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Background <p>Paraspinal muscles have been reported to associated with postoperative outcomes in patients undergoing lumbar spine surgery. This study aimed to determine whether preoperative radiological measures of lumbar paraspinal muscles could predict postoperative patient satisfaction.</p> Methods <p>A total of 302 patients aged 45 and older who underwent short-segment (≤ 2 segments) lumbar fusion surgery at the 960th Hospital of the People's Liberation Army between January 2019 and January 2022 were retrospectively analyzed. Based on the postoperative satisfaction index(PSI) assessed at the 24th months postoperatively , patients were divided into a satisfied group (PSI≤2, <i>n</i>=282) and a dissatisfied group ( PSI&gt; 2, <i>n</i>=20). Clinical data were collected, the ratio of the area of multifidus muscle (MF), erectus muscle (ES) and psoas major muscle (PS) at the L3 lower endplate level horizontal to the cross-sectional area of the L3 vertebra body (VB) was measured (relative cross-sectional area, rCSA). In addition, the cumulative percentage of fat infiltration (%FI) in the left MF and ES at the same level was measured. Baseline variables included age, gender, body mass index (BMI), smoking history, alcohol consumption history, diabetes history, fusion segments, duration of medical history, disease composition, surgical duration and intraoperative blood loss. The rCSA of the MF, ES and PS, as well as %FI in the left MF and ES, were compared. Multivariate logistic regression analysis was performed to further investigate the relationships between these variables and postoperative satisfaction of patients.</p> Results <p>Patients in the dissatisfied group were older and more likely to have undergone two-level fusion. They also exhibited a smaller rCSA in the ES and a higher %FI (<i>P</i>&lt;0.05). Multivariate logistic regression analysis revealed that a greater number of fusion segments, and a higher %FI in MF and ES showed a statistically significant negative correlation with postoperative satisfaction (<i>P </i>&lt; 0.05).</p> Conclusion <p>A greater number of fusion segments and a greater percentage (%FI) of fat infiltration in MS and ES are associated with reduced postoperative satisfaction in middle-aged and elderly patients undergoing short-level lumbar fusion surgery. These findings suggest that the FI, rather than atrophy, may serve as a more robust predictor of postoperative satisfaction and may have significant implications for preoperative assessment clinical decision-making.</p>

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The impact of preoperative radiological paraspinal lumbar measures on the postoperative satisfaction of patients following lumbar fusion surgery– a retrospective case-control study

  • 期刊论文

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  • 发表日期：

    2026年8月1日

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  • Lei Wang,
  • Jingming Wang,
  • Xiaoduo Xu,
  • Xin Chen,
  • Junjie Wu,
  • Weimin Huang

摘要

Background

Paraspinal muscles have been reported to associated with postoperative outcomes in patients undergoing lumbar spine surgery. This study aimed to determine whether preoperative radiological measures of lumbar paraspinal muscles could predict postoperative patient satisfaction.

Methods

A total of 302 patients aged 45 and older who underwent short-segment (≤ 2 segments) lumbar fusion surgery at the 960th Hospital of the People's Liberation Army between January 2019 and January 2022 were retrospectively analyzed. Based on the postoperative satisfaction index(PSI) assessed at the 24th months postoperatively , patients were divided into a satisfied group (PSI≤2, n=282) and a dissatisfied group ( PSI> 2, n=20). Clinical data were collected, the ratio of the area of multifidus muscle (MF), erectus muscle (ES) and psoas major muscle (PS) at the L3 lower endplate level horizontal to the cross-sectional area of the L3 vertebra body (VB) was measured (relative cross-sectional area, rCSA). In addition, the cumulative percentage of fat infiltration (%FI) in the left MF and ES at the same level was measured. Baseline variables included age, gender, body mass index (BMI), smoking history, alcohol consumption history, diabetes history, fusion segments, duration of medical history, disease composition, surgical duration and intraoperative blood loss. The rCSA of the MF, ES and PS, as well as %FI in the left MF and ES, were compared. Multivariate logistic regression analysis was performed to further investigate the relationships between these variables and postoperative satisfaction of patients.

Results

Patients in the dissatisfied group were older and more likely to have undergone two-level fusion. They also exhibited a smaller rCSA in the ES and a higher %FI (P<0.05). Multivariate logistic regression analysis revealed that a greater number of fusion segments, and a higher %FI in MF and ES showed a statistically significant negative correlation with postoperative satisfaction (P < 0.05).

Conclusion

A greater number of fusion segments and a greater percentage (%FI) of fat infiltration in MS and ES are associated with reduced postoperative satisfaction in middle-aged and elderly patients undergoing short-level lumbar fusion surgery. These findings suggest that the FI, rather than atrophy, may serve as a more robust predictor of postoperative satisfaction and may have significant implications for preoperative assessment clinical decision-making.