Abstract：
OBJECTIVE: This study aimed to investigate the impact of sarcopenia and lumbar paraspinal muscle composition (PMC) on patient-reported outcomes (PROs) after lumbar fusion surgery with 12-month follow-up (12 M-FU).
METHODS: A prospective investigation of patients undergoing elective lumbar fusion was conducted. Preoperative MRI-based evaluation of the cross-sectional area (CSA), the functional CSA (fCSA), and the fat infiltration(FI) of the posterior paraspinal muscles (PPM) and the psoas muscle at level L3 was performed. Sarcopenia was defined by the psoas muscle index (PMI) at L3 (CSAPsoas [cm2]/(patients\' height [m])2). PROs included Oswestry Disability Index (ODI), 12-item Short Form Healthy Survey with Physical (PCS-12) and Mental Component Scores (MCS-12) and Numerical Rating Scale back and leg (NRS-L) pain before surgery and 12 months postoperatively. Univariate and multivariable regression determined associations among sarcopenia, PMC and PROs.
RESULTS: 135 patients (52.6% female, 62.1 years, BMI 29.1 kg/m2) were analyzed. The univariate analysis demonstrated that a higher FI (PPM) was associated with worse ODI outcomes at 12 M-FU in males. Sarcopenia (PMI) and higher FI (PPM) were associated with worse ODI and MCS-12 at 12 M-FU in females. Sarcopenia and higher FI of the PPM are associated with worse PCS-12 and more leg pain in females. In the multivariable analysis, a higher preoperative FI of the PPM (β = 0.442; p = 0.012) and lower FI of the psoas (β = -0.439; p = 0.029) were associated with a worse ODI at 12 M-FU after adjusting for covariates.
CONCLUSIONS: Preoperative FI of the psoas and the PPM are associated with worse ODI outcomes one year after lumbar fusion. Sarcopenia is associated with worse ODI, PCS-12 and NRS-L in females, but not males. Considering sex differences, PMI and FI of the PPM might be used to counsel patients on their expectations for health-related quality of life after lumbar fusion.
METHODS: A prospective investigation of patients undergoing elective lumbar fusion was conducted. Preoperative MRI-based evaluation of the cross-sectional area (CSA), the functional CSA (fCSA), and the fat infiltration(FI) of the posterior paraspinal muscles (PPM) and the psoas muscle at level L3 was performed. Sarcopenia was defined by the psoas muscle index (PMI) at L3 (CSAPsoas [cm2]/(patients\' height [m])2). PROs included Oswestry Disability Index (ODI), 12-item Short Form Healthy Survey with Physical (PCS-12) and Mental Component Scores (MCS-12) and Numerical Rating Scale back and leg (NRS-L) pain before surgery and 12 months postoperatively. Univariate and multivariable regression determined associations among sarcopenia, PMC and PROs.
RESULTS: 135 patients (52.6% female, 62.1 years, BMI 29.1 kg/m2) were analyzed. The univariate analysis demonstrated that a higher FI (PPM) was associated with worse ODI outcomes at 12 M-FU in males. Sarcopenia (PMI) and higher FI (PPM) were associated with worse ODI and MCS-12 at 12 M-FU in females. Sarcopenia and higher FI of the PPM are associated with worse PCS-12 and more leg pain in females. In the multivariable analysis, a higher preoperative FI of the PPM (β = 0.442; p = 0.012) and lower FI of the psoas (β = -0.439; p = 0.029) were associated with a worse ODI at 12 M-FU after adjusting for covariates.
CONCLUSIONS: Preoperative FI of the psoas and the PPM are associated with worse ODI outcomes one year after lumbar fusion. Sarcopenia is associated with worse ODI, PCS-12 and NRS-L in females, but not males. Considering sex differences, PMI and FI of the PPM might be used to counsel patients on their expectations for health-related quality of life after lumbar fusion.
摘要：
目的：本研究旨在研究肌肉减少症和腰椎椎旁肌成分（PMC）对腰椎融合术12个月随访（12M-FU）后患者报告结局（PRO）的影响。
方法：对择期腰椎融合术患者进行前瞻性调查。术前基于MRI的横截面积（CSA）评估，功能CSA(FCSA)，并进行后椎旁肌（PPM）和腰肌L3水平的脂肪浸润（FI）。肌肉减少症定义为L3时的腰大肌指数（PMI）（CSAPsoas[cm2]/（患者身高[m]）2）。PROS包括Oswestry残疾指数(ODI)，手术前和术后12个月的12项简短形式健康调查，包括身体（PCS-12）和心理成分评分（MCS-12）和数字评分背部和腿部疼痛（NRS-L）。单变量和多变量回归确定肌少症之间的关联，PMC和PRO。
结果：135名患者（52.6%为女性，62.1年,BMI29.1kg/m2）进行分析。单变量分析表明，男性12M-FU时，较高的FI（PPM）与ODI结果较差有关。女性在12M-FU时，肌肉减少症（PMI）和较高的FI（PPM）与ODI和MCS-12较差相关。肌肉减少症和PPM的高FI与女性更差的PCS-12和更多的腿部疼痛相关。在多变量分析中，在校正协变量后,术前PPM的FI较高(β=0.442;p=0.012)和腰大肌的FI较低(β=-0.439;p=0.029)与12M-FU时ODI较差相关.
结论：腰大肌的术前FI和PPM与腰椎融合术后一年ODI结果较差相关。肌肉减少症与ODI恶化有关,女性的PCS-12和NRS-L，但不是男性。考虑到性别差异,PPM的PMI和FI可用于指导患者对腰椎融合后健康相关生活质量的期望。
方法：对择期腰椎融合术患者进行前瞻性调查。术前基于MRI的横截面积（CSA）评估，功能CSA(FCSA)，并进行后椎旁肌（PPM）和腰肌L3水平的脂肪浸润（FI）。肌肉减少症定义为L3时的腰大肌指数（PMI）（CSAPsoas[cm2]/（患者身高[m]）2）。PROS包括Oswestry残疾指数(ODI)，手术前和术后12个月的12项简短形式健康调查，包括身体（PCS-12）和心理成分评分（MCS-12）和数字评分背部和腿部疼痛（NRS-L）。单变量和多变量回归确定肌少症之间的关联，PMC和PRO。
结果：135名患者（52.6%为女性，62.1年,BMI29.1kg/m2）进行分析。单变量分析表明，男性12M-FU时，较高的FI（PPM）与ODI结果较差有关。女性在12M-FU时，肌肉减少症（PMI）和较高的FI（PPM）与ODI和MCS-12较差相关。肌肉减少症和PPM的高FI与女性更差的PCS-12和更多的腿部疼痛相关。在多变量分析中，在校正协变量后,术前PPM的FI较高(β=0.442;p=0.012)和腰大肌的FI较低(β=-0.439;p=0.029)与12M-FU时ODI较差相关.
结论：腰大肌的术前FI和PPM与腰椎融合术后一年ODI结果较差相关。肌肉减少症与ODI恶化有关,女性的PCS-12和NRS-L，但不是男性。考虑到性别差异,PPM的PMI和FI可用于指导患者对腰椎融合后健康相关生活质量的期望。
