The predictive value of preoperative paraspinal muscle morphometry on complications after lumbar surgery: a systematic review

Abstract

Purpose The effect of paraspinal muscles atrophy and fat infiltration (FI) on the complications of spinal surgery has not been established. Methods A review of the literature was conducted from a search of the PubMed, EMBASE, and Web of Science databases from inception through January 2021. The literature was searched and assessed by independent reviewers based on criteria that included an assessment of preoperative paraspinal muscle morphology in addition to measuring its relationship to surgical complications. All relevant papers were assessed for risk of bias according to the modified Newcastle Ottawa Scale and the Joanna Briggs Institute Critical Appraisal Tools. A narrative synthesis was conducted. Results The initial search yielded 5632 studies, of which 16 studies were included in the analysis. All included studies were at a low risk of bias. There existed strong evidence that the atrophy and FI of paraspinal muscles had an association with the development of bone nonunion (two high quality studies), pedicle screw loosening (two high quality studies), adjacent segment degeneration (three high quality studies) and proximal junctional kyphosis (five high quality studies) after lumbar surgery. Besides, there is also limited evidence for association between atrophy and FI of paraspinal extensor muscles and less local and global curve improvement. Conclusions Strong evidence was found for an association between preoperative paraspinal muscle degeneration and multiple postoperative complications after lumbar surgery. However, the findings should be interpreted with caution due to the small quantity of the available literature and high heterogeneity among studies.

Morphology of paraspinal muscles in frail and non-frail older adults evaluated through FRAIL scale

“…Paraspinal muscles play an essential role in maintaining the normal shape of the spine [ 18 ], and its composition is closely related to spinal diseases, including LBP, lumbar disc herniation (LDH), LSS, spondylolisthesis and spinal imbalance, and the prognosis of spinal surgery [ 19 ]. Fortin et al found that multifidus muscle FI and psoas relative CSA are associated with functional status in patients with LSS [ 10 ].…”

Risk Factor Analysis for Fat Infiltration in the Lumbar Paraspinal Muscles in Patients With Lumbar Degenerative Diseases

“…Regarding lumbar spinal surgery, fat infiltration of the paraspinal muscles has been reported to be related to the development of postoperative complications. [21][22][23][24] Lee et al described that the bone union rate decreased as the fat content of lumbar paraspinal muscles increased in patients with spinal degenerative diseases after instrumentation fusion. 22 Kim et al reported that preoperative higher fat infiltration of the paraspinal muscles was significantly associated with pedicle screw loosening.…”

“… 19 , 20 Moreover, several studies described that fat infiltration of the paraspinal muscles is associated with postoperative complications of lumbar spinal surgery, such as bone nonunion, pedicle screw loosening, and proximal junctional kyphosis. 21 - 24 …”

“…19,20 Moreover, several studies described that fat infiltration of the paraspinal muscles is associated with postoperative complications of lumbar spinal surgery, such as bone nonunion, pedicle screw loosening, and proximal junctional kyphosis. [21][22][23][24] Muscle fat infiltration is assessed using ultrasound, 25 computed tomography, 19 magnetic resonance imaging (MRI), 11,14,26 and magnetic resonance spectroscopy. 11,27 Among them, Kjaer et al 28 have reported a method of grading the degree of fat infiltration using MRI, 28 which is used in clinical settings.…”

A predictive scoring system for proximal junctional kyphosis after posterior internal fixation in elderly patients with chronic osteoporotic vertebral fracture: A single-center diagnostic study

“…Protective measures for patients' own factors mainly include: (a) lumbar back muscle function exercise. With the increase of a patients' age, paravertebral muscle atrophy and fat infiltration are serious, leading to the decline of paravertebral muscle strength, which is closely related to the occurrence of postoperative PJK (25). Therefore, appropriate muscle function training can help reduce the risk of PJK.…”