Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease

Abstract

Introduction

There is a growing number of publications highlighting sarcopenia and myosteatosis as poor prognosic factors for treatment results in oncological patients. The decrease in the cross-sectional area (CSA) of the multifidus muscle and muscle steatosis is associated with lumbar disc herniation and low back/limb pain. Nevertheless, no studies have analyzed the influence of the above parameters on patient satisfaction, pain decrease and return to daily activities. The aim of the study was to verify whether decreased preoperative CSA of the paraspinal and psoas major muscles and their fatty degeneration (myosteatosis) may influence the outcome of surgical treatment of lumbar disc disease (LDD).

Materials and methods

One hundred and one patients with LDD undergoing open microdiscectomy were enrolled in the analysis. Relative cross-sectional areas (rCSA) of the paraspinal and psoas major muscles as well as their fatty degeneration were measured. Patients were assessed according to the validated Polish versions of the EURO EQ-5D, Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) 1 and 6 months postoperatively. The association between the variables was calculated using Pearson r and Spearman rank correlation. The Kruskal–Wallis test was used to compare the results between the groups with different rCSA of paraspinal and psoas major muscles and a different degree of paraspinal muscle myosteatosis.

Results

Fatty degeneration of the paraspinal muscles correlated with better outcomes 1 and 6 months postoperatively according to ODI (P = 0.003 and P = 0.027, respectively). Patients with higher rCSA of the paraspinal and psoas major muscles achieved better results on the EURO EQ-5D scale (P = 0.0289 and P = 0.0089, respectively). Higher rCSA of the paraspinal and psoas major muscles did not correlate with better outcomes measured using ODI, COMI and VAS scales (P ≥ 0.072).

Conclusion

The degree of fatty degeneration of the paraspinal muscles correlates with better outcomes 1 and 6 months after microdiscectomy.

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References

  1. 1.

    Postacchini F, Postacchini R (2011) Operative management of lumber disc herniation: the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl 108:17–21. https://doi.org/10.1007/978-3-211-99370-5_4

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Parker SL, Mendenhall SK, Godil SS, Sivasubramanian P, Cahill K, Ziewacz J, McGirt MJ (2015) Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clin Orthop Relat Res 473(6):1988–1999. https://doi.org/10.1007/s11999-015-4193-1

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Pędziwiatr M, Pisarska M, Major P, Grochowska A, Matłok M, Przęczek K, Stefura T, Budzyński A, Kłęk S (2016) Laparoscopic colorectal cancer surgery combined with enhanced recovery after surgery protocol (ERAS) reduces the negative impact of sarcopenia on short-term outcomes. Eur J Surg Oncol 42(6):779–787. https://doi.org/10.1016/j.ejso.2016.03.037

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Ariën F, Baitar A, Perkisas S, Vandewoude M, De Cock AM (2020) The association between muscle mass and the degree of myosteatosis of the psoas muscle and mortality in older patients with cancer. J Geriatr Oncol. https://doi.org/10.1016/j.jgo.2020.06.024 ((S1879-4068(20)30066-7))

    Article  PubMed  Google Scholar 

  5. 5.

    Peng YC, Wu CH, Tien YW, Lu TP, Wang YH, Chen BB (2020) Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy. Eur Radiol. https://doi.org/10.1007/s00330-020-07294-7

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Lee CM, Kang J (2020) Prognostic impact of myosteatosis in patients with colorectal cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. https://doi.org/10.1002/jcsm.12575

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Oliveira VC, Oliveira P, Moreira M, Correia M, Lima P, Silva JC, Pereira RV, Fonseca M (2020) Impact of total psoas area and lean muscular area in mortality after endovascular aortic aneurysm repair. Ann Vasc Surg. https://doi.org/10.1016/j.avsg.2020.09.004(S0890-5096(20)30847-5)

    Article  PubMed  Google Scholar 

  8. 8.

    Kim JY, Ryu DS, Paik HK, Ahn SS, Kang MS, Kim KH, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU (2016) Paraspinal muscle, facet joint and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J 16(7):867–875. https://doi.org/10.1016/j.spinee.2016.03.010

    Article  PubMed  Google Scholar 

  9. 9.

    Jorgensen MJ, Marras WS, Gupta P (2003) Cross-sectional area of the lumbar back muscles as a function of torso flexion. Clin Biomech (Bristol, Avon) 18:280–286. https://doi.org/10.1016/S0268-0033(03)00027-5

    CAS  Article  Google Scholar 

  10. 10.

    Lee HJ, Lim WH, Park J-W, Kwon BS, Ryu KH, Lee JH (2012) The relationship between cross-sectional and strength of back muscles in patients with chronic low back pain. Ann Rehabil Med 36:173–181. https://doi.org/10.5535/arm.2012.36.2.173

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Lee JC, Cha J-G, KimY K-I, Shin B-J (2008) Quantitative analysis of back muscle degeneration in the patients with the degenerative lumbar flat back using a digital image analysis: comparison with the normal controls. Spine (Phila Pa 1976) 33:318–325. https://doi.org/10.1097/BRS.0b013e318162458f

    Article  Google Scholar 

  12. 12.

