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Review
. 2023 Aug;33(8):5269-5281.
doi: 10.1007/s00330-023-09548-6. Epub 2023 Mar 28.

Does paraspinal muscle morphometry predict functional status and re-operation after lumbar spinal surgery? A systematic review and meta-analysis

Gengyu Han #  1   2   3 , Haotian Wu #  1   2   3 , Jinyue Dai  1   2   3 , Xinhang Li  1   2   3 , Lihao Yue  1   2   3 , Zheyu Fan  1   2   3 , Qiaoyu Li  1 , Qirui Shao  1 , Yu Jiang  1   2   3 , Weishi Li  4   5   6
Affiliations
Review

Does paraspinal muscle morphometry predict functional status and re-operation after lumbar spinal surgery? A systematic review and meta-analysis

Gengyu Han et al. Eur Radiol. 2023 Aug.

Abstract

Objectives: Whether paraspinal muscle degeneration is related to poor clinical outcomes after lumbar surgery is still indistinct, which limits its clinical application. This study aimed to evaluate the predictive value of paraspinal muscle morphology on functional status and re-operation after lumbar spinal surgery.

Methods: A review of the literature was conducted using a total of 6917 articles identified from a search of PubMed, EMBASE, and Web of Science databases through September 2022. A full-text review of 140 studies was conducted based on criteria including an objective assessment of preoperative paraspinal muscle morphology including multifidus (MF), erector spinae (ES), and psoas major (PS) in addition to measuring its relationship to clinical outcomes including Oswestry disability index (ODI), pain and revision surgery. Meta-analysis was performed when required metrics could be calculated in ≥ three studies, otherwise vote counting model was a good alternative to show the effect direction of evidence. The standardized mean difference (SMD) and 95% confidence interval (CI) were calculated.

Results: A total of 10 studies were included in this review. Of them, five studies with required metrics were included in the meta-analysis. The meta-analysis suggested that higher preoperative fat infiltration (FI) of MF could predict higher postoperative ODI scores (SMD = 0.33, 95% CI 0.16-0.50, p = 0.0001). For postoperative pain, MF FI could also be an effective predictor for persistent low back pain after surgery (SMD = 0.17, 95% CI 0.02-0.31, p = 0.03). However, in the vote count model, limited evidence was presented for the prognostic effects of ES and PS on postoperative functional status and symptoms. In terms of revision surgery, there was conflicting evidence that FI of MF and ES could predict the incidence of revision surgery in the vote count model.

Conclusion: The assessment of MF FI could be a viable method to stratify patients with lumbar surgery by the risk of severe functional disability and low back pain.

Key points: • The fat infiltration of multifidus can predict postoperative functional status and low back pain after lumbar spinal surgery. • The preoperative evaluation of paraspinal muscle morphology is conducive for surgeons.

Keywords: Meta-analysis; Paraspinal muscles; Surgical procedures, operative; Treatment outcome.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection and inclusion process. A total of 6917 articles were identified from databases through September 2022. After the removal of duplicate records, 3482 studies were screened. Of these articles, 140 were eligible for full-text review. A total of 10 articles were included in the review and 5 articles were included in the meta-analysis
Fig. 2
Fig. 2
Risk of bias for the included studies. A = study participation, B = study attrition, C = prognostic factor measurement, D = outcome measurement, E = study confounding, F = statistical analysis and reporting, O = overall risk of bias. The overall risk of bias for an included study was defined as low risk with ≥ 4 low- and no high-risk domains, moderate risk with < 4 low- and no high-risk domains, and high risk with ≥ 1 high-risk domains
Fig. 3
Fig. 3
Forest plot of postoperative ODI between patients with high and low MF FI for lumbar surgery. Patients with high-grade preoperative MF FI had higher postoperative ODI scores, compared to those with low-grade MF FI (SMD = 0.33, 95% CI 0.16–0.50, p = 0.0001)
Fig. 4
Fig. 4
Forest plot of postoperative back pain between patients with high and low MF FI for lumbar surgery. Patients with higher preoperative FI of MF had greater postoperative LBP compared to those with low FI of MF (SMD = 0.17, 95%CI 0.02–0.31, p = 0.03)
Fig. 5
Fig. 5
Effect direction plot for vote counting model. Evidence remained conflicting in terms of whether MF atrophy could predict ODI, whether MF FI could predict leg pain, and whether PEM FI could predict revision surgery. Besides, evidence remained limited in terms of whether ES atrophy, ES FI, or PS atrophy could predict ODI, and whether PS atrophy could predict low back pain
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