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Original Articles

Degenerative

Frailty-Muscle Phenotypes Predict Outcomes After Lumbar Fusion in Adults Aged ≥75 Years: A Retrospective Cohort Study
Ma Chao Guo, Xiangyu Li, Shuaikang Wang, Xiaolong Chen, Chao Kong, Yuxi Liu, Shibao Lu
Neurospine 2026;23(2):242-254.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551838.919

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Frailty-Muscle Phenotypes Predict Outcomes After Lumbar Fusion in Adults Aged ≥75 Years: A Retrospective Cohort Study
Neurospine. 2026;23(2):242-254.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551838.919
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Frailty-Muscle Phenotypes Predict Outcomes After Lumbar Fusion in Adults Aged ≥75 Years: A Retrospective Cohort Study
Neurospine. 2026;23(2):242-254.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551838.919
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Objective
To evaluate whether combining clinical frailty with magnetic resonance imaging (MRI)-derived posterior paraspinal muscle degeneration identifies perioperative risk phenotypes in adults aged ≥75 years undergoing lumbar fusion.
Methods
We retrospectively studied patients aged ≥75 years undergoing lumbar fusion with preoperative lumbar MRI. Frailty was assessed using the Fried phenotype (frail: score ≥3). Posterior paraspinal muscle degeneration across L1–S1 was quantified using automated segmentation and a composite posterior frailty index (PFI); severe degeneration was defined as the upper quartile of PFI. Patients were classified into 4 frailty×muscle phenotypes. Primary outcomes were any in-hospital complication and prolonged length of stay (LOS ≥16 days).
Results
Among 248 patients, phenotypes A–D (A, nonfrail/nonsevere; B, frail/nonsevere; C, nonfrail/severe; D, frail/severe) comprised 132, 54, 20, and 42 patients, respectively. Any in-hospital complication occurred in 18.2% of phenotype A compared with 50.0%–57.1% in phenotypes B–D (p<0.001). Prolonged LOS (≥16 days; cohort 75th percentile) occurred in 0.8% of phenotype A versus 38.9% (B), 35.0% (C), and 78.6% (D) (p<0.001), corresponding to absolute risk increases of +34.2 to +77.8 percentage points. After adjustment, higher-risk phenotypes remained independently associated with increased odds of any complication and prolonged LOS; however, the prolonged-LOS odds estimates were imprecise due to sparse events in the reference group. Phenotype was not independently associated with 90-day readmission. Pain improvement (ΔVAS [visual analogue scale]) was attenuated in phenotypes B and D, while differences in ΔODI (Oswestry Disability Index) were not statistically significant.
Conclusion
Integrating frailty and MRI-based posterior paraspinal degeneration provides actionable stratification of complication and prolonged LOS risk after lumbar fusion in older adults.

Citations

Citations to this article as recorded by  Crossref logo
  • From the Editor-in-Chief: Featured Articles in the April 2026 Issue
    Inbo Han
    Neurospine.2026; 23(2): 227.     CrossRef
  • A Commentary on “Frailty-Muscle Phenotypes Predict Outcomes After Lumbar Fusion in Adults Aged ≥75 Years: A Retrospective Cohort Study”
    Julie L. Chan, Daniel J. Hoh
    Neurospine.2026; 23(2): 255.     CrossRef
  • 1,211 View
  • 66 Download
  • 2 Crossref

Deformity

The Contribution of Paraspinal Sarcopenia on Sagittal Imbalance in Degenerative Kyphosis
Ming Wang, Abdukahar Kiram, Jie Li, Yunlong Xu, Jingtan Hu, Xiaodong Qin, Yu Wang, Jun Qiao, Benlong Shi, Saihu Mao, Zezhang Zhu, Yong Qiu, Zhen Liu
Neurospine 2025;22(3):680-691.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550436.218

