Degenerative lumbar scoliosis patients with proximal junctional kyphosis have lower muscularity, fatty degeneration at t
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ORIGINAL ARTICLE
Degenerative lumbar scoliosis patients with proximal junctional kyphosis have lower muscularity, fatty degeneration at the lumbar area Lei Yuan1 · Yan Zeng1 · Zhongqiang Chen1 · Weishi Li1 · Xinling Zhang1 · Shuo Mai1 Received: 15 October 2019 / Revised: 4 March 2020 / Accepted: 25 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess the lumbar muscle conditions on the incidence of proximal junctional kyphosis (PJK) after long-level correction and instrumentation surgery for degenerative lumbar scoliosis (DLS) patients with a minimum 2-year follow-up. Methods Eighty-four DLS patients undergoing long instrumented fusion surgery (≥ 5 vertebrae) were retrospectively studied. According to the occurrence of PJK at the final follow-up, patients were divided into the PJK group and the Non-PJK group. Patient characteristics, surgical variables and radiographic parameters were analyzed statistically. The lumbar muscularity (cross-sectional area of muscle–disc ratio × 100) and fatty degeneration (signal intensity of muscle–subcutaneous fat ratio × 100) were evaluated on magnetic resonance imaging . Results The prevalence of PJK was 20.24%. Gender, age at surgery, body mass index, uppermost instrumented vertebrae level, fusions extending to the sacrum, and levels fused were not significantly different between the groups. Lower bone mineral density, smaller functional cross-sectional area (FCSA) of paraspinal extensor muscles (PSE), higher lean muscle–fat index and total muscle–fat index of PSE, greater preoperative thoracolumbar kyphosis (TLK), smaller preoperative sacral slope (SS), larger preoperative sagittal vertical axis were identified in PJK group. Logistic regression analysis showed that osteoporosis, preoperative TLK > 15°, SS > 24°, FCSA of PSE > 138.75, and total muscle–fat index of PSE > 4.08 were independently associated with PJK. The final follow-up VAS score for back pain was higher, and SRS-22 subcategories of pain, function, self-image, and total score were significantly lower in the PJK group. Conclusion Osteoporosis, lower lumbar muscularity and higher fatty degeneration, preoperative greater TLK and smaller SS were found to be strongly associated with the presence of PJK in DLS. Keywords Degenerative lumbar scoliosis · Proximal junctional kyphosis · Paraspinal muscle · Fatty degeneration
Introduction Degenerative lumbar scoliosis (DLS) is a spinal deformity defined as a lumbar Cobb angle greater than 10° without previous history of scoliosis [1]. DLS is common with prevalence ranging from 7.5 to 68% [2–7], which was about 13.3% in the Chinese Han population aged more than 40 years old [8]. With the aging of the population, the incidence of DLS will continue to increase [3, 4, 7]. DLS can cause severe * Yan Zeng [email protected] 1
Department of Orthopedics, Peking University Third Hospital, No 49, North Garden Street, Hai Dian District, Beijing 100191, China
back and leg pain symptoms in patients and resulting in a compromise in hea
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