Differences in lumbar paraspinal muscle morphology in patients with sagittal malalignment undergoing posterior lumbar fusion surgery,European Spine Journal

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Differences in lumbar paraspinal muscle morphology in patients with sagittal malalignment undergoing posterior lumbar fusion surgery
European Spine Journal ( IF 2.6 ) Pub Date : 2022-08-29 , DOI: 10.1007/s00586-022-07351-3
Maximilian Muellner _{1,

2} , Henryk Haffer _{1,

2} , Erika Chiapparelli ₁ , Yusuke Dodo ₁ , Ek T Tan ₃ , Jennifer Shue ₁ , Jiaqi Zhu ₄ , Andrew A Sama ₁ , Frank P Cammisa ₁ , Federico P Girardi ₁ , Alexander P Hughes ₁

Affiliation

Purpose

To investigate whether (1) there is a difference between patients with normal or sagittal spinal and spinopelvic malalignment in terms of their paraspinal muscle composition and (2) if sagittal malalignment can be predicted using muscle parameters.

Methods

A retrospective review of patients undergoing posterior lumbar fusion surgery was conducted. A MRI-based muscle measurement technique was used to assess the cross-sectional area, the functional cross-sectional area, the intramuscular fat and fat infiltration (FI) for the psoas and the posterior paraspinal muscles (PPM). Intervertebral disc degeneration was graded for levels L1 to S1. Sagittal vertical axis (SVA; ≥ 50 mm defined as spinal malalignment), pelvic incidence (PI) and lumbar lordosis (LL) were measured, and PI-LL mismatch (PI-LL; ≥ 10° defined as spinopelvic malalignment) was calculated. A receiver operating characteristic (ROC) analysis was conducted to determine the specificity and sensitivity of the FI_PPM for predicting sagittal malalignment.

Results

One hundred and fifty patients were analysed. The PI-LL and SVA malalignment groups were found to have a significantly higher FI_PPM (PI-LL:47.0 vs. 42.1%; p = 0.019; SVA: 47.7 vs. 41.8%; p = 0.040). ROC analysis predicted sagittal spinal malalignment using FI_PPM (cut-off value 42.69%) with a sensitivity of 73.4% and a specificity of 54.1% with an area under the curve of 0.662.

Conclusion

Significant differences in the muscle composition between normal and malalignment groups with respect to FI_PPM in both sagittal spinal and spinopelvic alignment were found. This work underlines the imminent impact of the paraspinal musculature on the sagittal alignment.

中文翻译：

后路腰椎融合术矢状面畸形患者腰椎椎旁肌形态的差异

目的

调查是否 (1) 正常或矢状脊柱和脊柱骨盆排列不齐的患者在椎旁肌肉组成方面存在差异，以及 (2) 是否可以使用肌肉参数预测矢状排列不齐。

方法

对接受后路腰椎融合手术的患者进行了回顾性分析。基于 MRI 的肌肉测量技术用于评估横截面积、功能横截面积、肌肉内脂肪和腰大肌和后椎旁肌 (PPM) 的脂肪浸润 (FI)。椎间盘退变分级为 L1 至 S1 级。测量矢状纵轴（SVA；≥ 50 mm 定义为脊柱排列不齐）、骨盆发生率（PI）和腰椎前凸（LL），并计算 PI-LL 不匹配（PI-LL；≥ 10° 定义为脊柱骨盆排列不齐）。进行接受者操作特征 (ROC) 分析以确定 FI _PPM预测矢状面不对准的特异性和敏感性。

结果

对一百五十名患者进行了分析。发现 PI-LL 和 SVA 错位组具有显着更高的 FI _PPM（PI-LL：47.0 对 42.1%；p = 0.019；SVA：47.7 对 41.8%；p = 0.040）。ROC 分析使用 FI _PPM（截止值 42.69%）预测矢状面脊柱排列不齐，灵敏度为 73.4%，特异性为 54.1%，曲线下面积为 0.662。