Does pre-operative multifidus morphology on MRI predict clinical outcomes in adults following surgical treatment for degenerative lumbar spine disease? A systematic review

Abstract

Aim Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor to global disability. Changes in the morphology of the lumbar multifidus muscle on magnetic-resonance imaging (MRI) are associated with worse LBP and disability, but the association between multifidus morphology and post-operative outcomes is not known. The purpose of this systematic review is to examine the relationship between pre-operative multifidus morphology and postoperative changes in pain and disability. Methods We performed a systematic search using the Cochrane Library, EMBASE, MEDLINE, CINAHL and Scopus databases covering the period from January 1946 to January 2018. The literature was searched and assessed by independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. All relevant papers were assessed for risk of bias according to the Quality in Prognosis Studies tool. Results The initial search yielded 436 studies, of which 6 studies were included in the analysis. Four studies were at a low risk of bias. These studies included a total of 873 patients undergoing spinal surgery. An association between low fat infiltration and greater improvement in LBP and disability following surgery was identified. There was insufficient evidence to identify a relationship between cross-sectional area (CSA) and LBP or disability. Conclusions This systematic review found evidence for an association between low multifidus fat infiltration on MRI at baseline and greater reductions in measures of LBP and disability following surgical treatment. There is also limited evidence for an association between larger pre-operative multifidus CSA and improvements in disability, but not pain. The findings of this review should be interpreted with caution due to the small quantity of the available literature.

The predictive value of preoperative paraspinal muscle morphometry on complications after lumbar surgery: a systematic review

“…For abating the effect of heterogeneity, we conducted subgroup analyses in each complication according to measured paraspinal muscles and its method of morphology measure. Similar subgroup analyses were performed by previous studies [14,19]. We defined the paraspinal extensor muscle (PSE) group as the integrity of MF and ES.…”

“…Although substantial work has been carried out to identify potential factors for spine surgery prognosis [11,12], few unequivocal predictive factors related with paraspinal muscle have come to light. Some reviews previously concluded the degree of preoperative paraspinal muscle degeneration in relation to disability and persistent pain after surgery [13,14], whereas no review has focused on the predictive value of paraspinal muscles on complications.…”

Prognostic and Predictive Value of CCND1/Cyclin D1 Amplification in Breast Cancer With a Focus on Postmenopausal Patients: A Systematic Review and Meta-Analysis

“…Discrepancies between ratings of the investigators were resolved by consensus. Each study was then given an overall rating based on a method reported by Jermy et al, whereby low bias studies have ≤2 domains rated as moderate with the remainder rated low; moderate bias studies have either 3 moderate ratings or one moderate and one high with the remainder rated low; and high bias studies having either ≥2 moderate plus one high rating, or ≥2 high ratings, or ≥4 of moderate ratings for each domain (35).…”

“…Low, moderate, and high refer to the level of risk of bias for each domain, for each study. Overall Rating Scoring System(35): Low risk: Up to 2 moderate ratings with remainder low. Moderate risk: 3 low + 3 moderate OR 1 moderate + 1 high.…”

Age- and sex-dependent differences in the morphology and composition of paraspinal muscles between subjects with and without lumbar degenerative diseases

“…Fortin et al clarified that the morphology and fatty infiltration of the multifidus and psoas is associated with patients’ functional status and symptoms [ 5 ]. Jermy et al found a trend for better outcomes following surgery if pre-operative multifidus quality is better [ 6 ].…”