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The Contribution of Paraspinal Sarcopenia on Sagittal Imbalance in Degenerative Kyphosis
Neurospine. 2025;22(3):680-691.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550436.218
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The Contribution of Paraspinal Sarcopenia on Sagittal Imbalance in Degenerative Kyphosis
Neurospine. 2025;22(3):680-691.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550436.218
Close
Objective
To investigate the correlation between paraspinal sarcopenia (PS) and sagittal imbalance (SI) in degenerative kyphosis (DK), and to explore the correlation between paraspinal muscle (PSM) function loss and morphology change in DK.
Methods
One hundred thirty-eight patients with DK and 204 with lumbar spinal stenosis (LSS) were enrolled. The spinopelvic parameters and sagittal vertical axis (SVA) were measured. Patients were divided into the sagittal balance (SB, SVA ≤ 5 cm, n = 61) and SI (SVA > 5 cm, n = 77) groups. Sagittal balanced LSS patients were served as control group. PSM function was evaluated by measuring the maximal voluntary exertion (MVE) and endurance time (ET). Magnetic resonance imaging-derived cross-sectional area (CSA) and fat infiltration rate (FI%) of PSM at T10–L5 were normalized to intervertebral disc CSA. Psoas CSA and FI% were calculated at L3–4 disc level. The correlation assessment using Spearman rank correlation coefficient and multiple linear regression. Logistic regression was used to identify the risk factors of SI.
Results
Significantly lower ET, MVE, relative CSA (rCSA) and higher rFI% was found in the SI group than in the SB and control. The PS were correlated with spinopelvic parameters and regional kyphosis, while lack of correlation was found between the rFI% and MVE. Logistic regression and Youden index analysis showed ET < 15.5 seconds, MVE < 1.3 N/kg, and rCSA (L1–5) atrophy to be potential risk factors for SI in DK.
Conclusion
DK patients with SI demonstrate acerbated PS that indicated by significant PSM dysfunction and morphological alterations. We highlight the significance of PSM combined evaluation and revealed that PS plays an indispensable role in the progression of SI, providing novel insights into the underlying sagittal compensatory mechanisms.
  • 3,889 View
  • 87 Download

Deformity

Impact of Paraspinal Muscle Degeneration on Surgical Outcomes and Radiographical Sagittal Alignment in Adult Spinal Deformity: A Multicenter Study
Jun Ouchida, Yoshinori Morita, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Tokumi Kanemura, Tetsuya Ohara, Taichi Tsuji, Ryuichi Shinjyo, Shiro Imagama, Hiroaki Nakashima
Neurospine 2025;22(1):30-37.   Published online March 31, 2025
DOI: https://doi.org/10.14245/ns.2449174.587

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Impact of Paraspinal Muscle Degeneration on Surgical Outcomes and Radiographical Sagittal Alignment in Adult Spinal Deformity: A Multicenter Study
Neurospine. 2025;22(1):30-37.   Published online March 31, 2025
DOI: https://doi.org/10.14245/ns.2449174.587
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Impact of Paraspinal Muscle Degeneration on Surgical Outcomes and Radiographical Sagittal Alignment in Adult Spinal Deformity: A Multicenter Study
Neurospine. 2025;22(1):30-37.   Published online March 31, 2025
DOI: https://doi.org/10.14245/ns.2449174.587
Close
Objective
This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD).
Methods
A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups.
Results
The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006).
Conclusion
Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Preoperative undernutrition in older people with adult spinal deformities is associated with worse postoperative sagittal vertical axis
    Jun Ouchida, Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Tokumi Kanemura, Tetsuya Ohara, Taichi Tsuji, Ryuichi Shinjo, Ippei Yamauchi, Yukihito Ode, Shiro Imagama
    Journal of Orthopaedic Science.2026; 31(2): 277.     CrossRef
  • Letter to the Editor concerning “Abdominal wall tension after spinal deformity correction compromises postoperative biomechanics and May contribute to proximal junctional kyphosis” by Jolas E, et al. (Eur Spine J [2025]; doi: 10.1007/s00586-025-09063-w)
    Rafia Raza, Ammar Yahya, Arooba Khan
    European Spine Journal.2026; 35(1): 305.     CrossRef
  • The effect of paraspinal sarcopenia on postoperative sagittal balance: a multivariate analysis following multilevel lumbar fusion surgery
    Tianci Fang, Zhifang Xue, Junxin Zhang, Huilin Yang, Feng Zhou, Hao Liu
    The Spine Journal.2026; 26(4): 709.     CrossRef
  • Mapping the landscape of vitamin D in chronic and idiopathic pain: A bibliometric analysis (2000–2023)
    Zhaohui Jiang, Yijie Wang, Wei Zhang, Zhenzhen Hu, Fang Lin, Zhou Lin
    Medicine.2026; 105(19): e48575.     CrossRef
  • Relationship Between Paraspinal Muscle Degeneration and Functional Outcomes Following Anterior Cervical Spine Surgery for Degenerative Disk Disease: A Systematic Review
    Jan Chrzanowski, Tomasz A. Dziedzic, Przemyslaw Kunert
    Journal of Clinical Medicine.2025; 14(23): 8453.     CrossRef
  • Establishing Optimal L1 Pelvic Angle Targets to Minimize Both Proximal Junctional Kyphosis and Pelvic Nonresponse in Adult Spinal Deformity Surgery
    Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee, Hyun-Jun Kim
    Neurospine.2025; 22(4): 987.     CrossRef
  • 4,838 View
  • 150 Download
  • 9 Web of Science
  • 6 Crossref

