Predictive value of MRI-based paraspinal muscle parameters for postoperative recurrence in patients undergoing single-level percutaneous endoscopic lumbar discectomy

doi:10.11958/20253241

Abstract

Abstract:

Objective To investigate the independent impact of paraspinal muscle parameters on postoperative recurrence after percutaneous transforaminal endoscopic discectomy (PTED) in patients with lumbar disc herniation (LDH) and to evaluate their predictive value for postoperative recurrence. Methods A total of 186 patients with single-segment LDH who underwent PTED were selected. Patients were followed up for more than 6 months and were divided into the recurrence group (24 cases) and the non-recurrence group (162 cases) based on the follow-up results. Baseline data were collected in the two groups, and the standardized cross-sectional area (SCSA) and fat infiltration rate (FIR) of the multifidus and erector spinae muscles were measured and calculated. The fat infiltration grade was evaluated. Multivariate Logistic regression was used to analyze the influence of paraspinal muscle parameters on postoperative recurrence, and the predictive efficacy was evaluated by the receiver operating characteristic (ROC) curve. Results The body mass index (BMI), proportion of diabetes history, pain visual analogue scale (VAS) score, Oswestry disability index (ODI), proportion of Pfirrmann grade Ⅳ/Ⅴ, FIR of multifidus muscle, FIR of erector spinae muscle, proportion of patients with severe infiltration (Grade 2) of multifidus muscle and erector spinae muscle in the recurrence group were higher than those in the non-recurrence group, while the SCSA of the multifidus and erector spinae muscles were smaller (P<0.05). The difference in fat infiltration degree was statistically significant. The Firth bias-corrected Logistic regression analysis showed that decreased SCSA of the multifidus and erector spinae muscles, increased FIR were all risk factors for postoperative recurrence in LDH patients after PTED. ROC curve analysis indicated that the area under the ROC curve (AUC) of the combined prediction of paraspinal muscle parameters for postoperative recurrence was 0.898 (95%CI: 0.845-0.937), with a sensitivity of 83.3% and a specificity of 88.3%. Conclusion MRI-based measurements of paraspinal muscle parameters demonstrate good predictive value for postoperative recurrence and can serve as useful indicators for preoperative risk assessment, identification of high-risk patients, and guiding individualized intervention strategies.

Key words: lumbar vertebrae, intervertebral disc displacement, diskectomy, percutaneous, recurrence, paraspinal muscles, fat infiltration

CLC Number:

R681.57

Figures/Tables 8

References 24

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组别	n	性别（男/女）			年龄/岁			BMI/（kg/m²）
未复发组	162	98/64			60.21±7.92			24.15±2.27
复发组	24	15/9			62.63±8.75			25.31±2.42
t或χ²		0.035			1.280			2.209^＊
组别	职业类型									吸烟史
组别	久坐办公		轻体力劳动				重体力劳动			吸烟史
未复发组	42（25.93）		68（41.98）				52（32.09）			51（31.48）
复发组	8（33.33）		7（29.17）				9（37.50）			10（41.67）
t或χ²	1.463									0.984
组别	饮酒史			合并症
组别	饮酒史			糖尿病		高血压			骨质疏松症
未复发组	45（27.78）			13（8.02）		25（15.43）			25（15.43）
复发组	8（33.33）			5（20.83）		5（20.83）			3（15.20）
χ²	0.317			3.923^＊		0.451			0.731

组别	n	性别（男/女）			年龄/岁			BMI/（kg/m²）
未复发组	162	98/64			60.21±7.92			24.15±2.27
复发组	24	15/9			62.63±8.75			25.31±2.42
t或χ²		0.035			1.280			2.209^＊
组别	职业类型									吸烟史
组别	久坐办公		轻体力劳动				重体力劳动			吸烟史
未复发组	42（25.93）		68（41.98）				52（32.09）			51（31.48）
复发组	8（33.33）		7（29.17）				9（37.50）			10（41.67）
t或χ²	1.463									0.984
组别	饮酒史			合并症
组别	饮酒史			糖尿病		高血压			骨质疏松症
未复发组	45（27.78）			13（8.02）		25（15.43）			25（15.43）
复发组	8（33.33）			5（20.83）		5（20.83）			3（15.20）
χ²	0.317			3.923^＊		0.451			0.731

组别	n	病程/月		突出类型
组别	n	病程/月		突出型			脱出型			游离型
未复发组	162	11.67±4.92		123（75.93）			37（22.84）			2（1.23）
复发组	24	14.15±5.83		16（66.67）			6（25.00）			2（8.33）
t或χ²		1.982		5.180
组别	突出节段							疼痛VAS评分/分
组别	L3—4		L4—5			L5—S1		疼痛VAS评分/分
未复发组	15（9.26）		83（51.23）			64（39.51）		6.15±1.37
复发组	3（12.50）		12（50.00）			9（37.50）		6.83±1.52
t或χ²	0.255							2.071^＊
组别	ODI/%				Pfirrmann分级
组别	ODI/%				Ⅰ—Ⅲ级				Ⅳ—Ⅴ级
未复发组	41.35±7.98				106（65.43）				56（34.57）
复发组	45.62±8.73				10（41.67）				14（58.33）
t或χ²	3.209^＊＊				5.030^＊

组别	n	病程/月		突出类型
组别	n	病程/月		突出型			脱出型			游离型
未复发组	162	11.67±4.92		123（75.93）			37（22.84）			2（1.23）
复发组	24	14.15±5.83		16（66.67）			6（25.00）			2（8.33）
t或χ²		1.982		5.180
组别	突出节段							疼痛VAS评分/分
组别	L3—4		L4—5			L5—S1		疼痛VAS评分/分
未复发组	15（9.26）		83（51.23）			64（39.51）		6.15±1.37
复发组	3（12.50）		12（50.00）			9（37.50）		6.83±1.52
t或χ²	0.255							2.071^＊
组别	ODI/%				Pfirrmann分级
组别	ODI/%				Ⅰ—Ⅲ级				Ⅳ—Ⅴ级
未复发组	41.35±7.98				106（65.43）				56（34.57）
复发组	45.62±8.73				10（41.67）				14（58.33）
t或χ²	3.209^＊＊				5.030^＊

组别	n	腰大肌	多裂肌				竖脊肌
		SCSA/%	SCSA/%	FIR/%	脂肪浸润分级		SCSA/%	FIR/%	脂肪浸润分级
		SCSA/%	SCSA/%	FIR/%	0—1级	2级	SCSA/%	FIR/%	0—1级	2级
未复发组	162	74.83±7.25	73.96±7.82	26.04±6.98	140（86.42）	22（13.38）	75.62±8.13	24.38±7.05	137（84.57）	25（15.43）
复发组	24	72.56±6.98	65.28±8.15	34.72±7.33	9（37.50）	15（62.50）	68.35±7.21	31.65±6.87	12（50.00）	12（50.00）
t或χ²		1.647	4.894^＊＊	5.447^＊＊	31.392^＊＊		4.531^＊＊	4.822^＊＊	15.675^＊＊