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Differences in lumbar paraspinal muscle morphology in patients with sagittal malalignment undergoing posterior lumbar fusion surgery

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Abstract

Purpose

To investigate whether (1) there is a difference between patients with normal or sagittal spinal and spinopelvic malalignment in terms of their paraspinal muscle composition and (2) if sagittal malalignment can be predicted using muscle parameters.

Methods

A retrospective review of patients undergoing posterior lumbar fusion surgery was conducted. A MRI-based muscle measurement technique was used to assess the cross-sectional area, the functional cross-sectional area, the intramuscular fat and fat infiltration (FI) for the psoas and the posterior paraspinal muscles (PPM). Intervertebral disc degeneration was graded for levels L1 to S1. Sagittal vertical axis (SVA; ≥ 50 mm defined as spinal malalignment), pelvic incidence (PI) and lumbar lordosis (LL) were measured, and PI-LL mismatch (PI-LL; ≥ 10° defined as spinopelvic malalignment) was calculated. A receiver operating characteristic (ROC) analysis was conducted to determine the specificity and sensitivity of the FIPPM for predicting sagittal malalignment.

Results

One hundred and fifty patients were analysed. The PI-LL and SVA malalignment groups were found to have a significantly higher FIPPM (PI-LL:47.0 vs. 42.1%; p = 0.019; SVA: 47.7 vs. 41.8%; p = 0.040). ROC analysis predicted sagittal spinal malalignment using FIPPM (cut-off value 42.69%) with a sensitivity of 73.4% and a specificity of 54.1% with an area under the curve of 0.662.

Conclusion

Significant differences in the muscle composition between normal and malalignment groups with respect to FIPPM in both sagittal spinal and spinopelvic alignment were found. This work underlines the imminent impact of the paraspinal musculature on the sagittal alignment.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Dr. Sama reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, IVY II, LLC, ISPH 3, LLC, and VBros Venture Partners X Centinel Spine; consulting fee from Clariance, Inc., Kuros Biosciences AG, and Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of scientific advisory board of Clariance, Inc., and Kuros Biosciences AG; and trips/travel of Medical Device Business research support from Spinal Kinetics, Inc., outside the submitted work. Dr. Cammisa reports royalties from NuVasive, Inc. Accelus; private investments for 4WEB Medical/4WEB, Inc., Bonovo Orthopedics, Inc., Healthpoint Capital Partners, LP, ISPH II, LLC, ISPH 3 Holdings, LLC, Ivy Healthcare Capital Partners, LLC, Medical Device Partners II, LLC, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, Tissue Differentiation Intelligence, LLC, VBVP VI, LLC, VBVP X, LLC (Centinel) and Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., DePuy Synthes Spine, NuVasive, Inc., Spine Biopharma, LLC, and Synexis, LLC, Accelus; membership of scientific advisory board/other office of Healthpoint Capital Partners, LPIVY, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine, outside the submitted work. Dr. Girardi reports royalties from Lanx, Inc., and Ortho Development Corp.; private investments for Centinel Spine, and BCMID; stock ownership of Healthpoint Capital Partners, LP; and consulting fees from NuVasive, Inc., and DePuy Synthes Spine, outside the submitted work. Dr. Hughes reports research support from NuVasive, Inc. and Kuros Biosciences AG; and fellowship support from NuVasive, Inc. and Kuros Biosciences AG, outside the submitted work.

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Science of the National Institute of Health Under Award Number UL1TR002384.

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Authors and Affiliations

  1. Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA

    Maximilian Muellner, Henryk Haffer, Erika Chiapparelli, Yusuke Dodo, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany

    Maximilian Muellner & Henryk Haffer

  3. Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA

    Ek T. Tan

  4. Biostatistics Core, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA

    Jiaqi Zhu

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  1. Maximilian Muellner
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Contributions

Conception and design was done by M.M. Acquisition of data was done by M.M. and H.H. Analysis and interpretation of data were carried out by M.M. and H.H. Drafting the article was done by M.M. Critically revising the article was done by all authors. Preparation of graphical content was done by M.M. and H.H. Reviewed submitted version of manuscript was done by all authors. H.H. approved the final version of the manuscript on behalf of all authors. Statistical analysis was done by M.M. and J.Z. Administrative/technical/material support was done by E.T.T. and J.S. Study supervision was done by A.H.

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Correspondence to Alexander P. Hughes.

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The work was performed at the Hospital for Special Surgery, New York City, NY, USA. The institutional review board of the Hospital for Special Surgery approved this study.

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Muellner, M., Haffer, H., Chiapparelli, E. et al. Differences in lumbar paraspinal muscle morphology in patients with sagittal malalignment undergoing posterior lumbar fusion surgery. Eur Spine J 31, 3109–3118 (2022). https://doi.org/10.1007/s00586-022-07351-3

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