelo MIJ, Fuentes RMA, Contreras ZMF, Santos BHA, Santos UIE

Language: Spanish
References: 17
Page: 89-96
PDF size: 233.85 Kb.


ABSTRACT

Introduction: degenerative lumbar stenosis (DLS) is one of the main causes of pain and disability in older adults. It was described by Kirkaldy-Willis, who divided the anatomical changes into three progressive stages: dysfunction, instability, and stabilization. These alterations cause narrowing of the spaces around neurovascular structures, which can trigger symptoms such as lumbosciatica and neurogenic claudication. Pain in DLS is a complex phenomenon, characterized by the interaction of multiple anatomical structures. These include the multifidus and erector spinae muscles, which make up the posterior paravertebral musculature (PPM) and play an important role in the overall balance of the lumbar spine. Degenerative changes in the paravertebral musculature, such as atrophy and fatty infiltration, are common in patients with DLS and have been associated with unfavorable surgical results. Objective: we hypothesized that lower muscle volume and a higher degree of fatty infiltration in the posterior paravertebral musculature are associated with unfavorable surgical outcomes in patients with degenerative lumbar stenosis. Material and methods: an observational study was conducted that included 187 patients with degenerative lumbar stenosis undergoing elective surgical treatment. Their preoperative magnetic resonance images were analyzed to determine muscle volume and percentage of fatty infiltration in the posterior paravertebral musculature. The association between muscle atrophy and postoperative clinical outcomes reported in the ODI and the JOABPEQ was studied. Results: the ODI results showed better scores in individuals classified as Kjaer Grade 0 and 1, as well as in patients with high muscle volume. The JOABPEQ questionnaire showed a non-significant improvement in low back pain in patients with Kjaer 2 and low muscle volume. Conclusions: the findings of this investigation indicate that severe fatty infiltration and reduced volume of the posterior paravertebral muscles are associated with unfavorable surgical outcomes in patients with degenerative lumbar stenosis. Identifying these variables will allow for better risk stratification and promote interventions that minimize damage to the paravertebral musculature. Furthermore, the methods used in this study offer an accessible alternative for application in hospital practice.


REFERENCES

  1. Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and management of lumbar spinal stenosis: a review. JAMA. 2022; 327: 1688-1699.

  2. Saremi A, Goyal KK, Benzel EC, Orr RD. Evolution of lumbar degenerative spondylolisthesis with key radiographic features. Spine J. 2024; 24: 989-1000. Available in https://doi.org/10.1016/j.spinee.2024.01.001

  3. Kim HS, Wu PH, Jang IT. Lumbar degenerative disease part 1: anatomy and pathophysiology of intervertebral discogenic pain and radiofrequency ablation of basivertebral and sinuvertebral nerve treatment for chronic discogenic back pain: a prospective case series and review of literature. Int J Mol Sci. 2020; 21: 1483. Available in: https://doi.org/10.3390/ijms21041483

  4. You KH, Cho M, Lee JH. Effect of muscularity and fatty infiltration of paraspinal muscles on outcome of lumbar interbody fusion. J Korean Med Sci. 2023; 38: e151. Available in: https://doi.org/10.3346/jkms.2023.38.e151

  5. Khan AB, Weiss EH, Khan AW, Omeis I, Verla T. Back muscle morphometry: effects on outcomes of spine surgery. World Neurosurg. 2017; 103: 174-179. Available in: https://doi.org/10.1016/j.wneu.2017.03.097

  6. D'hooge R, Cagnie B, Crombez G, Vanderstraeten G, Dolphens M, Danneels L. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther. 2012; 17: 584-588. Available in: https://doi.org/10.1016/j.math.2012.06.007

  7. Haffer H, Muellner M, Chiapparelli E, Dodo Y, Camino-Willhuber G, Zhu J, et al. Georg Schmorl Prize of the German Spine Society (DWG) 2023: the influence of sarcopenia and paraspinal muscle composition on patient-reported outcomes: a prospective investigation of lumbar spinal fusion patients with 12-month follow-up. Eur Spine J. 2024; 33: 1737-1746. Available in: https://doi.org/10.1007/s00586-024-08268-9

  8. Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007; 5: 2. Available in: https://doi.org/10.1186/1741-7015-5-2

  9. Jun HS, Kim JH, Ahn JH, Chang IB, Song JH, Kim TH, et al. The effect of lumbar spinal muscle on spinal sagittal alignment. Neurosurgery. 2016; 79: 847-855. Available in: https://doi.org/10.1227/neu.0000000000001269

  10. Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O'Sullivan R, et al. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J. 2015; 15: 1593-1601. Available in: https://doi.org/10.1016/j.spinee.2015.03.039

  11. Han G, Zou D, Liu Z, Zhang B, Gong C, Zhou S, et al. Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion. BMC Musculoskelet Disord. 2022; 23: 232. Available in: https://doi.org/10.1186/s12891-022-05178-z

  12. Gaddikeri MB, Nene A, Patel P, Bamb H, Bhaladhare S. Sarcopenia and its effects on outcome of lumbar spine surgeries. Eur Spine J. 2024; 33: 1369-1380. Available in: https://doi.org/10.1007/s00586-024-08155-3

  13. Zhao Y, Huang M, Serrano Sosa M, Cattell R, Fan W, Li M, et al. Fatty infiltration of paraspinal muscles is associated with bone mineral density of the lumbar spine. Arch Osteoporos. 2019; 14: 99. Available in: https://doi.org/10.1007/s11657-019-0639-5

  14. Kim JB, Park SW, Lee YS, Nam TK, Park YS, Kim YB. The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc. 2015; 58: 357-362. Available in: https://doi.org/10.3340/jkns.2015.58.4.357

  15. Charest-Morin R, Street J, Zhang H, Roughead T, Ailon T, Boyd M, et al. Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine. Spine J. 2018; 18: 245-254. Available in: https://doi.org/10.1016/j.spinee.2017.07.003

  16. Akbik OS, Al-Adli N, Pernik MN, Hicks WH, Hall K, Aoun SG, et al. A comparative analysis of frailty, disability, and sarcopenia with patient characteristics and outcomes in adult spinal deformity surgery. Global Spine J. 2023; 13: 2345-2356. Available in: https://doi.org/10.1177/21925682221082053

  17. Seo YG, Park WH, Lee CS, Kang KC. Lumbar extensor muscle size and isometric muscle strength in women with symptomatic lumbar degenerative diseases. Asian Spine J. 2018; 12: 943-950. Available in: https://doi.org/10.31616/asj.2018.12.5.943




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