Regular Issue

Different Degeneration Patterns of Paraspinal Muscles Between Double-Level and Single-Level Lumbar Spondylolisthesis: An Magnetic Resonance Imaging Analysis of 140 Patients
Yi Li, Ruiling Wang, Junjun Li, Linfeng Wang, Yong Shen
Neurospine 2024;21(3):1029-1039.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448576.288

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Different Degeneration Patterns of Paraspinal Muscles Between Double-Level and Single-Level Lumbar Spondylolisthesis: An Magnetic Resonance Imaging Analysis of 140 Patients
Neurospine. 2024;21(3):1029-1039.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448576.288
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Different Degeneration Patterns of Paraspinal Muscles Between Double-Level and Single-Level Lumbar Spondylolisthesis: An Magnetic Resonance Imaging Analysis of 140 Patients
Neurospine. 2024;21(3):1029-1039.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448576.288
Close
Objective
To evaluate the degeneration patterns of paraspinal muscles in double-level degenerative lumbar spondylolisthesis (dl-DLS) versus single-level degenerative lumbar spondylolisthesis (sl-DLS).
Methods
A total of 67 dl-DLS and 73 sl-DLS patients were included. Multifidus (MF), erector spinae (ES), and psoas major (PM)’s fatty infiltration (FI) and relative cross-sectional area (rCSA) were measured. Sagittal parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) were also assessed. Comparisons and correlation analysis were performed between the 2 groups.
Results
MF atrophy is worse in dl-DLS patients from L3–4 to L5–S1, with higher FI from L1–2 to L5–S1 compared to sl-DLS patients. ES atrophy and FI are more pronounced in dl-DLS patients from L1–2 to L5–S1. PM atrophy is more significant in dl-DLS patients at L2–3 to L5–S1, with heavier FI from L1–2 to L3–4, though no difference in FI from L4–5 to L5–S1. The rCSA and FI of MF and ES show significant differences between adjacent segments in both groups, except for MF rCSA between L3–4 and L4–5 in dl-DLS. In dl-DLS, PM rCSA negatively correlates with PT from L4–5 to L2–3, while FI of MF and ES in L5–S1 positively correlates with LL. In sl-DLS, PM FI in L4–5 and L5–S1 negatively correlates with LL.
Conclusion
Degeneration of MF, ES, and PM is more severe in dl-DLS patients, particularly at the spondylolisthesis level. Severe paraspinal muscle degeneration can lead to spinal force imbalance and progression from sl-DLS to dl-DLS. The degradation of PM and ES correlates negatively with PT and SVA, indicating a link to pelvic decompensation and SVA abnormalities, potentially causing disproportionate degenerative changes in dl-DLS patients.

Citations

Citations to this article as recorded by  Crossref logo
  • Level-Specific Differences in Degenerative Spondylolisthesis: A Comparative Analysis of L3 versus L4 Spinopelvic Alignment, Facet Joint Morphology, and Muscle Degeneration Patterns
    Xinghua Zhou, Jianhua Ren, Junkai Kou, Hengrui Chang, Di Zhang, Xianzhong Meng
    World Neurosurgery.2026; 205: 124629.     CrossRef
  • PVMQ score: a novel imaging parameter for indicating lumbar degeneration and prognosis in patients with L4/5 degenerative lumbar spondylolisthesis
    Tianshu Feng, Yaoyu Wang, Ruichun Jin, Yonggang Li, Jinbo Zhao, Shuo Wang, Xia Wang, Jun Yan, Mingzheng Chang, Xinyu Liu
    European Spine Journal.2026;[Epub]     CrossRef
  • Investigation of spinopelvic sagittal alignment and its correlations in asymptomatic pediatric populations
    Hao Qi, ZengHui Zhao, Feiyu Zu, Chenchen Wang, Chenxi Wang, Zuzhuo Zhang, Jianhua Ren, Rui Xue, Zhaoxuan Wang, Zhiyong Hou, Wei Chen, Di Zhang
    Scientific Reports.2025;[Epub]     CrossRef
  • Clarifying the impact of spine-specific sarcopenia and generalized sarcopenia on clinical features in patients with lumbar degenerative diseases
    Tianshu Feng, Jinbo Zhao, Jinghang Li, Yaoyu Wang, Lianlei Wang, Xinyu Liu
    The Spine Journal.2025; 25(11): 2503.     CrossRef
  • The influence of sarcopenia on clinical and radiological features in patients with single-segment degenerative lumbar spondylolisthesis at L4/5 level
    Tianshu Feng, Congyu Wang, Xinyu Yang, Jinghang Li, Jinbo Zhao, Shuo Wang, Xinyu Liu, Lianlei Wang
    European Spine Journal.2025; 34(10): 4607.     CrossRef
  • Association Between Facet Joint Orientation and Degenerative Spondylolisthesis: A Radiological Study of Double-Level Versus Single-Level Degenerative Spondylolisthesis
    Zhentao Zhang, Qingshuang Zhou, Haicheng Zhou, Bin Wang, Yong Qiu, Zezhang Zhu, Xu Sun
    Neurospine.2025; 22(3): 803.     CrossRef
  • Research progress on ferroptosis in drug resistance and therapy of gastric cancer
    Yuexin Liu, Lizhou Jia, Liu Yang, Zhang Ning, Yanmei Li
    Journal of Cancer Research and Clinical Oncology.2025;[Epub]     CrossRef
  • 5,911 View
  • 145 Download
  • 6 Web of Science
  • 7 Crossref

