Erector Spinae Degeneration and Gait in NPH: An MRI-Based Retrospective Study

Area of Science:

• Neurosurgery
• Neurology
• Orthopedics

Background:

• Normal pressure hydrocephalus (NPH) presents with gait disturbance, cognitive decline, and incontinence.
• Shunt surgery can improve NPH symptoms, but outcomes vary, suggesting other factors influence recovery.

Purpose of the Study:

• To investigate if preoperative paraspinal muscle degeneration predicts gait function in NPH patients before and after shunt surgery.

Main Methods:

• Retrospective review of 33 NPH patients who underwent lumboperitoneal shunts.
• Preoperative MRI assessed muscle degeneration (fatty infiltration, lean CSA) of paraspinal muscles at L3.
• Gait and functional status evaluated using Timed Up and Go, 10-m walk speed, and modified Rankin Scale.

Main Results:

• Increased fatty infiltration and reduced lean erector spinae cross-sectional area (CSA) correlated with poorer preoperative gait (Timed Up and Go).
• Smaller lean CSA was associated with lower functional status (modified Rankin Scale).
• Preoperative lean CSA predicted postoperative gait performance but not changes in functional status at 12 months.

Conclusions:

• Erector spinae muscle degeneration is associated with reduced baseline mobility in NPH patients.
• This degeneration does not predict postoperative gait improvement following shunt surgery.
• Preoperative muscle degeneration may indicate a lower overall functional status in NPH patients.