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. 2023 Jul;32(7):2326-2335.
doi: 10.1007/s00586-023-07533-7. Epub 2023 Apr 3.

Preoperative cross-sectional area of psoas muscle correlates with short-term functional outcomes after posterior lumbar surgery

Hikari Urakawa  1 , Kosuke Sato  1 , Avani S Vaishnav  1 , Ryan Lee  1 , Chirag Chaudhary  1 , Jung Kee Mok  1 , Sohrab Virk  2   3 , Evan Sheha  1   4 , Yoshihiro Katsuura  5 , Takashi Kaito  6 , Catherine Himo Gang  1 , Sheeraz A Qureshi  7   8
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Preoperative cross-sectional area of psoas muscle correlates with short-term functional outcomes after posterior lumbar surgery

Hikari Urakawa et al. Eur Spine J. 2023 Jul.

Abstract

Purpose: To determine the optimal level for the measurement of psoas cross-sectional area and examine the correlation with short-term functional outcomes of posterior lumbar surgery.

Methods: Patients who underwent minimally invasive posterior lumbar surgery were included in this study. The cross-sectional area of psoas muscle was measured at each intervertebral level on T2-weighted axial images of preoperative MRI. Normalized total psoas area (NTPA) (mm2/m2) was calculated as total psoas area normalized to patient height. Intraclass Correlation Coefficient (ICC) was calculated for the analysis of inter-rater reliability. Patient reported outcome measures including Oswestry disability index (ODI), visual analog scale (VAS), short form health survey (SF-12) and patient-reported outcomes measurement information system were collected. A multivariate analysis was performed to elucidate independent predictors associated with failure to reach minimal clinically important difference (MCID) in each functional outcome at 6 months.

Results: The total of 212 patients were included in this study. ICC was highest at L3/4 [0.992 (95% CI: 0.987-0.994)] compared to the other levels [L1/2 0.983 (0.973-0.989), L2/3 0.991 (0.986-0.994), L4/5 0.928 (0.893-0.952)]. Postoperative PROMs were significantly worse in patients with low NTPA. Low NTPA was an independent predictor of failure to reach MCID in ODI (OR = 2.68; 95% CI: 1.26-5.67; p = 0.010) and VAS leg (OR = 2.43; 95% CI: 1.13-5.20; p = 0.022).

Conclusion: Decreased psoas cross-sectional area on preoperative MRI correlated with functional outcomes after posterior lumbar surgery. NTPA was highly reliable, especially at L3/4.

Keywords: Functional outcomes; Minimal clinically important difference; Muscle health; Posterior lumbar surgery; Psoas; Sarcopenia.

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