    Kader DF, Wardlaw D, Smith FW (2005) Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 55:145–149. https://doi.org/10.1053/crad.1999.0340

    Article  Google Scholar 

  13. 13.

    Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C (2007) Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med 5:2. https://doi.org/10.1186/1741-7015-5-2

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Parkkola R, Rytokoski U, Kormano M (1993) Magnetic resonance imaging of the discs and trunk muscle in patients with chronic low back pain and healthy control subjects. Spine 18(7):830–836. https://doi.org/10.1097/00007632-199306000-00004

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Arbanas J, Pavlovic I, Marijancic V, Vlahovic H, Starcevic-Klasan G, Peharec S, Bajek S, Miletic D, Malnar D (2013) MRI features of the psoas major muscle in patients with low back pain. Eur Spine J 22(9):1965–1971. https://doi.org/10.1007/s00586-013-2749-x

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Ropponen A, Videman T, Battié MC (2008) The reliability of paraspinal muscles composition measurements using routine spine MRI and their association with back function. Man Ther 13:349–356. https://doi.org/10.1016/j.math.2007.03.004

    Article  PubMed  Google Scholar 

  17. 17.

    Golicki D, Niewada M (2017) EQ-5D-5L Polish population norms. Arch Med Sci 13(1):191–200. https://doi.org/10.5114/aoms.2015.52126

    Article  PubMed  Google Scholar 

  18. 18.

    Miękisiak G, Kołłątaj M, Dobrogowski J, Kloc W, Libionka W, Banach M, Łątka D, Sobolewski T, Sulewski A, Nowakowski A, Kiwic G, Pala A, Potaczek T (2013) Cross-cultural adaptation and validation of the Polish version of the Core Outcome Measures Index for low back pain. Eur Spine J 22(5):995–1001. https://doi.org/10.1007/s00586-012-2607-2

    Article  PubMed  Google Scholar 

  19. 19.

    Miękisiak G, Kołłątaj M, Dobrogowski J, Kloc W, Libionka W, Banach M, Łątka D, Sobolewski T, Sulewski A, Nowakowski A, Kiwic G, Pala A, Potaczek T, Gierlotka M (2013) Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index. Spine (Phila Pa 1976) 38(4):E237–E243. https://doi.org/10.1097/BRS.0b013e31827e948b

    Article  Google Scholar 

  20. 20.

    Kamaz M, Kireşi D, Oğuz H, Emlik D, Levendoğlu F (2007) CT measurement of trunk muscle areas in patients with chronic low back pain. Diagn Interv Radiol 13:144–148

    PubMed  Google Scholar 

  21. 21.

    Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ (2000) CT imaging of trunk muscles in chronic low pain patients and healthy control subjects. Eur Spine J 9:266–272. https://doi.org/10.1007/s005860000190

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581. https://doi.org/10.1097/00007632-199304000-00009

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Khan AB, Weiss EH, Khan AW, Omeis I, Verla T (2017) Back muscle morphometry: effects on outcome of spine surgery. World Neurosurg 103:174–179. https://doi.org/10.1016/j.wneu.2017.03.097

    Article  PubMed  Google Scholar 

  24. 24.

    Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH (1994) Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine (Suppl) 19:165–172. https://doi.org/10.1097/00007632-199401001-00009

    CAS  Article  Google Scholar 

  25. 25.

    Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O’Sullivan R, Cicuttini FM (2015) Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J 15(7):1593–1601. https://doi.org/10.1016/j.spinee.2015.03.039

    Article  PubMed  Google Scholar 

  26. 26.

    Kalichman L, Hodges P, Li L, Guermazi A, Hunter DJ (2010) Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J 19:1136–1144. https://doi.org/10.1007/s00586-009-1257-5

    Article  PubMed  Google Scholar 

  27. 27.

    Kang CH, Shin MJ, Kim SM, Lee SH, Lee C-S (2007) MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain. Clin Radiol 62(5):479–486. https://doi.org/10.1016/j.crad.2006.12.002

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    D’Hooge R, Cagnie B, Crombez G, Vanderstaeten G, Dolphens M, Danneels L (2012) Increased intramuscular fat infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther 17:584–588. https://doi.org/10.1016/j.math.2012.06.00729

    Article  PubMed  Google Scholar 

  29. 29.

    Dzierżanowski M, Dzierżanowski M, Maćkowiak P, SłomkoW RA, Kaźmierczak U, Strojek K, Srokowski G, Żukow W (2013) The influence of active exercise in low positions on the functional condition of the lumbar-sacral segment in patients with discopathy. Adv Clin Exp Med 22(3):421–430

    PubMed  Google Scholar 

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Correspondence to Agnieszka Stanuszek.

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Stanuszek, A., Jędrzejek, A., Gancarczyk-Urlik, E. et al. Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease. Arch Orthop Trauma Surg (2021). https://doi.org/10.1007/s00402-021-03754-x

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Keywords

  • Paraspinal muscle atrophy
  • Psoas major muscle atrophy
  • Muscle fatty degeneration
  • Lumbar disc disease