{"title":"脊柱旁肌退变对成人脊柱畸形手术结果和矢状位线的影响:一项多中心研究。","authors":"Jun Ouchida, Yoshinori Morita, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Tokumi Kanemura, Tetsuya Ohara, Taichi Tsuji, Ryuichi Shinjyo, Shiro Imagama, Hiroaki Nakashima","doi":"10.14245/ns.2449174.587","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups.</p><p><strong>Results: </strong>The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006).</p><p><strong>Conclusion: </strong>Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 1","pages":"30-37"},"PeriodicalIF":3.6000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010842/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of Paraspinal Muscle Degeneration on Surgical Outcomes and Radiographical Sagittal Alignment in Adult Spinal Deformity: A Multicenter Study.\",\"authors\":\"Jun Ouchida, Yoshinori Morita, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Tokumi Kanemura, Tetsuya Ohara, Taichi Tsuji, Ryuichi Shinjyo, Shiro Imagama, Hiroaki Nakashima\",\"doi\":\"10.14245/ns.2449174.587\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups.</p><p><strong>Results: </strong>The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006).</p><p><strong>Conclusion: </strong>Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.</p>\",\"PeriodicalId\":19269,\"journal\":{\"name\":\"Neurospine\",\"volume\":\"22 1\",\"pages\":\"30-37\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010842/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurospine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.14245/ns.2449174.587\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/31 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurospine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.14245/ns.2449174.587","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/31 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:本多中心研究旨在评估椎旁肌肉(pvm)退变,特别是脂肪浸润对成人脊柱畸形(ASD)患者术前矢状面不平衡、术后并发症和矢状面排列改变的影响。方法:对5所医院454例ASD手术患者进行回顾性分析。根据MRI棘旁肌脂肪浸润情况将患者分为两组:有明显浸润者(FI-PVM(+))和极少或无浸润者(FI-PVM(-))。进行倾向评分匹配以调整人口统计学因素和术前影像学参数。术前、术后和2年随访时评估脊柱参数。比较两组间的机械并发症。结果:FI-PVM(+)组术前矢状向纵轴更大(86.4±57.5比51.8±59.2,p < 0.001),需要更广泛的手术矫正,融合椎节数明显更多(7.3±3.7比6.7±3.7,p < 0.039)。倾向评分匹配后,两组术后脊柱-骨盆对齐均有显著改善,并在2年随访中保持。然而,FI-PVM(+)组显示出更高的远端结缔组织后凸发生率(6.3% vs. 0.9%, p = 0.070),术后骨盆倾斜明显降低(4.3°±7.6°vs. 1.3°±8.2°,p = 0.006)。结论:PVM的脂肪浸润增加了手术复杂性和机械并发症的风险。术前肌肉质量评估,以及有针对性的康复和更密切的术后监测,可能对改善ASD手术的长期疗效至关重要。
Impact of Paraspinal Muscle Degeneration on Surgical Outcomes and Radiographical Sagittal Alignment in Adult Spinal Deformity: A Multicenter Study.
Objective: This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD).
Methods: A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups.
Results: The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006).
Conclusion: Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.