Does Paraspinal Muscle Mass Predict Lumbar Lordosis before and after Decompression for Degenerative Spinal Stenosis?

STUDY DESIGN

Retrospective Cohort Study.

OBJECTIVE

The purpose of this study was to determine if 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

Over time, either due to degenerative changes or other spinal conditions, individuals may develop sagittal imbalance. 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 Goutallier grade of the PVM. Patients were divided into 3 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).

CONCLUSION

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 a need to address risk factors for poor muscle quality in patients with sagittal imbalance.

Informations de copyright

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Déclaration de conflit d'intérêts

Conflict of Interests: Jose A. Canseco, MD, PhD serves as a board/committee member for the Clinical Spine Research Society and has stock/stock options in PathKeeper Surgical. He receives research support from Accelus. Mark F. Kurd, MD is a paid consultatnt for Camber Spine and Spinal Elements. He has received royalty payments from Spinal Elements and Stryker and maintains stock or stock options with DuraStat LLC. Alan S. Hilibrand, MD receives royalties from Biomet and CTL Amedica and has stock or stock options with Paradigm Spine. Alexander R. Vaccaro, MD, PhD, MBA serves as a board/committee member of the National Spine Health Foundation. He has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. Christopher K. Kepler, MD, MBA serves on the editorial board of Clinical Spine Surgery and receives royalties from Curetiva and Regeneration Technologies, Inc. Gregory D. Schroeder MD is a paid consultant for Advance Medical, Bioventus, and Surgalign. He serves on the board of Clinical Spine Surgery, AO Spine, Cervical Spine Research Society and Wolters Kluwer Health – Lippincott Williams & Wilkins. He receives research support from Cerapedics, DePuy, A Johnson and Johnson Company, and Medtronic Sofamor Danek.The remaining authors declare no conflict of interest.