The Effect of Paraspinal Muscle Degeneration on Distal Pedicle Screw Loosening Following Corrective Surgery for Degenerative Lumbar Scoliosis.

Abstract

A retrospective study. The aim of this study was to evaluate the effect of degeneration of paraspinal muscles, including psoas muscles, erector spinae muscles, and multifidus muscles on pedicle screw loosening at lower instrumented vertebra (LIV) following corrective surgery for degenerative lumbar scoliosis (DLS). The relation between paraspinal muscles and pedicle screw loosening in DLS patients has not been reported. A total of 137 DLS patients underwent corrective surgery with at least 1-year follow-up were included. The patients were divided into two groups: Group A (68 patients) had six or more fused levels and Group B (69 patients) had four or five fused levels. Muscular parameters, including relative cross-sectional area (rCSA) and muscle-fat index (MFI), were measured on preoperative magnetic resonance imaging. rCSA and MFI were measured for both gross muscle (G) and functional muscle (F) as rGCSA, rFCSA, GMFI, and FMFI. Muscle ratio was calculated as rFCSA/rGCSA. Pedicle screw loosening was assessed on spine radiographs or CT at final follow-up. Clinical and radiological screw loosening were classified according to clinical significance. LIV screw loosening occurred in 77 patients at final follow-up. In Group A, patients with LIV screw loosening had significantly higher FMFI of psoas muscles and lower rFCSA and rGCSA of erector spinae. Logistic regression revealed that mean rFCSA of erector spinae <0.71 (odds ratio = 5.0, 95% confidence interval = 1.5-16.4) was an independent risk factor of LIV screw loosening. Mean muscle ratio of erector spinae was significantly lower in patients with clinical screw loosening compared with radiological screw loosening in univariate analysis. In Group B, all muscular parameters showed no significant difference. Degeneration of paraspinal muscles, especially psoas muscles and erector spinae, affected LIV screw loosening in six or more level fusion in corrective surgery for DLS, whereas the four- or five-level fusion had no this influence. 3.