ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025
Fatty infiltration in the multifidus predicts screw-loosening following short-segment decompression and fusion: proof of why we should protect and rehabilitate the paraspinal muscles.
Article in 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, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Sarcopenia, paraspinal muscle degeneration, and bone quality as prognostic factors for adjacent segment degeneration or disease after lumbar fusion: a systematic review and meta-analysis.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
- Role of paraspinal muscle fatty infiltration in predicting adjacent segment disease after lumbar spinal fusion: a systematic review and meta-analysis.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 · 2026Review
- Clinical significance and future applications of standardized imaging parameters for assessing paraspinal muscle fatty infiltration in lumbar degenerative disease: a narrative review.Journal of orthopaedic surgery and research · 2026Review
- Association between multifidus fatty infiltration and lumbar facet degeneration in unilateral disc herniation: a retrospective study.Journal of orthopaedic surgery and research · 2026Article
- Machine Learning-Based Prediction for Axial Pain Following Expansive Unilateral Open-Door Laminoplasty: A Retrospective Cohort Study.Pain and therapy · 2026Article
- Percutaneous modified iliac screw fixation: technique and clinical experience.Acta neurochirurgica · 2026Article
- Multifidus degeneration correlates with the extent of L4 translation in degenerative lumbar spondylolisthesis.Brain & spine · 2026Article
- Impact of different paraspinal muscle mass on the prognosis of ACDF-a finite element analysis.Frontiers in bioengineering and biotechnology · 2026Article
- Effect of sarcopenia and paraspinal muscle morphology on conservative treatment outcomes in lumbar spinal stenosis: a prospective cohort study.Frontiers in aging · 2026Article
- Unveiling the role of lumbar intervertebral space morphology: a novel classification and its impact on cage migration in lumbar fusion surgery.European journal of medical research · 2025Article
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Authors and funding
13 authors.
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Abstract
purposeScrew-loosening is a common instrumentation-related complication following fusion. Patients who present with pain and neurological symptoms due to screw-loosening require revision. It has been reported that fat-infiltrated and/or atrophied paraspinal muscles were associated with low back pain, disability, radiculopathy, and instrumentation-related failures. However, there is limited and conflicting knowledge regarding the association of paraspinal muscles with screw-loosening. In the present study, we aimed to identify whether fatty infiltration in the paraspinal muscles was associated with screw-loosening.
methodsA retrospective analysis of the clinical and radiological data of the patients who underwent short-segment decompression and fusion for lumbar spinal stenosis (LSS) at a tertiary spine clinic between 2013 and 2023. Goutallier's classification system was used for grading fatty infiltration in the paraspinal muscles.
resultsPatients with screw-loosening had fattier multifidus at the upper lumbar spine (particularly L2-L3, cephalad to the upper instrumented level of L3-L4) compared to those without screw-loosening. In univariate analysis fatty multifidus at L2-L3 level, elder age, and male sex had ORs of 1.509 (p = 0.008), 1.116 (p = 0.001) and 4.702 (p = 0.004), respectively. In multivariate analysis fatty multifidus at L2-L3 level, elder age and male sex had ORs 1.428 (p = 0.043), 1.109 (p = 0.003), and 5.911 (p = 0.004), respectively.
conclusionFatty infiltration in the multifidus muscle (particularly in the one at the cranial end of the fusion mass) is predictive for screw-loosening following short-segment lumbar decompression and fusion for LSS. Preserving multifidus in subjects is essential to prevent future long-term complications of spine surgery.
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