Regular Issue

A Retrospective Study of the Effect of Spinopelvic Parameters on Fatty Infiltration in Paraspinal Muscles in Patients With Lumbar Spondylolisthesis
Jia-Chen Yang, Jia-Yu Chen, Yin Ding, Yong-Jie Yin, Zhi-Ping Huang, Xiu-Hua Wu, Zu-Cheng Huang, Yi-Kai Li, Qing-An Zhu
Neurospine 2024;21(1):223-230.   Published online February 1, 2024
DOI: https://doi.org/10.14245/ns.2347136.568

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A Retrospective Study of the Effect of Spinopelvic Parameters on Fatty Infiltration in Paraspinal Muscles in Patients With Lumbar Spondylolisthesis
Neurospine. 2024;21(1):223-230.   Published online February 1, 2024
DOI: https://doi.org/10.14245/ns.2347136.568
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A Retrospective Study of the Effect of Spinopelvic Parameters on Fatty Infiltration in Paraspinal Muscles in Patients With Lumbar Spondylolisthesis
Neurospine. 2024;21(1):223-230.   Published online February 1, 2024
DOI: https://doi.org/10.14245/ns.2347136.568
Close
Objective
The effect on fat infiltration (FI) of paraspinal muscles in degenerative lumbar spinal diseases has been demonstrated except for spinopelvic parameters. The present study is to identify the effect of spinopelvic parameters on FI of paraspinal muscle (PSM) and psoas major muscle (PMM) in patients with degenerative lumbar spondylolisthesis.
Methods
A single-center, retrospective cross-sectional study of 160 patients with degenerative lumbar spondylolisthesis (DLS) and lumbar stenosis (LSS) who had lateral full-spine x-ray and lumbar spine magnetic resonance imaging was conducted. PSM and PMM FIs were defined as the ratio of fat to its muscle cross-sectional area. The FIs were compared among patients with different pelvic tilt (PT) and pelvic incidence (PI), respectively.
Results
The PSM FI correlated significantly with pelvic parameters in DLS patients, but not in LSS patients. The PSM FI in pelvic retroversion (PT > 25°) was 0.54 ± 0.13, which was significantly higher in DLS patients than in normal pelvis (0.41 ± 0.14) and pelvic anteversion (PT < 5°) (0.34 ± 0.12). The PSM FI of DLS patients with large PI ( > 60°) was 0.50 ± 0.13, which was higher than those with small ( < 45°) and normal PI (0.37 ± 0.11 and 0.36 ± 0.13). However, the PSM FI of LSS patients didn’t change significantly with PT or PI. Moreover, the PMM FI was about 0.10–0.15, which was significantly lower than the PSM FI, and changed with PT and PI in a similar way of PSM FI with much less in magnitude.
Conclusion
FI of the PSMs increased with greater pelvic retroversion or larger pelvic incidence in DLS patients, but not in LSS patients.

Citations

Citations to this article as recorded by  Crossref logo
  • A local and systemic path in L4 degenerative spondylolisthesis: independent roles of paraspinal muscle fat infiltration and dyslipidemia
    Yilong Zhang, Wenbin Wu, Bu Yang, Feng Feng, Yuefei Guo, Sijin Cheng, Jiajun Deng, Yuejian Sun, Da An, Jian Mo, Limin Rong, Peigen Xie
    European Spine Journal.2026;[Epub]     CrossRef
  • Lumbar spine fusion in elderly patients: risk factors for failure in achieving favorable outcomes
    Peng Cui, Qingyang Huang, Peng Wang, Xiaolong Chen, Chao Kong, Shibao Lu
    European Spine Journal.2025; 34(5): 1771.     CrossRef
  • Correlation between the severity of lumbar spinal stenosis and lumbar paraspinal muscle atrophy
    Xiaoyu Mu
    American Journal of Translational Research.2025; 17(6): 4247.     CrossRef
  • Different Degeneration Patterns of Paraspinal Muscles Between Double-Level and Single-Level Lumbar Spondylolisthesis: An Magnetic Resonance Imaging Analysis of 140 Patients
    Yi Li, Ruiling Wang, Junjun Li, Linfeng Wang, Yong Shen
    Neurospine.2024; 21(3): 1029.     CrossRef
  • Development and validation of a nomogram to predict the unfavorable outcomes in elderly patients undergoing lumbar fusion surgery for degenerative disease
    Peng Cui, Shuaikang Wang, Haojie Zhang, Peng Wang, Xiaolong Chen, Chao Kong, Shibao Lu
    BMC Surgery.2024;[Epub]     CrossRef
  • 6,545 View
  • 140 Download
  • 5 Web of Science
  • 5 Crossref

