Erector spinae could be the game changer in surgical decision-making in patients with lumbar spondylolisthesis: a cross-sectional analysis of an age-, sex-, subtype-, level-matched patients with similar spinopelvic parameters received surgical or conservative management.

Abstract

In this study we aimed to identify whether paraspinal muscle morphology could play a role in surgical decision-making in patients with lumbar spondylolisthesis. We conducted a cross-sectional analysis of a prospectively collected database between January 2013 and May 2023. Consecutive women and men, who visited our outpatient clinics with chronic LBP, neurogenic claudication, and had lumbar spine magnetic resonance imaging (MRI) for their complaints were included into the preliminary dataset. We compared the patients who had conservative management (conservative group) or underwent surgery for lumbar spondylolisthesis (surgical group) in terms of intervertebral disc degeneration, end-plate changes, fatty infiltration in the paraspinal muscles and spinopelvic parameters. Conservative and surgical groups were similar in terms of severe IVDD and Modic changes at any lumbar level. Surgical group had significantly fattier erector spinae compared to the conservative group. Regression analysis and ROC analysis revealed an OR of 1.088 and a cut-off value of 17 points for fatty infiltration in the erector spinae to predict which patient could undergo surgery for lumbar spondylolisthesis. Each 1-point increment in fatty infiltration in the erector spinae at any lumbar level increased the likelihood of surgery by 8%. Lumbar spondylolisthesis patients with fatty infiltration score for erector spinae at or above 17 were more likely to have surgery. We recommend clinicians to focus on improving erector spinae muscles in patients with lumbar spondylolisthesis.