Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?

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  • 1 Departments of Neurological Surgery and
  • 2 Orthopaedic Surgery, University of California, San Francisco, California; and
  • 3 Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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OBJECTIVE

The aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.

METHODS

A total of 178 patients undergoing single-level L4–5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4–5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.

RESULTS

A total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).

CONCLUSIONS

Fat infiltration of the LM may be associated with ASD after L4–5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3–4 after L4–5 TLIF.

ABBREVIATIONS ASD = adjacent-segment degeneration; CSA = cross-sectional area; LM = lumbar multifidus; TLIF = transforaminal lumbar interbody fusion.

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Contributor Notes

Correspondence Ping-Guo Duan: University of California, San Francisco, CA. pink1198@163.com.

INCLUDE WHEN CITING Published online October 30, 2020; DOI: 10.3171/2020.6.SPINE20238.

Disclosures Dr. Mummaneni: consultant for Globus, DePuy Synthes, and Stryker; direct stock ownership in Spinicity/ISD; honoraria from Spineart; royalties from DePuy Synthes, Thieme Publishers, and Springer Publishers; and non–study-related clinical or research effort from AO Spine and NREF. Dr. Berven: consultant for Green Sun Medical, Globus, Medtronic, Medicrea, and Integrity and royalties from Medtronic and Stryker. Dr. Chou: consultant for Globus and Medtronic and royalties from Globus.

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