PVMQ score: a novel imaging parameter for indicating lumbar degeneration and prognosis in patients with L4/5 degenerative lumbar spondylolisthesis.

PURPOSE: To assess the paravertebral muscle quality (PVMQ) score, a novel MRI-based parameter defined by the signal intensity ratio of paraspinal muscles to cerebrospinal fluid, in patients with L4/5 degenerative lumbar spondylolisthesis (DLS), and to investigate its correlations with lumbar degeneration and clinical outcomes. MATERIALS AND METHODS: This retrospective study analyzed data from a prospectively collected cohort of L4/5 DLS patients who underwent minimally invasive transforaminal lumbar interbody fusion (MISTLIF) and completed 1-year follow-up. Demographic characteristics, patient-reported outcome measures (PROMs) including the visual analogue scale (VAS) and Oswestry disability index (ODI), radiological outcomes such as disc height index (DHI), slip distance, vertebral bone quality (VBQ) score, Pfirrmann classification, Weishaupt classification, and the functional cross-sectional area (FCSA) and fat infiltration area (FI) of paraspinal muscles were collected. RESULTS: A total of 170 patients were included. Patients were divided by quartiles of the PVMQ score into four groups (Q1-Q4). The Q4 group exhibited more severe preoperative pain and functional impairment, greater slip distance, higher VBQ score, intervertebral disc and facet joint degeneration as well as lower FCSA and higher FI of paraspinal muscles. Despite significant improvement after MISTLIF, VAS back remained significantly higher in the Q4 group at 1-year follow-up. PVMQ score was independently associated with slip distance (B = 0.002, p = 0.006), VBQ score (B = 0.022, p < 0.001), FI of MF (B = 0.007, P = 0.012) and FI of ES (B = 0.012, p < 0.001). Further analyses identified PVMQ score as an independent risk factor for predicting preoperative VAS back (B = 0.113, 95%CI: 0.065 to 0.162), preoperative VAS Leg (B = 0.069, 95%CI: 0.014 to 0.123), preoperative ODI (B = 0.390, 95%CI: 0.007 to 0.774) and VAS Back at 1-year (B = 0.044, 95%CI: 0.014 to 0.073). CONCLUSION: The PVMQ score not only reflects paraspinal muscle degeneration but also demonstrates significant associations with lumbar degeneration and clinical prognosis. As a novel imaging parameter, it may provide valuable guidance in both clinical practice and scientific investigations.