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Updated: Mar 24, 2026

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Multifidus Muscle Atrophy Predicts Spinal Cage Subsidence After Lumbar Fusion.

Cong Zhang1,2, Chengming Li1, Xiaotao Wu1

  • 1Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.

Journal of Pain Research
|March 23, 2026
PubMed
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This summary is machine-generated.

Cage subsidence after Transforaminal Lumbar Interbody Fusion (TLIF) for degenerative lumbar spondylolisthesis is linked to intervertebral height correction, segmental lordosis angle correction, and multifidus muscle atrophy (MMA). Addressing these factors can improve surgical outcomes.

Area of Science:

  • Spine surgery
  • Orthopedics
  • Degenerative spine disease

Background:

  • Degenerative lumbar spondylolisthesis (DLS) is a prevalent condition causing significant low back and lower extremity pain.
  • Transforaminal Lumbar Interbody Fusion (TLIF) is a common surgical treatment for DLS.
  • Cage subsidence is a known postoperative complication following TLIF, with complex contributing factors.

Purpose of the Study:

  • To investigate the characteristics of cage subsidence after TLIF in DLS patients.
  • To identify independent risk factors associated with cage subsidence following TLIF for DLS.

Main Methods:

  • A cohort of 131 TLIF patients with DLS were retrospectively analyzed.
  • Patients were categorized into a subsidence group (n=39) and a non-subsidence group (n=92).
Keywords:
degenerative lumbar spondylolisthesislumbar vertebraemultifidus muscleosteoporosisspondylolysis

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  • Data collected included demographics, surgical details, and preoperative/postoperative imaging parameters (e.g., multifidus muscle atrophy, lordosis angles, intervertebral height).
  • Statistical analyses, including univariable and multivariable logistic regression, were employed to determine risk factors.

    • Main Results:

    • Preoperative multifidus muscle atrophy (MMA) was significantly greater in the subsidence group compared to the non-subsidence group (p<0.001).
    • Significant differences were observed in final Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores between the groups.
    • Independent risk factors for cage subsidence included intervertebral height correction (OR=11.19), segmental lordosis angle correction (OR=3.43), and MMA (OR=0.73).

    Conclusions:

    • Intervertebral height correction, segmental lordosis angle correction, and MMA are identified as independent risk factors for cage subsidence after TLIF in DLS patients.
    • Preoperative physiotherapy and core strengthening to improve multifidus muscle quality may reduce MMA.
    • Careful selection of cage height and avoidance of excessive lordotic correction can mitigate cage subsidence and enhance clinical outcomes.