Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2022 | Research

Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion

Authors: Gengyu Han, Da Zou, Zexiang Liu, Bo Zhang, Chunjie Gong, Siyu Zhou, Wei Li, Zhuoran Sun, Weishi Li

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

The prognosis value of paraspinal muscle degeneration on clinical outcomes has been revealed. However no study has investigated the effect of the fat infiltration (FI) of paraspinal muscles on bone nonunion after posterior lumbar interbody fusion (PLIF).

Methods

Three hundred fifty-one patients undergoing PLIF for lumbar spinal stenosis with 1-year follow-up were retrospectively identified. Patients were categorized into bone union (n = 301) and bone nonunion (n = 50) groups based on dynamic X-ray at 1-year follow-up. The relative total cross-sectional area (rTCSA) and FI of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured on preoperative magnetic resonance imaging.

Results

The nonunion group had a significantly higher MF FI and a higher ES FI and a smaller MF rTCSA than the union group (p = 0.001, 0.038, 0.026, respectively). Binary logistic regression revealed that MF FI (p = 0.029, odds ratio [OR] = 1.04), lumbosacral fusion (p = 0.026, OR = 2193) and length of fusion (p = 0.001, OR = 1.99) were independent factors of bone nonunion. In subgroup analysis, in one or two-level fusion group, the patients with nonunion had a higher MF FI and a higher ES FI than those of the patients with union (all p < 0.05). Similarly, in lumbosacral fusion group, the patients with nonunion had a higher MF FI and a higher ES FI than those of the patients with union (all p < 0.05). The logistic regressions showed that MF FI remained an independent factor of bone nonunion both in the patients with one or two-level fusion (p = 0.003, OR = 1.074) and in the patients with lumbosacral fusion (p = 0.006, OR = 1.073).

Conclusions

Higher fatty degeneration was strongly associated with bone nonunion after PLIF. Surgeons should pay attention to the FI of paraspinal muscles when performing posterior surgery for patients, especially those who need short-segment fusion or to extend fusion to S1.

Available only for authorised users

Meng B, Bunch J, Burton D, Wang J. Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies. Eur Spine J. 2021;30(1):22–33.CrossRef

Mo GY, Guo HZ, Guo DQ, Tang YC, Li YX, Yuan K, et al. Augmented pedicle trajectory applied on the osteoporotic spine with lumbar degenerative disease: mid-term outcome. J Orthop Surg Res. 2019;14:170.CrossRef

Formica M, Vallerga D, Zanirato A, Cavagnaro L, Basso M, Divano S, et al. Fusion rate and influence of surgery-related factors in lumbar interbody arthrodesis for degenerative spine diseases: a meta-analysis and systematic review. Musculoskelet Surg. 2020;104:1–15.CrossRef

Lee C, Dorcil J, Radomisli TE. Nonunion of the spine: a review. Clin Orthop Relat Res. 2004;419:71–5.

Vaccaro AR, Chiba K, Heller JG, Patel T, Thalgott JS, Truumees E, et al. Bone grafting alternatives in spinal surgery. Spine J. 2002;2:206–15.CrossRef

Choi MK, Kim SB, Park BJ, Park CK, Kim SM. Do trunk muscles affect the lumbar interbody fusion rate?: correlation of trunk muscle cross sectional area and fusion rates after posterior lumbar interbody fusion using stand-alone cage. J Korean Neurosurg Soc. 2016;59:276–81.CrossRef

Choi MK, Kim SB, Park CK, Malla HP, Kim SM. Cross-sectional area of the lumbar spine trunk muscle and posterior lumbar interbody fusion rate: a retrospective study. Clin Spine Surg. 2017;30:E798-803.CrossRef

Leng J, Han G, Zeng Y, Chen Z, Li W. The effect of paraspinal muscle degeneration on distal pedicle screw loosening following corrective surgery for degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2020;45:590–8.CrossRef

Yuan L, Zeng Y, Chen Z, Li W, Zhang X, Mai S. Degenerative lumbar scoliosis patients with proximal junctional kyphosis have lower muscularity, fatty degeneration at the lumbar area. Eur Spine J. 2020;30:1133–43.

10.

Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis: Definition, natural history, conservative management, and surgical treatment. Neurosurg Clin N Am. 2019;30:299–304.CrossRef

11.

Zou D, Muheremu A, Sun Z, Zhong W, Jiang S, Li W. Computed tomography Hounsfield unit-based prediction of pedicle screw loosening after surgery for degenerative lumbar spine disease. J Neurosurg Spine. 2020;32:1–6.

12.

