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. 2025 Jul;34(7):3031-3037.
doi: 10.1007/s00586-025-09030-5. Epub 2025 Jun 13.

Relationship between posterior paraspinal muscle fat infiltration and early conversion to lumbar spinal fusion following decompression surgery

Erika Chiapparelli  1 , Thomas Caffard  1   2 , Samuel J Medina  1 , Krizia Amoroso  1 , Jiaqi Zhu  1   3 , Ali E Guven  1 , Gisberto Evangelisti  1   4 , Jan Hambrecht  1 , Paul Kohli  1   5 , Koki Tsuchiya  1   6 , Vidushi Tripathi  1 , Bruno Verna  1 , Jennifer Shue  1 , Andrew Sama  1 , Federico P Girardi  1 , Frank P Cammisa  1 , Alexander P Hughes  7
Affiliations

Relationship between posterior paraspinal muscle fat infiltration and early conversion to lumbar spinal fusion following decompression surgery

Erika Chiapparelli et al. Eur Spine J. 2025 Jul.

Abstract

Purpose: Spinal stenosis, a common degenerative condition causing back pain and neurogenic claudication, often requires decompression surgery when conservative treatments fail. This study investigates the relationship between posterior paraspinal muscle (PPM) measurements and early conversion to lumbar fusion in patients following decompression surgery. Understanding this relationship is crucial, as prior research suggests paraspinal fat infiltration impacts spinal alignment and surgical outcomes, potentially necessitating revision lumbar fusion surgery.

Methods: An institutional database of posterior lumbar fusion patients was reviewed, excluding those with prior fusion history and missing pre-decompression MRIs. Conversions within two years post-decompression were "early conversion," those between 2 and 5 years "intermediate conversion," and those 5 years or later "late conversion." Muscle segmentations were performed using ITK-SNAP, with ROI set in the bilateral psoas muscle and PPM on preoperative T2-weighted axial MRI at the superior endplate of L4. Muscle metrics were calculated using Matlab™, and sagittal alignment was assessed on sagittal standing spinal radiographs.

Results: The final analysis included 50 patients, with early conversion to fusion observed in 21 patients (42%), intermediate in 14 patients (28%), and late in 15 patients (30%). Patients with early conversion showed significantly higher total PPM FI compared to those with late conversion (p = 0.03). No differences were noted in sagittal alignment measurements among groups.

Conclusion: Higher PPM FI may estimate early conversion to lumbar fusion post-decompression surgery, emphasizing the importance of muscle health in surgical planning and patient management for spinal stenosis. Further research is needed to refine risk stratification and optimize treatment strategies.

Keywords: Conversion to fusion; Decompression; Degenerative spine disease; Fat infiltration; Muscle health; PPM; Revision surgery; Spinal stenosis; Spine.

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Conflict of interest statement

Declarations. Ethics approval: The investigation follows the Declaration of Helsinki and was approved by the HSS Institutional Review Board (IRB) under the approval number IRB#2014-084. No drug or devices requiring FDA approval was discussed. Competing Interests: Dr. Sama reports royalties from Ortho Development, Corp. DePuy Spine Products/Medical Device Business Services, Clariance, Inc.; private investments for Vestia Ventures MiRUS Investment, LLC, ISPH II, LLC, ISPH 3, LLC, and Centinel Spine (Vbros Venture Partners V); consulting fees from DePuy Spine Products/Medical Device Business Services, Clariance, Inc., Kuros Biosciences AG; speaking and/or teaching arrangements for DePuy Spine Products/Medical Device Business Services; membership of scientific advisory board of DePuy Spine Products/Medical Device Business Services, Kuros Biosciences AG, Clariance, Inc., and research support from Spinal Kinetics, Inc./Orthofix, Inc., outside the submitted work. Dr. Cammisa reports royalties from Accelus; ownership interest for 4WEB Medical/4WEB, Inc.; Healthpoint Capital Partners, LP; ISPH II, LLC; ISPH 3 Holdings, LLC; Ivy Healthcare Capital Partners, LLC; Medical Device Partners II, LLC; Medical Device Partners III, LLC; Orthobond Corporation; Spine Biopharma, LLC; Tissue Differentiation Intelligence, LLC; Tissue Connect Systems, Inc.; VBVP VI, LLC; VBVP X, LLC; Woven Orthopedics Technologies; consulting fees from Spine Biopharma, LLC, and Accelus; membership of scientific advisory board/other office of Healthpoint Capital Partners, Medical Device Partners II, LLC, Orthobond Corporation, Spine Biopharma, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Camber Spine, Choice Spine, DePuy Synthes, Centinel Spine, and Royal Biologics outside the submitted work. Dr. Girardi reports royalties from Lanx, Inc. and Ortho Development Corp.; ownership interest in Centinel Spine, BICMD; consulting fees from Lanx, Inc,, Ortho Development Corp, and Sea Spine;and stock ownership in Centinel Spine, Healthpoint Capital Partners, LP; membership of scientific advisory board/other office of Healthpoint Capital Partners, outside the submitted work. Dr. Hughes reports research support from Kuros Biosciences AG and Expanding Innovations, Inc.; private investments in Tissue Connect Systems, Inc.; and fellowship support from NuVasive, Inc. outside the submitted work. Authors Erika Chiapparelli, MD; Thomas Caffard, MD; Samuel J. Medina, BS; Krizia Amoroso, MD Jiaqi Zhu, MA; Ali E. Guven, MD; Gisberto Evangelisti, MD; Jan Hambrecht, MD; Paul Kohli, MD; Koki Tsuchiya, MD; Vidushi Tripathi, BS; Bruno Verna, MD; Jennifer Shue declare they have no financial interest. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: The participants have consented to the submission of this research paper.

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