ArticleThe spine journal : official journal of the North American Spine Society2022
Paraspinal musculature impairment is associated with spinopelvic and spinal malalignment in patients undergoing lumbar fusion surgery.
Article in The spine journal : official journal of the North American Spine Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Association of paraspinal muscle morphology or composition with sagittal spinopelvic alignment: a systematic review and meta-analysis.BMC musculoskeletal disorders · 2025Pooled it
- Impaired Preoperative Spinopelvic Function Does Not Compromise the Patient-Reported Outcome at 2-Years After Total Hip Arthroplasty.Arthroplasty today · 2026Article
- Associations Between Paraspinal Muscle Degeneration, Trunk Isokinetic Strengths, and Spinopelvic Alignment in Patients Undergoing Lumbar Fusion: A Cross-Sectional Study.Journal of clinical medicine · 2026Article
- Reduced paraspinal muscle endurance and electromyographic fatigability are associated with greater global spinal imbalance in symptomatic lumbar spinal stenosis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Gluteal Muscle Degeneration Is Associated with Compensation Failure in Age-Related Spinopelvic Malalignment: A Cross-Sectional Study.Spine surgery and related research · 2026Article
- Fatty infiltration of paraspinal muscles and its association with sagittal spinal malalignment in the general population.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Machine learning-based identification and ranking of risk factors for lumbar paraspinal muscle atrophy.Archives of orthopaedic and trauma surgery · 2026Article
- Multifidus degeneration correlates with the extent of L4 translation in degenerative lumbar spondylolisthesis.Brain & spine · 2026Article
- Limitations of fusion without pelvic foundation in adult spinal deformity surgery.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Characteristics of paraspinal muscle in asymptomatic population with pelvic anteversion: correlation between bony alignment and paraspinal muscle.Journal of orthopaedic surgery and research · 2025Article
- The Contribution of Paraspinal Sarcopenia on Sagittal Imbalance in Degenerative Kyphosis.Neurospine · 2025Article
- Relationship between posterior paraspinal muscle fat infiltration and early conversion to lumbar spinal fusion following decompression surgery.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Sarcopenia and the management of spinal disease in the elderly.GeroScience · 2025Review
- Long-Term Refined Paraspinal Muscle Exercises Combined with ERAS Protocol Enhance Postoperative Recovery Following Lumbar Fusion Surgery.Journal of pain research · 2025Article
- Effects of different physical therapy training protocols on patients with idiopathic scoliosis: Short-term results.PloS one · 2025Observational
- Muscle fat infiltration: a narrative review of the magnetic resonance (MR)-based evaluation methods and their clinical applications.Quantitative imaging in medicine and surgery · 2024Review
- The Association between prior arthroplasty and Paraspinal Muscle Degeneration in patients undergoing elective lumbar surgery.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2024Article
- Association patterns between lumbar paraspinal muscles and sagittal malalignment in preoperative patients undergoing lumbar three-column osteotomy.Spine deformity · 2024Article
- Georg Schmorl Prize of the German Spine Society (DWG) 2023: the influence of sarcopenia and paraspinal muscle composition on patient-reported outcomes: a prospective investigation of lumbar spinal fusion patients with 12-month follow-up.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2024Article
- Association patterns between lumbar paraspinal muscles and sagittal malalignment in preoperative patients undergoing lumbar three-column osteotomy.Spine deformity · 2024Article
Corrections and comments
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Authors and funding
14 authors at 2 institutions in 2 countries.
Funding
Abstract
background contextThe concept of sagittal spinal malalignment is well established in spinal surgery. However, the effect of musculature on its development has not been fully considered and the position of the pelvis is mostly seen as compensatory and not necessarily a possible cause of sagittal imbalance. PURPOSE: This study aimed to investigate the influence of the posterior paraspinal muscles (PPM, erector spinae, and multifidus) and the psoas muscle on spinopelvic and spinal alignment. STUDY DESIGN/
settingRetrospective cross-sectional study. PATIENT SAMPLE: Patients undergoing posterior lumbar fusion between 2014 and 2021 for degenerative conditions at a tertiary care center, with preoperative lumbar magnetic resonance imaging (MRI) within 12 months prior the surgery and a preoperative whole spine radiograph were included. OUTCOME MEASURES: PPM and psoas muscle measurements including the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the amount of intramuscular fat (FAT), and the percentage of fat infiltration (FI). Spinopelvic measurements including lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and sagittal vertical axis (SVA).
methodsA T2-weighted MRI-based quantitative assessment of the CSA, the fCSA and the amount FAT was conducted, and FI was further calculated. The regions of interest included the psoas muscle and the PPM on both sides at the L4 level that were summarized and normalized by the patient's height (cm
resultsA total of 150 patients (53.3% female) were included in the final analysis with a median age of 65.6 years and a median BMI of 28.2 kg/m
conclusionsThis study demonstrated the potential role of posterior paraspinal muscles and psoas muscle on pelvic retroversion and elucidated the relation to sagittal spinal malalignment. Although we cannot establish causality, we propose that increasing FI
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