目的:腰椎管狭窄症(LSS)患者需要显微手术减压(MSD)手术;然而,MSD通常与手术水平的术后不稳定有关。椎旁肌肉支撑脊柱;最近,椎旁体积已被用作肌肉减少症的良好指标。这项研究旨在确定术前放射学因素,包括椎旁肌肉体积,与LSS患者MSD术后滑脱进展相关。
方法:回顾性回顾了在我们研究所接受单级别(L3/4或L4/5)MSD治疗症状性LSS并随访≥5年的患者,以测量术前影像参数集中在手术水平上。计算使用术前腰椎轴向CT中每个肌肉/L3椎体区域的总横截面面积定义的椎旁肌体积(腰大肌指数[PMI]和多裂肌指数[MFMI])。在最后一次随访X射线时评估了静态平移(ST)≥2mm的术后滑脱。
结果:我们纳入了95例患者,平均年龄为69±8.2岁和7.51±2.58岁,分别。PMI和MFMI与年龄显着相关,男性患者明显更大。女性性别,术前ST,动态翻译,矢状旋转角度,刻面角度,骨盆发病率,腰椎前凸,PMI与术后长期ST恶化相关。然而,根据多变量分析,无独立因素与术后滑脱进展相关。
结论:LSS患者术前腰大肌体积较低是MSD术后滑脱进展的重要预测因素。术后滑脱进展的预测因素是多因素的;然而,包括腰大肌强化在内的结构良好的术后运动方案可能对MSD后的LSS患者有益.
OBJECTIVE: Patients with lumbar spinal stenosis (LSS) require microsurgical decompression (MSD) surgery; however, MSD is often associated with postoperative instability at the operated level. Paraspinal muscles support the spinal column; lately, paraspinal volume has been used as a good indicator of sarcopenia. This study aimed to determine preoperative radiological factors, including paraspinal muscle volume, associated with postoperative slippage progression after MSD in LSS patients.
METHODS: Patients undergoing single-level (L3/4 or L4/5) MSD for symptomatic LSS and followed-up for ≥ 5 years in our institute were reviewed retrospectively to measure preoperative imaging parameters focused on the operated level. Paraspinal muscle volumes (psoas muscle index [PMI] and multifidus muscle index [MFMI]) defined using the total cross-sectional area of each muscle/L3 vertebral body area in the preoperative lumbar axial CT) were calculated. Postoperative slippage in the form of static translation (ST) ≥ 2 mm was assessed on the last follow-up X-ray.
RESULTS: We included 95 patients with average age and follow-up periods of 69 ± 8.2 years and 7.51 ± 2.58 years, respectively. PMI and MFMI were significantly correlated with age and significantly larger in male patients. Female sex, preoperative ST, dynamic translation, sagittal rotation angle, facet angle, pelvic incidence, lumbar lordosis, and PMI were correlated with long-term postoperative worsening of ST. However, as per multivariate analysis, no independent factor was associated with postoperative slippage progression.
CONCLUSIONS: Lower preoperative psoas muscle volume in LSS patients is an important predictive factor of postoperative slippage progression at the operated level after MSD. The predictors for postoperative slippage progression are multifactorial; however, a well-structured postoperative exercise regimen involving psoas muscle strengthening may be beneficial in LSS patients after MSD.