Frontiers in surgery · 2026
Impact of preoperative lumbar paraspinal muscle quality on the prognosis of open pedicle screw fixation for thoracolumbar fractures.
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Liu Hao, Gong Yan, Shen Yang, Wen Moshan, Kuang Zhen, Wang Mai, Huang Yufeng, Liu Jintao, Yao Zhensong, Cui Jianchao
Аннотация
OBJECTIVE: To investigate the association of preoperative paraspinal muscle quality (quantified by fat infiltration) on the clinical and radiographic outcomes following open pedicle screw fixation (OPSF) for thoracolumbar fractures.
METHODS: This retrospective study analyzed the clinical data of 48 patients with single-segment thoracolumbar fractures who underwent OPSF surgery between January 2021 and December 2023. Patients were stratified into a low-fat group (LFG, FI < 25%, n = 26) and a high-fat group (HFG, FI ≥ 25%, n = 22) based on the preoperative fat infiltration rate (FI) of paraspinal muscles at the L4/5 level measured on MRI. General clinical data, perioperative indicators, radiographic parameters (anterior vertebral body height ratio - AVBHr, vertebral body angle - VBA, regional kyphosis angle - RKA), and clinical efficacy scores (Visual Analogue Scale - VAS, Oswestry Disability Index - ODI) were compared between groups preoperatively, at 1 month, and 1 year postoperatively.
RESULTS: The groups were comparable in all baseline and perioperative characteristics (P > 0.05). The LFG demonstrated significantly better paraspinal muscle parameters at multiple spinal levels (P < 0.05). Although the immediate postoperative radiographic correction achieved was similar between groups (P > 0.05), the HFG exhibited significantly greater loss of correction in both VBA and RKA at the 1-year follow-up (P < 0.05). This difference in correction loss was particularly pronounced in the subgroup of patients with more severe, unstable fractures (AO type A3/A4). No significant differences were found in VAS and ODI scores at any postoperative time point (P > 0.05). Complication rates were similar between groups (P > 0.05).
CONCLUSION: Preoperative lumbar paraspinal muscle quality is not associated with the initial surgical reduction but is significantly associated with the long-term maintenance of radiographic correction after OPSF, especially in unstable fracture patterns. Assessment of paraspinal muscle quality could serve as a valuable prognostic tool for surgical planning and patient counseling.
METHODS: This retrospective study analyzed the clinical data of 48 patients with single-segment thoracolumbar fractures who underwent OPSF surgery between January 2021 and December 2023. Patients were stratified into a low-fat group (LFG, FI < 25%, n = 26) and a high-fat group (HFG, FI ≥ 25%, n = 22) based on the preoperative fat infiltration rate (FI) of paraspinal muscles at the L4/5 level measured on MRI. General clinical data, perioperative indicators, radiographic parameters (anterior vertebral body height ratio - AVBHr, vertebral body angle - VBA, regional kyphosis angle - RKA), and clinical efficacy scores (Visual Analogue Scale - VAS, Oswestry Disability Index - ODI) were compared between groups preoperatively, at 1 month, and 1 year postoperatively.
RESULTS: The groups were comparable in all baseline and perioperative characteristics (P > 0.05). The LFG demonstrated significantly better paraspinal muscle parameters at multiple spinal levels (P < 0.05). Although the immediate postoperative radiographic correction achieved was similar between groups (P > 0.05), the HFG exhibited significantly greater loss of correction in both VBA and RKA at the 1-year follow-up (P < 0.05). This difference in correction loss was particularly pronounced in the subgroup of patients with more severe, unstable fractures (AO type A3/A4). No significant differences were found in VAS and ODI scores at any postoperative time point (P > 0.05). Complication rates were similar between groups (P > 0.05).
CONCLUSION: Preoperative lumbar paraspinal muscle quality is not associated with the initial surgical reduction but is significantly associated with the long-term maintenance of radiographic correction after OPSF, especially in unstable fracture patterns. Assessment of paraspinal muscle quality could serve as a valuable prognostic tool for surgical planning and patient counseling.