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Association between paraspinal muscle quality and surgery for adjacent segment disease
Peter Zhongxi Du1, Gurmit Singh1, Spencer Smith1
1Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, OR, United States.
North American Spine Society Journal
|March 27, 2025
Summary
Adjacent segment disease (ASD) surgery is linked to higher paraspinal muscle fat. Patients needing ASD surgery showed significantly increased paraspinal fat percentage at L3 and the fusion construct
Area of Science:
- Spine surgery outcomes
- Degenerative spine disease research
- Musculoskeletal imaging analysis
Background:
- Adjacent segment disease (ASD) is a common complication following spinal fusion surgery.
- Paraspinal muscle quality is an emerging risk factor for ASD.
- Understanding these factors is crucial for improving spinal fusion outcomes.
Purpose of the Study:
- To investigate the association between paraspinal muscle degeneration and the risk of requiring surgery for ASD.
- To quantify differences in paraspinal muscle composition in patients who develop ASD requiring surgery versus those who do not.
Main Methods:
- Retrospective review of spinal fusion patients (2009-2022) who underwent subsequent ASD surgery.
- Matched control cohort without ASD surgery (minimum one-year follow-up).
- Measurement of paraspinal fat percentage and cross-sectional area (CSA) at L3 and construct levels using ImageJ.
Main Results:
- 154 patients reviewed (77 per group), matched for age, gender, and BMI.
- Patients undergoing ASD surgery had 24% higher paraspinal fat percentage at L3 (p=0.02).
- A 22% increase in paraspinal fat percentage was observed at the proximal fusion construct level (p=0.03).
Conclusions:
- Increased paraspinal fat percentage is significantly associated with subsequent surgery for adjacent segment disease.
- Degenerated paraspinal musculature may be a key risk factor for ASD development.
- These findings highlight the importance of muscle quality in spinal fusion success.