Regular Issue

Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years
Xinyu Yang, Shijun Zhang, Junxiao Su, Sai Guo, Yakubu Ibrahim, Kai Zhang, Yonghao Tian, Lianlei Wang, Suomao Yuan, Xinyu Liu
Neurospine 2024;21(1):303-313.   Published online February 1, 2024
DOI: https://doi.org/10.14245/ns.2347026.513

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Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years
Neurospine. 2024;21(1):303-313.   Published online February 1, 2024
DOI: https://doi.org/10.14245/ns.2347026.513
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Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years
Neurospine. 2024;21(1):303-313.   Published online February 1, 2024
DOI: https://doi.org/10.14245/ns.2347026.513
Close
Objective
To compare the long-term clinical and radiographic outcomes of transforaminal endoscopic lumbar discectomy (TELD) versus microdiscectomy (MD).
Methods
The data of 154 patients with lumbar disc herniation (LDH) who underwent TELD (n = 89) or MD (n = 65) were retrospectively analyzed. The patients’ clinical outcomes were evaluated using visual analogue scales for leg and low back pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI). The evolution of radiographic manifestations was observed during follow-up. Potential risk factors for a poor clinical outcome were investigated.
Results
During a mean follow-up of 5.5 years (range, 5–7 years), the recurrence rate was 4.49% in the TELD group and 1.54% in the MD group. All scores significantly improved from preoperatively to postoperatively in both groups (p < 0.01). The improvement in the ODI and JOA scores was significantly greater in the TELD than MD group (p < 0.05). Forty-seven patients (52.8%) in the TELD group and 32 (49.2%) in the MD group had Modic changes before surgery, most of which showed no changes at the last follow-up. The degeneration grades of 292 discs (71.0%) were unchanged at the last follow-up, while 86 (20.9%) showed improvement, mostly at the upper adjacent segment. No significant difference was observed in the intervertebral height index or paraspinal muscle-disc ratio.
Conclusion
Both TELD and MD provide generally satisfactory long-term clinical outcomes for patients with LDH. TELD can be used as a reliable alternative to MD with less surgical trauma. Modic type II changes, decreased preoperative intervertebral height, and a high body mass index are predictors of a poor prognosis.

