Rajkishen Narayanan, Teeto Ezeonu, Alec Kellish, Sydney Somers, Yunsoo Lee, Akshay Khanna, Anthony Labarbiera, Sebastian Fras, Jose A Canseco, Mark F Kurd, Alan S Hilibrand, Alexander R Vaccaro, Christopher Kepler, Gregory D Schroeder
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引用次数: 0
Abstract
Study design: Retrospective cohort study.
Objective: The purpose of this study was to determine whether muscle mass and quality of the lumbar paraspinal muscles was associated with improvements in lumbar lordosis and other sagittal parameters after isolated posterior lumbar decompression surgery for lumbar spinal stenosis.
Summary of background data: Individuals may develop sagittal imbalance over time, either due to degenerative changes or other spinal conditions. In patients with lumbar spinal stenosis, sagittal imbalance can further exacerbate symptoms of pain and radiculopathy. Sarcopenia of paraspinal muscles has been implicated in previous spine research as a variable with influence on surgical outcomes.
Methods: Sagittal parameters were measured on preoperative and postoperative lateral lumbar radiographs and included lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Preoperative MRI images were evaluated at the base of the L4 vertebral body to assess muscles mass of the psoas muscle and paravertebral muscles (PVM) and the Goutallier grade of the PVM. Patients were divided into three muscle size groups based on PVM normalized for body size (PVM/BMI): Group A (smallest), Group B, and Group C (largest).
Results: Patients in group C had greater LL preoperatively (51.5° vs. 47.9° vs. 43.2, P =0.005) and postoperatively (52.2° vs. 48.9° vs. 45.7°, P =0.043). There was no significant difference in the ∆LL values between groups ( P >0.05). Patients in group C had larger SS preoperatively (35.2° vs. 32.1° vs. 30.0°, P =0.010) and postoperatively (36.1° vs. 33.0° vs. 31.7°, P =0.030). Regression analysis showed that PVM/BMI was a significant predictor of LL preoperatively ( P =0.039) and postoperatively ( P =0.031), as well as SS preoperatively ( P =0.001) and postoperatively ( P <0.001).
Conclusions: Muscle mass of the paravertebral muscles significantly impacts lumbar lordosis and sacral slope in patients with lumbar spinal stenosis before and after posterior lumbar decompression. These findings highlight the need to address risk factors for poor muscle quality in patients with sagittal imbalance.
研究设计回顾性队列研究：本研究的目的是确定腰椎旁肌肉的质量和品质是否与腰椎管狭窄症孤立后路腰椎减压手术后腰椎前凸和其他矢状面参数的改善有关：随着时间的推移，由于退行性病变或其他脊柱疾病，患者可能会出现矢状面失衡。对于腰椎管狭窄症患者来说，矢状面失衡会进一步加重疼痛和根性病变的症状。脊柱旁肌肉减少症在以往的脊柱研究中被认为是影响手术效果的一个变量：方法： 通过术前和术后腰椎侧位片测量矢状面参数，包括腰椎前凸（LL）、骶骨斜度（SS）和骨盆倾斜（PT）。术前对 L4 椎体底部的核磁共振成像进行评估，以评估腰大肌和椎旁肌（PVM）的肌肉质量以及 PVM 的 Goutallier 等级。根据PVM对体型的归一化（PVM/BMI）将患者分为3个肌肉大小组：A组（最小）、B组和C组（最大）：结果：C 组患者术前（51.5° vs. 47.9° vs. 43.2，P=0.005）和术后（52.2° vs. 48.9° vs. 45.7°，P=0.043）的 LL 更大。各组之间的 ∆LL 值无明显差异（P>0.05）。C 组患者术前（35.2° vs. 32.1° vs. 30.0°，P=0.010）和术后（36.1° vs. 33.0° vs. 31.7°，P=0.030）的 SS 均较大。回归分析显示，PVM/BMI 是 LL 术前（P=0.039）和术后（P=0.031）以及 SS 术前（P=0.001）和术后（PConclusion：腰椎后路减压术前后，椎旁肌的肌肉质量对腰椎管狭窄症患者的腰椎前凸和骶骨斜度有明显影响。这些发现突出表明，有必要解决矢状面失衡患者肌肉质量差的风险因素。
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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