Importance of the lumbar paraspinal muscles on the maintenance of global sagittal alignment after lumbar pedicle subtraction osteotomy.

Autor:	Caffard T; 1Spine Care Institute.; 2Department of Orthopedic Surgery, University of Ulm, Germany., Arzani A; 1Spine Care Institute., Amoroso K; 1Spine Care Institute., Chiapparelli E; 1Spine Care Institute., Medina SJ; 1Spine Care Institute., Schönnagel L; 1Spine Care Institute.; 3Center for Musculoskeletal Surgery, University of Berlin, Germany., Zhu J; 4Biostatistics Core, and., Verna B; 1Spine Care Institute., Finos K; 1Spine Care Institute., Nathoo I; 1Spine Care Institute., Tani S; 1Spine Care Institute.; 5Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan; and., Camino-Willhuber G; 1Spine Care Institute., Guven AE; 1Spine Care Institute., Zadeh A; 1Spine Care Institute., Tan ET; 6Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York., Carrino JA; 6Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York., Shue J; 1Spine Care Institute., Dobrindt O; 2Department of Orthopedic Surgery, University of Ulm, Germany., Zippelius T; 2Department of Orthopedic Surgery, University of Ulm, Germany., Dalton D; 1Spine Care Institute.; 7Department of Orthopedic Surgery, University Hospital Galway, Galway, Ireland., Sama AA; 1Spine Care Institute., Girardi FP; 1Spine Care Institute., Cammisa FP; 1Spine Care Institute., Hughes AP; 1Spine Care Institute.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Spine [J Neurosurg Spine] 2024 Jun 07; Vol. 41 (3), pp. 332-340. Date of Electronic Publication: 2024 Jun 07 (Print Publication: 2024).
DOI:	10.3171/2024.3.SPINE231052
Abstrakt:	Objective: There are limited data about the influence of the lumbar paraspinal muscles on the maintenance of sagittal alignment after pedicle subtraction osteotomy (PSO) and the risk factors for sagittal realignment failure. The authors aimed to investigate the influence of preoperative lumbar paraspinal muscle quality on the postoperative maintenance of sagittal alignment after lumbar PSO. Methods: Patients who underwent lumbar PSO with preoperative lumbar MRI and pre- and postoperative whole-spine radiography in the standing position were included. Spinopelvic measurements included pelvic incidence, sacral slope, pelvic tilt, L1-S1 lordosis, T4-12 thoracic kyphosis, spinosacral angle, C7-S1 sagittal vertical axis (SVA), T1 pelvic angle, and mismatch between pelvic incidence and L1-S1 lordosis. Validated custom software was used to calculate the percent fat infiltration (FI) of the psoas major, as well as the erector spinae and multifidus (MF). A multivariable linear mixed model was applied to further examine the association between MF FI and the postoperative progression of SVA over time, accounting for repeated measures over time that were adjusted for age, sex, BMI, and length of follow-up. Results: Seventy-seven patients were recruited. The authors' results demonstrated significant correlations between MF FI and the maintenance of corrected sagittal alignment after PSO. After adjustment for the aforementioned parameters, the model showed that the MF FI was significantly associated with the postoperative progression of positive SVA over time. A 1% increase from the preoperatively assessed total MF FI was correlated with an increase of 0.92 mm in SVA postoperatively (95% CI 0.42-1.41, p < 0.0001). Conclusions: This study included a large patient cohort with midterm follow-up after PSO and emphasized the importance of the lumbar paraspinal muscles in the maintenance of sagittal alignment correction. Surgeons should assess the quality of the MF preoperatively in patients undergoing PSO to identify patients with severe FI, as they may be at higher risk for sagittal decompensation.
Databáze:	MEDLINE
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