Citations

Citations to this article as recorded by  Crossref logo
  • Comparison of the Converging Decompression Technique and Foraminoplasty Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Very Highly Upward Migrated Lumbar Disc Herniation
    Jianing Yang, Rongbo Yu, Yuyang Zheng, Pengfei Wang, Haitian Zhang, Bin Chen
    World Neurosurgery.2026; 205: 124718.     CrossRef
  • Bracing and Activity Restriction After Lumbar Discectomy Surgery: An International Survey of AO Spine Members
    Waeel O. Hamouda, Stipe Ćorluka, Sathish Muthu, Luca Ambrosio, Carla Cunha, Stjepan Ivandic, Mohamed A.R. Soliman, Fabrizio Russo, Sibylle Grad, In Ho Han, Gianluca Vadala, Hans-Jorg Meisel, Sam K. Cho, Tim S. Yoon, Jeffrey C. Wang, Amit Jain, Zorica Buse
    Neurospine.2026; 23(1): 109.     CrossRef
  • Efficacy of visualized reamer foraminoplasty in transforaminal endoscopic lumbar discectomy: a retrospective controlled study
    Honglin Liu, Yuxiang Hu, Yang Zhan, Zhixin Kang, Zhuoxuan Zhang, Chengyu Huang, Ningjing Zeng, Yang Xiao, Juntao Ma, Zibo Gao, Hao Liu, Guoyi Su, Yongpeng Lin, Zhirong Fan, Dingkun Lin, Yihao Liang, Yongjin Li
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • Does Transforaminal Endoscopic Lumbar Discectomy Provide More Value than Microdiscectomy? An Application of the Operative Value Index
    Advith Sarikonda, Adam Leibold, Ashmal Sami, Cheritesh R. Amaravadi, Daniyal Mansoor Ali, Sara Thalheimer, Jack Jallo, Joshua Heller, Srinivas K. Prasad, Ashwini Sharan, James Harrop, Alexander R. Vaccaro, Ahilan Sivaganesan
    Operative Neurosurgery.2025; 29(2): 209.     CrossRef
  • Cost-effectiveness analysis of extended endoscopic lumbar foraminotomy (EELF) and transforaminal lumbar interbody fusion (TLIF): a prospective observational study
    Jun-Hoe Kim, Hangeul Park, Chang-Hyun Lee, Chi Heon Kim
    Scientific Reports.2025;[Epub]     CrossRef
  • Full-endoscopic lumbar spine discectomy: Are We Finally There? A Meta-Analysis of Its Effectiveness Against Non-microscopic Discectomy, Microdiscectomy and Tubular Discectomy
    Kajetan Latka, Klaudia Kozlowska, Kacper Domisiewicz, Tomasz Klepinowski, Dariusz Latka
    The Spine Journal.2025;[Epub]     CrossRef
  • A Commentary on “Far-Lateral Transforaminal Unilateral Biportal Endoscopic Lumbar Discectomy for Upper Lumbar Disc Herniations”
    Jason Pui Yin Cheung
    Neurospine.2025; 22(1): 28.     CrossRef
  • Far-Lateral Transforaminal Unilateral Biportal Endoscopic Lumbar Discectomy for Upper Lumbar Disc Herniations
    Jin Seop Hwang, Sang Hyub Lee, Dain Jeong, Jae-Won Jang, Yong Eun Cho, Dong-Geun Lee, Choon Keun Park, Chung Kee Chough
    Neurospine.2025; 22(1): 14.     CrossRef
  • Acute Spinal Problems in the Elderly
    Joshua Rutnagur, Andrew Frost, Mohit Arora, Jennifer Lowrie, Santosh Baliga
    British Journal of Hospital Medicine.2025; 86(4): 1.     CrossRef
  • Comparison of Clinical and Radiographic Outcomes Between Percutaneous Endoscopic Transforaminal Diskectomy and Unilateral Biportal Endoscopic Diskectomy for the Treatment of L4/5-Level MSU Size-3 Lumbar Disk Herniation: A 2-Year Retrospective Cohort Study
    Rongkun Xu, Liang Wang, Xinyu Yang, Xing Chen, Wenyang Fu, Shangye Li, Xinzhi Zhang, Xinyu Liu, Lianlei Wang
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    Asian Spine Journal.2025; 19(2): 194.     CrossRef
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    The Healer Journal of Physiotherapy and Rehabilitation Sciences.2025; 5(1): 209.     CrossRef
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Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level
Jinyoung Park, Yong Eun Cho, Kyung Hyun Kim, Sanghoon Shin, Sungjun Kim, Chae Hwan Lim, Seok Young Chung, Yoon Ghil Park
Neurospine 2023;20(3):921-930.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346506.253

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Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level
Neurospine. 2023;20(3):921-930.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346506.253
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Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level
Neurospine. 2023;20(3):921-930.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346506.253
Close
Objective
This study aimed to investigate the correlation between ossification of the posterior longitudinal ligament (OPLL) size and multifidus fatty degeneration (MFD), hypothesizing that larger OPLL sizes are associated with worse MFD.
Methods
One hundred four patients with cervical OPLL who underwent surgery were screened. OPLL occupying diameter and area ratios, the severity of MFD using the Goutallier classification, and range of motion (ROM) of cervical flexion-extension (ΔCobb) were measured. Correlation analyses between OPLL size, MFD severity, and ΔCobb were conducted. MFD severity was compared for each OPLL type using one-way analysis of variance.
Results
The final clinical data from 100 patients were analyzed. The average Goutallier grade of C2–7 significantly correlated with the average OPLL diameter and area occupying ratios, and OPLL involved vertebral level (r = 0.58, p < 0.01; r = 0.40, p < 0.01; r = 0.47, p < 0.01, respectively). The OPLL size at each cervical level significantly correlated with MFD of the same or 1–3 adjacent levels. ΔCobb angle was negatively correlated with the average Goutallier grade (r = -0.31, p < 0.01) and average OPLL occupying diameter and area ratios (r = -0.31, p < 0.01; r = -0.35, p < 0.01, respectively). Patients with continuous OPLL exhibited worse MFD than those with segmental OPLL (p < 0.01).
Conclusion
OPLL size is clinically correlated with MFD and cervical ROM. OPLL at one spinal level affects MFD at the same and 1–3 adjacent spinal levels. The worsening severity of MFD is associated with the longitudinal continuity of OPLL.

