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Purpose <p>Screw-loosening is a common instrumentation-related complication following fusion. Patients who present with pain and neurological symptoms due to screw-loosening require revision. It has been reported that fat-infiltrated and/or atrophied paraspinal muscles were associated with low back pain, disability, radiculopathy, and instrumentation-related failures. However, there is limited and conflicting knowledge regarding the association of paraspinal muscles with screw-loosening. In the present study, we aimed to identify whether fatty infiltration in the paraspinal muscles was associated with screw-loosening.</p> Methods <p>A retrospective analysis of the clinical and radiological data of the patients who underwent short-segment decompression and fusion for lumbar spinal stenosis (LSS) at a tertiary spine clinic between 2013 and 2023. Goutallier’s classification system was used for grading fatty infiltration in the paraspinal muscles.</p> Results <p>Patients with screw-loosening had fattier multifidus at the upper lumbar spine (particularly L2-L3, cephalad to the upper instrumented level of L3-L4) compared to those without screw-loosening. In univariate analysis fatty multifidus at L2-L3 level, elder age, and male sex had ORs of 1.509 (<Emphasis Type="BoldItalic">p</Emphasis><b> = 0.008</b>), 1.116 (<Emphasis Type="BoldItalic">p</Emphasis><b> = 0.001</b>) and 4.702 (<Emphasis Type="BoldItalic">p</Emphasis><b> = 0.004</b>), respectively. In multivariate analysis fatty multifidus at L2-L3 level, elder age and male sex had ORs 1.428 (<Emphasis Type="BoldItalic">p</Emphasis><b> = 0.043</b>), 1.109 (<Emphasis Type="BoldItalic">p</Emphasis><b> = 0.003</b>), and 5.911 (<Emphasis Type="BoldItalic">p</Emphasis><b> = 0.004</b>), respectively.</p> Conclusion <p>Fatty infiltration in the multifidus muscle (particularly in the one at the cranial end of the fusion mass) is predictive for screw-loosening following short-segment lumbar decompression and fusion for LSS. Preserving multifidus in subjects is essential to prevent future long-term complications of spine surgery.</p>

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Fatty infiltration in the multifidus predicts screw-loosening following short-segment decompression and fusion: proof of why we should protect and rehabilitate the paraspinal muscles

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月27日

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  • Murat Şakir Ekşi,
  • Arda Topçu,
  • Fatma Topaloğlu,
  • Nursena Tanriverdi,
  • Sidar Cenk Yeşilyurt,
  • Umut Can Duymaz,
  • Furkan Karakaş,
  • Jülide Hazneci,
  • Arif Topal,
  • Ali Börekci,
  • Tayfun Hakan,
  • Erhan Çelikoğlu,
  • Emel Ece Özcan-Ekşi

摘要

Purpose

Screw-loosening is a common instrumentation-related complication following fusion. Patients who present with pain and neurological symptoms due to screw-loosening require revision. It has been reported that fat-infiltrated and/or atrophied paraspinal muscles were associated with low back pain, disability, radiculopathy, and instrumentation-related failures. However, there is limited and conflicting knowledge regarding the association of paraspinal muscles with screw-loosening. In the present study, we aimed to identify whether fatty infiltration in the paraspinal muscles was associated with screw-loosening.

Methods

A retrospective analysis of the clinical and radiological data of the patients who underwent short-segment decompression and fusion for lumbar spinal stenosis (LSS) at a tertiary spine clinic between 2013 and 2023. Goutallier’s classification system was used for grading fatty infiltration in the paraspinal muscles.

Results

Patients with screw-loosening had fattier multifidus at the upper lumbar spine (particularly L2-L3, cephalad to the upper instrumented level of L3-L4) compared to those without screw-loosening. In univariate analysis fatty multifidus at L2-L3 level, elder age, and male sex had ORs of 1.509 (p = 0.008), 1.116 (p = 0.001) and 4.702 (p = 0.004), respectively. In multivariate analysis fatty multifidus at L2-L3 level, elder age and male sex had ORs 1.428 (p = 0.043), 1.109 (p = 0.003), and 5.911 (p = 0.004), respectively.

Conclusion

Fatty infiltration in the multifidus muscle (particularly in the one at the cranial end of the fusion mass) is predictive for screw-loosening following short-segment lumbar decompression and fusion for LSS. Preserving multifidus in subjects is essential to prevent future long-term complications of spine surgery.