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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2025, Number 2

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Cir Columna 2025; 3 (2)

Impact of paravertebral muscle atrophy on surgical results of degenerative lumbar stenosis

Verde BJC, González MA, Sotelo MIJ, Fuentes RMA, Contreras ZMF, Santos BHA, Santos UIE

Language: Spanish
References: 17
Page: 89-96
PDF size: 233.85 Kb.


ABSTRACT

Introduction: degenerative lumbar stenosis (DLS) is one of the main causes of pain and disability in older adults. It was described by Kirkaldy-Willis, who divided the anatomical changes into three progressive stages: dysfunction, instability, and stabilization. These alterations cause narrowing of the spaces around neurovascular structures, which can trigger symptoms such as lumbosciatica and neurogenic claudication. Pain in DLS is a complex phenomenon, characterized by the interaction of multiple anatomical structures. These include the multifidus and erector spinae muscles, which make up the posterior paravertebral musculature (PPM) and play an important role in the overall balance of the lumbar spine. Degenerative changes in the paravertebral musculature, such as atrophy and fatty infiltration, are common in patients with DLS and have been associated with unfavorable surgical results. Objective: we hypothesized that lower muscle volume and a higher degree of fatty infiltration in the posterior paravertebral musculature are associated with unfavorable surgical outcomes in patients with degenerative lumbar stenosis. Material and methods: an observational study was conducted that included 187 patients with degenerative lumbar stenosis undergoing elective surgical treatment. Their preoperative magnetic resonance images were analyzed to determine muscle volume and percentage of fatty infiltration in the posterior paravertebral musculature. The association between muscle atrophy and postoperative clinical outcomes reported in the ODI and the JOABPEQ was studied. Results: the ODI results showed better scores in individuals classified as Kjaer Grade 0 and 1, as well as in patients with high muscle volume. The JOABPEQ questionnaire showed a non-significant improvement in low back pain in patients with Kjaer 2 and low muscle volume. Conclusions: the findings of this investigation indicate that severe fatty infiltration and reduced volume of the posterior paravertebral muscles are associated with unfavorable surgical outcomes in patients with degenerative lumbar stenosis. Identifying these variables will allow for better risk stratification and promote interventions that minimize damage to the paravertebral musculature. Furthermore, the methods used in this study offer an accessible alternative for application in hospital practice.


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