Citations

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  • The Impact of Cervical Multifidus Sarcopenia on Outcomes After Laminoplasty for Cervical Ossification of the Posterior Longitudinal Ligament
    Yiwei Zhao, Ye Tian, Dihan Sun, Jianguo Zhang, Siyi Cai
    Journal of Bone and Joint Surgery.2026; 108(5): 370.     CrossRef
  • Degenerative characteristics of the subaxial cervical spine in patients with degenerative lateral atlantoaxial osteoarthritis: A propensity score-matched study based on computed tomography imaging
    Shun Han, Yuliang Wu, Haotian Tian, Bo Sun, Songbo Gao, Weitao Han, Zhengqi Huang, Xiaohe Zhang, Yan Peng, Youxi Lin, Wei Ye
    Journal of Craniovertebral Junction and Spine.2026; 17(2): 125.     CrossRef
  • Cervical facet joint angle and deep extensor degeneration are correlated with laterally deviated type ossification of the posterior longitudinal ligament
    Hao Zhou, Tianyu Yao, Tenghui Zhang, Fazhi Zang, Xiaodong Wu, Lei Liang, Huajiang Chen
    European Journal of Medical Research.2026;[Epub]     CrossRef
  • The role of paraspinal muscle degeneration in cervical spondylosis
    Zhifei Li, Yisheng Zhang, Yuanfang Lin, Chunyu Fan, Yin Yang, Yueli Sun, Zhihua Wu, Ziyang Liang
    European Spine Journal.2025; 34(3): 1187.     CrossRef
  • Association between Congestive Heart Failure and Ossification of the Posterior Longitudinal Ligament in Korea: A Nationwide Longitudinal Cohort Study
    Dong Soon Jang, Hakyung Kim, Seung Hun Sheen, Inbo Han, Soo Hyun Lee, Woo Seok Choi, Je Beom Hong, Min Jai Cho, Seil Sohn
    The Nerve.2024; 10(1): 19.     CrossRef
  • 5,130 View
  • 179 Download
  • 3 Web of Science
  • 5 Crossref
Proteomic Comparison of Paraspinal Muscle Imbalance Between Idiopathic Scoliosis and Congenital Scoliosis
Zhen Wang, Xu’an Huang, Haining Tan, Jinqian Liang, Zheng Li, Jianxiong Shen
Neurospine 2023;20(2):709-724.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346366.183

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Proteomic Comparison of Paraspinal Muscle Imbalance Between Idiopathic Scoliosis and Congenital Scoliosis
Neurospine. 2023;20(2):709-724.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346366.183
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Proteomic Comparison of Paraspinal Muscle Imbalance Between Idiopathic Scoliosis and Congenital Scoliosis
Neurospine. 2023;20(2):709-724.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346366.183
Close
Objective
This study aims to compare the proteomic profiles of paraspinal muscle imbalance between idiopathic scoliosis (IS) and congenital scoliosis (CS).
Methods
Bilateral paraspinal muscles of 5 pairs of matched IS and CS patients were collected. Proteome patterns of paraspinal muscles were established. Differentially expressed proteins (DEPs) in paraspinal muscles between the convexity and the concavity were screened out. DEPs shared by both IS and CS and IS-specific DEPs were identified. Bioinformatic analyses of DEPs were performed.
Results
Among 105 DEPs identified in IS, 30 displayed predominant expression on the convexity, whereas other 75 exhibited predominant expression on the concavity. DEPs in IS were mainly enriched in calcium ion binding and DNA binding in gene ontology (GO) term and glycolysis/gluconeogenesis and purine metabolism in Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. Among 48 DEPs identified in CS, 25 were predominantly expressed on the convexity and 23 on the concavity. DEPs in CS were mainly enriched in receptor activity and immune response in GO term and glycolysis/gluconeogenesis and cellular senescence in KEGG pathway. Comparison of DEPs between IS and CS identified only 8 proteins shared by both types of scoliosis. Among the 97 IS-specific DEPs, 28 were predominantly expressed on the convexity and 69 on the concavity. IS-specific genes were enriched in calcium ion binding and protein glycosylation in GO term and glycolysis/gluconeogenesis and hypertrophic cardiomyopathy in KEGG pathway.
Conclusion
IS and CS exhibit proteomic imbalance in bilateral paraspinal muscles but share few similarities. Paraspinal muscle imbalance in IS might not be the consequence of spinal deformities.

