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Abstract
Study Design
A retrospective study on the outcomes of surgical treatment for degenerative lumbar spinal disease.
Objectives
To evaluate the pre-operative paravertebral muscle condition as a predictive factor in patients with degenerative lumbar spinal disease who undergo surgery.
Summary of Literature Review
Previous studies have reported that the atrophy of the paravertebral muscle is associated with chronic low back pain. However, few studies have reported on the relationship of the pre-operative paravertebral muscle status with the postoperative functional disability scale.
Materials and Methods
In this study, we reviewed the history of 20 patients with degenerative lumbar spinal disease treated by decompression and posterior lumbar interbody fusion with posterior instrumentation between 2010 and 2011. The evaluation included the paravertebral muscle volume, fat infiltration on magnetic resonance imaging (MRI), preoperative lumbar lordosis, levels operated on, and the Oswestry Disability Index (ODI). Further, the inter-relationship of the pre-operative paravertebral muscle status, lumbar lordosis, and levels operated on with the postoperative ODI was analyzed.
Results
The mean crosssectional area (CSA) of the paravertebral muscle at the L3–4 and L4–5 levels was 21.9±3.4 cm2 and 21.4± 3.3 cm2, respectively. The mean pre- and postoperative lumbar lordotic angle was 41.0±17.5°, and 42.3±11.1°, respectively. The lumbar lordotic angle and the levels operated on were not correlated with the postoperative ODI. However, the CSA of the paravertebral muscle at the L3–4 (r=–0.582, p<0.01) and L4–5 (r=–0.568, p<0.01) levels showed a negative correlation with the postoperative ODI. The levels operated on showed a positive correlation with the postoperative ODI (r=0.420, p<0.01).
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Figures and Tables%
Fig. 1.
Cross-sectional area (CSA) The CSA of the multifidus and erector spinae muscles was obtained using axial T2-weighted images at the lower margin of the L3 and L4 vertebrae with the Marosis m-view program (version 5.4).
Fig. 2.
Fat infiltration (Grades 0/1/2) Examples of amounts of fat in the lumbar multifidus muscles as seen on axial T1-weighted magnetic resonance imaging scans. These were rated as grade 0 (A) for normal condition; grade 1 (B) for moderate fat infiltration (10%–50%), and grade 2 (C) for severe fat infiltration (>50%).
Fig. 3.
Lordotic angle (L1–S1) Cobb's angle for whole lumbar lordosis. The segmental lordosis at L1–S1 was defined as the angle subtended by the superior endplate line of L1 and the superior endplate line of S1.
Fig. 4.
Scatterplots showing the association among crosssectional area, levels operated on, and the Oswestry Disability Index (ODI).
Table 1.
Inter and Intra Reliability for Cross Sectional Area (CSA) of Paravertebral Muscle on MRI
| Measurement parameters | Inter-observer ICC* | Intra-observer ICC* |
|---|---|---|
| CSA at L3/4 | 0.91 | 0.96 |
| CSA at L4/5 | 0.85 | 0.95 |
Table 2.
Cross Sectional Area of Paravertebral Muscle and Lordotic Angle of the Patients
| Total (n=20) | Male (n=9) | Female (n=11) | p-value* | |
|---|---|---|---|---|
| L3-4 level (CSA, cm2) | 21.9±3.4 | 22.0±4.0 | 21.9±2.9 | 1.000 |
| L4-5 level (CSA, cm2) | 21.4±3.3 | 20.9±3.8 | 21.8±2.9 | 0.552 |
| Pre-op lordotic angle (°) | 41.0±17.5 | 34.9±12.7 | 39.7±9.4 | 0.131 |
| Postop lordotic angle (°) | 42.3±11.1 | 46.0±19.8 | 44.4±12.4 | 0.603 |
Table 3.
The Functional Outcome of Surgery at Last Follow up
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