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Association patterns between lumbar paraspinal muscles and sagittal malalignment in preoperative patients undergoing lumbar three-column osteotomy

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Abstract

Purpose

We aim to investigate the associations between lumbar paraspinal muscles and sagittal malalignment in patients undergoing lumbar three-column osteotomy.

Methods

Patients undergoing three-column osteotomy between 2016 and 2021 with preoperative lumbar magnetic resonance imaging (MRI) and whole spine radiographs in the standing position were included. Muscle measurements were obtained using a validated custom software for segmentation and muscle evaluation to calculate the functional cross-sectional area (fCSA) and percent fat infiltration (FI) of the m. psoas major (PM) as well as the m. erector spinae (ES) and m. multifidus (MM). Spinopelvic measurements included pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), L1–S1 lordosis (LL), T4–12 thoracic kyphosis (TK), spino-sacral angle (SSA), C7–S1 sagittal vertical axis (SVA), T1 pelvic angle (TPA) and PI–LL mismatch (PI − LL). Statistics were performed using multivariable linear regressions adjusted for age, sex, and body mass index (BMI).

Results

A total of 77 patients (n = 40 female, median age 64 years, median BMI 27.9 kg/m2) were analyzed. After adjusting for age, sex and BMI, regression analyses demonstrated that a greater fCSA of the ES was significantly associated with greater SS and SSA. Moreover, our results showed a significant correlation between a greater FI of the ES and a greater kyphosis of TK.

Conclusion

This study included a large patient cohort with sagittal alignment undergoing three-column osteotomy and is the first to demonstrate significant associations between the lumbar paraspinal muscle parameters and global sagittal alignment. Our findings emphasize the importance of the lumbar paraspinal muscles in sagittal malalignment.

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Availability of data and material

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

Code availability

Not applicable.

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Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

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

    Thomas Caffard, Samuel J. Medina, Artine Arzani, Erika Chiapparelli, Lukas Schönnagel, Soji Tani, Gaston Camino-Willhuber, David Dalton, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Department of Orthopedic Surgery, University of Ulm, Ulm, Germany

    Thomas Caffard & Timo Zippelius

  3. Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany

    Lukas Schönnagel

  4. Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan

    Soji Tani

  5. Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA

    Jiaqi Zhu

Authors
  1. Thomas Caffard
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Contributions

Conception and design: TC, DD, TZ, AS, FC, FG, AH. Acquisition of data: TC, SM, AA, EC, LS, ST, GC, JZ. Analysis and interpretation of data: TC, SM, AA, EC, LS, ST, GC, JZ, DD, TZ, AS, FC, FG, AH. Drafting the article article: TC, SM, AA, EC, LS, ST, GC, JZ, DD. Critically revising the article: TC, SM, AA, EC, LS, ST, GC, JZ, DD, TZ, AS, FC, FG, AH. Preparation of graphical content: TC, SM, AA. Reviewed submitted version of manuscript: TC, SM, AA, EC, LS, ST, GC, JZ, DD, TZ, AS, FC, FG, AH. Approved the final version of the manuscript: TC, SM, AA, EC, LS, ST, GC, JZ, DD, TZ, AS, FC, FG, AH. Statistical analysis: TC, LS, JZ. Administrative/technical/material support: TC, SM, AA, EC, LS, ST, GC, JZ, DD, TZ, AS, FC, FG, AH. Study supervision: AH.

Corresponding author

Correspondence to Alexander P. Hughes.

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Conflict of interest

Dr. Sama reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, IVY II, LLC, ISPH II, LLC, ISPH 3, LLC, HS2, LLC, HSS ASC Development Network, LLC, and Centinel Spine (Vbros Venture Partners V); consulting fee from Depuy Synthes Products, Inc., Clariance, Inc., Kuros Biosciences AG, Ortho Development Corp., Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of scientific advisory board of Depuy Synthes Products, Inc., Clariance, Inc., and Kuros Biosciences AG; Medical Device Business Service, Inc.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; ownership interest for 4WEB Medical/4WEB, 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; Tissue Differentiation Intelligence, LLC; VBVP VI, LLC; VBVP X, LLC; Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., DePuy Synthes, NuVasive, Inc., Spine Biopharma, LLC, and Synexis, LLC, Accelus; membership of scientific advisory board/other office of Healthpoint Capital Partners, Medical Device Partners II, LLC, Orthobond Corporation, Spine Biopharma, 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 BCIMD; and stock ownership of Healthpoint Capital Partners, LP, outside the submitted work. Dr. Hughes reports research support from Kuros Biosciences AG and fellowship support from NuVasive, Inc. and Kuros Biosciences BV, outside the submitted work. The manuscript submitted does not contain information about medical device(s)/drug(s).

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The investigation was approved by the institutional review board. IRB#2019-2137.

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Informed consent was obtained from all individual participants included in the study.

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Caffard, T., Medina, S.J., Arzani, A. et al. Association patterns between lumbar paraspinal muscles and sagittal malalignment in preoperative patients undergoing lumbar three-column osteotomy. Spine Deform 12, 801–809 (2024). https://doi.org/10.1007/s43390-024-00828-9

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  • DOI: https://doi.org/10.1007/s43390-024-00828-9

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