Larsen JM, Rimoldi RL, Capen DA, Nelson RW, Nagelberg S, Thomas JC Jr. Assessment of pseudarthrosis in pedicle screw fusion: a prospective study comparing plain radiographs, flexion/extension radiographs, CT scanning, and bone scintigraphy with operative findings. J Spinal Disord. 1996;9:117–20.CrossRef

13.

Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013;158:588–95.CrossRef

14.

Wang W, Sun Z, Li W, Chen Z. The effect of paraspinal muscle on functional status and recovery in patients with lumbar spinal stenosis. J Orthop Surg Res. 2020;15:235.CrossRef

15.

Dohzono S, Toyoda H, Takahashi S, Matsumoto T, Suzuki A, Terai H, et al. Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis. J Neurosurg Spine. 2016;25:39–45.CrossRef

16.

Yu B, Jiang K, Li X, Zhang J, Liu Z. Correlation of the features of the lumbar multifidus muscle with facet joint osteoarthritis. Orthopedics. 2017;40:e793–800.CrossRef

17.

Lee C-S, Chung SS, Choi SW, Yu JW, Sohn MS. Critical length of fusion requiring additional fixation to prevent nonunion of the lumbosacral junction. Spine. 2010;35:E206–11.CrossRef

18.

Meakin JR, Fulford J, Seymour R, Welsman JR, Knapp KM. The relationship between sagittal curvature and extensor muscle volume in the lumbar spine. J Anat. 2013;222:608–14.CrossRef

19.

Katsu M, Ohba T, Ebata S, Haro H. Comparative study of the paraspinal muscles after OVF between the insufficient union and sufficient union using MRI. BMC Musculoskelet Disord. 2018;19:143.CrossRef

20.

Schlaeger S, Inhuber S, Rohrmeier A, Dieckmeyer M, Freitag F, Klupp E, et al. Association of paraspinal muscle water-fat MRI-based measurements with isometric strength measurements. Eur Radiol. 2019;29:599–608.CrossRef

21.

Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61:1059–64.CrossRef

22.

Kornblatt MD, Casey MP, Jacobs RR. Internal fixation in lumbosacral spine fusion. A biomechanical and clinical study. Clin Orthop Relat Res. 1986;(203):141–50.

23.

Bawa M, Schimizzi AL, Leek B, Bono CM, Massie JB, Macias B, et al. Paraspinal muscle vasculature contributes to posterolateral spinal fusion. Spine (Phila Pa 1976). 2006;31:891–6.CrossRef

24.

Yang L, Yuzeng L, Yong H, Tie L, Li G, Chen X. Fat infiltration in the multifidus muscle as a predictor of prognosis after decompression and fusion in patients with single-segment degenerative lumbar spinal stenosis: an ambispective cohort study based on propensity score matching. World Neurosurg. 2019;128:E989–E1001.CrossRef

25.

Hong X, Shi R, Wang Y-T, Liu L, Bao J-P, Wu X-T. Lumbar disc herniation treated by microendoscopic discectomy: prognostic predictors of long-term postoperative outcome. Orthopade. 2018;47:993–1001.CrossRef

26.

Wilke HJ, Wolf S, Claes LE, Arand M, Wiesend A. Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine (Phila Pa 1976). 1995;20:192–8.CrossRef

27.

Aono H, Takenaka S, Nagamoto Y, Tobimatsu H, Yamashita T, Furuya M, et al. Fusion rate and clinical outcomes in two-level posterior lumbar interbody fusion. World Neurosurg. 2018;112:e473–8.CrossRef

28.

Otsuki B, Fujibayashi S, Tanida S, Shimizu T, Murata K, Matsuda S. Possible association of pedicle screw diameter on pseudoarthrosis rate after transforaminal lumbar interbody fusion. World Neurosurg. 2021;150:e155–61.CrossRef

Title: Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion
Authors: Gengyu Han
Da Zou
Zexiang Liu
Bo Zhang
Chunjie Gong
Siyu Zhou
Wei Li
Zhuoran Sun
Weishi Li
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05178-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Clinical evaluation of S1 alar screws application in short-segment lumbosacral fixation and fusion for spine infection with severe S1 vertebral body loss

Spinopelvic alignment and low back pain after total hip arthroplasty: a scoping review

Periprosthetic femoral fractures in Total Hip Arthroplasty (THA): a comparison between osteosynthesis and revision in a retrospective cohort study

Effects of continuous subcutaneous insulin infusion on the microstructures, mechanical properties and bone mineral compositions of lumbar spines in type 2 diabetic rats

Total hip arthroplasty after rotational acetabular osteotomy for developmental dysplasia of the hip: a retrospective observational study

Randomized, double-blind, noninferiority study of diclofenac diethylamine 2.32% gel applied twice daily versus diclofenac diethylamine 1.16% gel applied four times daily in patients with acute ankle sprain