Citations

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  • Genetic Association of CANT1 Gene with Scoliosis: An Integrative Study Involving Methylation, Immune Factors, and Metabolites
    Xiao Zhang, Wenbo Gu, Yanrong Tian, Hongyang Zhao, Donghui Cao, Tenyao Niu, Xusheng Li, Haifeng Yuan
    Journal of Molecular Neuroscience.2025;[Epub]     CrossRef
  • Spinal muscle characteristics during three different types of locomotion activities among college students with idiopathic scoliosis
    Yanyun Gou, Jing Tao, Jia Huang, Meijin Hou, Yifan Sun, Xiang Chen, Xiangbin Wang
    BMC Musculoskeletal Disorders.2024;[Epub]     CrossRef
  • 6,897 View
  • 209 Download
  • 2 Web of Science
  • 2 Crossref
Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk
Junseok Bae, Ashwin Sathe, Shih-Min Lee, Alexander A. Theologis, Vedat Deviren, Sang-Ho Lee
Neurospine 2021;18(3):495-503.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142510.255

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Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk
Neurospine. 2021;18(3):495-503.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142510.255
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Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk
Neurospine. 2021;18(3):495-503.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142510.255
Close
Objective
The purpose of this study was to investigate the changes in spinopelvic parameters before and after the setting of muscle fatigue along with its correlation with pre-existing paraspinal and psoas muscle mass.
Methods
Single-center retrospective review of prospectively collected data was conducted on 145-adults with symptomatic loss of lumbar lordosis (LL). Radiographs were taken before and after walking for 10 minutes. Magnetic resonance imaging was used to calculate paraspinal muscle (PSM) cross-sectional area (CSA), mean signal intensity, fatty infiltration (FI), and lean muscle mass at thoracolumbar junction (T12) and lower lumbar level (L4). Psoas CSA was calculated at L3. Patients were divided into 2 groups namely compensated sagittal deformity (CSD) (SVA ≤ 4 cm, PT > 20°) and decompensated sagittal deformity (DSD) (SVA > 4 cm, PT > 20°) based on prewalk measurements.
Results
Initial mean SVA was 1.8 cm and 11 cm for CSD and DSD respectively (p < 0.01). After walking, significant deteriorations in SVA, PT–LL (p < 0.01) were observed in CSD without significant change in thoracic kyphosis (TK). All sagittal parameters in DSD deteriorated significantly. DSD group had significantly poorer PSM quality at T12 and L4 compared to CSD group. In CSD group, sagittal decompensation correlated with muscle quality, i.e. , decreases in LL (ΔLL) correlated with CSA of PSM/vertebral body (VB) at L4 (r = -0.412, p = 0.046) while increases in TK (ΔTK) correlated with CSA of PSM/VB at T12 (r = 0.477, p = 0.018). ΔSVA and ΔPT correlated with FI at L4 (r = 0.577, p = 0.003 and r = -0.407, p = 0.048, respectively). DSD group, had weak correlations (-0.3 < r < -0.1) between changes in sagittal and PSM parameters.
Conclusion
PSM quality in adults with spinal deformity correlates with patients’ ability to maintain an upright posture and sagittal decompensation after walking for 10 minutes.

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  • Three-dimensional gait analysis reveals differences in spinal balance and muscle activity during prolonged walking in patients with dropped head syndrome based on global spinal alignment
    Kotaro Sakashita, Kousei Miura, Hideki Kadone, Tomoyuki Asada, Takahiro Sunami, Takane Nakagawa, Yosuke Ogata, Shun Okuwaki, Hisanori Gamada, Hiroshi Noguchi, Hiroshi Takahashi, Toru Funayama, Masao Koda, Masashi Yamazaki
    European Spine Journal.2026; 35(4): 1539.     CrossRef
  • The Association of Lumbar Paraspinal Muscle Size and Quality With Physical Function, Disability, and Pain in Adults With Chronic Low Back Pain
    Cristiane R. Carlesso, Jaclyn M. Sions, William J. Anderst, Charity G. Patterson, Allison M. Voss, Luiza P. Weissmann, Blake S. Johnson, Michael J. Schneider, Sara R. Piva
    JOSPT Open.2026; 4(2): 181.     CrossRef
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    European Spine Journal.2025; 34(6): 2127.     CrossRef
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    Donghua Huang, Zhan Wang, Mihir Dekhne, Atahan Durbas, Tejas Subramanian, Gabrielle Dykhouse, Robert N. Uzzo, Luis Felipe Colón, Stephane Owusu-Sarpong, Han Jo Kim, Francis Lovecchio
    Journal of Clinical Medicine.2025; 14(10): 3293.     CrossRef
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    Ming Wang, Abdukahar Kiram, Jie Li, Yunlong Xu, Jingtan Hu, Xiaodong Qin, Yu Wang, Jun Qiao, Benlong Shi, Saihu Mao, Zezhang Zhu, Yong Qiu, Zhen Liu
    Neurospine.2025; 22(3): 680.     CrossRef
  • Persistent Lower Extremity Compensation for Sagittal Imbalance After Surgical Correction of Complex Adult Spinal Deformity: A Radiographic Analysis of Early Impact
    Tyler K. Williamson, Pooja Dave, