Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case–control study

Abstract

Background: The aim of this study was to investigate the correlation between lumbar multifidus fat infiltration and lumbar postoperative surgical site infection (SSI). Several clinical studies have found that spine postoperative SSI is associated with age, diabetes, obesity, and multilevel surgery. However, few studies have focused on the correlation between lumbar multifidus fat infiltration and SSI. Method: A retrospective review was performed on patients who underwent posterior lumbar interbody fusion (PLIF) between 2011 and 2016 at our hospital. The patients were divided into SSI and non-SSI groups. Data of risk factors [age, diabetes, obesity, body mass index (BMI), number of levels, and surgery duration] and indicators of body mass distribution (subcutaneous fat thickness and multifidus fat infiltration) were collected. The degree of multifidus fat infiltration was analyzed on magnetic resonance images using Image J. Results: Univariate analysis indicated that lumbar spine postoperative SSI was associated with urinary tract infection, subcutaneous fat thickness, lumbar multifidus muscle (LMM) fat infiltration, multilevel surgery (≥2 levels), surgery duration, drainage duration, and number of drainage tubes. In addition, multiple logistic regression analysis revealed that spine SSI development was associated with sex (male), age (> 60 years), subcutaneous fat thickness, LMM fat infiltration, and drainage duration. Receiver operating characteristic curve analysis indicated that the risk of SSI development was higher when the percentage of LMM fat infiltration exceeded 29.29%. Furthermore, Pearson's correlation analysis demonstrated that LMM fat infiltration was correlated with age but not with BMI. Conclusion: Indicators of body mass distribution may better predict SSI risk than BMI following PLIF. Lumbar Multifidus fat infiltration is a novel spine-specific risk factor for SSI development.

Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients

“…Fat deposition within the muscles, known as myosteatosis, significantly reduces muscle quality and strength, demonstrating a close association with morbidity and mortality in geriatric patients 4 . In addition, there is a growing number of publications highlighting high fat infiltration of paraspinal muscles as a poor prognostic factor for patient outcomes of spine surgery 5–8 …”

“…4 In addition, there is a growing number of publications highlighting high fat infiltration of paraspinal muscles as a poor prognostic factor for patient outcomes of spine surgery. [5][6][7][8] Epidural steroid injection (ESI) is one of the most commonly applied interventions used to manage low back or radicular pain. 9 A high prevalence of sarcopenia was consistently observed in elderly patients with chronic low back pain.…”

The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

“…Located on both the sides of the spinous process, the paraspinal muscle is one of the core muscles behind the spine; its structural integrity plays the key role in preserving the spine structural stability and the physiological flexor of the thoracolumbar spine [ 12 – 14 ]. Several studies have documented that PLIF inevitably directly stretches the muscles, affects the blood supply and innervation of the muscles, and decreases the vertebral body mobility, which leads to paraspinal muscle atrophy, fatty infiltration, and intractable low back pain [ 9 , 15 – 18 ]. To address these concerns, the researchers are constantly exploring new surgical techniques with the aim of reducing the incidence of iatrogenic injuries to the paraspinal muscles, accelerating the postoperative recovery, and reducing the postoperative low back pain [ 19 , 20 ].…”

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

“…Table 1 shows the risk factor correlated to the lumbar SSI with the infection rate 1.5% -10%, which fulfills the reported prevalence SSI infection rate. [26]. Therefore, patient selection will be a key for elective interventions, and appropriate infrastructure aids in the ultimate outcomes for both elective and nonelective surgical treatments to minimize SSI happened [27].…”