Predictive Analysis Of Paraspinal Muscle Degeneration On The Effect Of Single-segment Posterior Lumbar Decompression,Fusion And Internal Fixation

Objective: To explore the risk factors of preoperative lumbar paraspinal muscle degeneration for single-segment posterior lumbar decompression,fusion and internal fixation by measuring imaging parameters.Methods: Clinical data and outcomes of patients who underwent single segment(L4/5)posterior lumbar decompression and fusion and internal fixation surgery for degenerative lumbar spinal stenosis from January 2016 to October 2018 in Department of Spine Surgery,Shengjing Hospital,China Medical University were retrospectively collected,collect the patient’s preoperative general information,operative time,intraoperative blood loss,preoperative ODI score,ODI score at the last follow-up postoperatively,and use the deep learning automatic segmentation method developed by our hospital and the Shenyang Institute of Automation Chinese Academy of Sciences to measure preoperative lumbar paraspinal muscle imaging data which including:the multifidus muscle cross sectional area,(CSA),erector spinae cross sectional area(CSA),multifidus muscle fatty infiltration rate(FIR)and erector spinae fatty infiltration rate(FIR).Post-operative ODI score and the change of ODI score were used as the evaluation index of surgery.Use Person correlation analysis was used to quantify the relationship between the efficacy and prognosis of singlesegment posterior lumbar decompression and fusion and internal fixation and the preoperative paraspinal muscle imaging parameters,preoperative ODI score,gender,age,body mass index,operation time,intraoperative blood loss.Use multiple linear regression to analyze the risk factors that affect the prognosis of single-segment posterior lumbar decompression,fusion and internal fixation and the change of ODI scores.Results: A total of 135 patients were collected.The last follow-up time of all patients was more than 2 years,and the average follow-up time was 31.63 months.Person correlation analysis showed that the preoperative ODI score,multifidus muscle fatty infiltration rate,and erector spinae fatty infiltration rate were positive correlated with the postoperative ODI score,and the erector spinae cross sectional area was negatively correlated with the postoperative ODI score,and the difference was statistically significantly(P<0.05);multifidus muscle fatty infiltration rate,and erector spinae fatty infiltration rate were negatively correlated with the change of ODI score,and the erector spinae cross sectional area was positively correlated with the change of ODI score,and the difference was statistically significantly(P <0.05).Multiple linear regression analysis indicated that the erector spinae fatty infiltration rate and preoperative ODI score were independent risk factors that affected the ODI score after posterior lumbar decompression,fusion and internal fixation,and the difference was statistically significantly(P<0.05),while erector spinae fatty infiltration rate is also an independent risk factor affecting the change of ODI scores,and the difference is statistically significantly(P<0.05).Conclusion: The preoperative lumbar function score become higher,the erector spinae fatty infiltration rate become smaller,post-operation lumbar spinal function would get better.the erector spinae fatty infiltration rate become smaller,the change of lumbar spine function would get bigger.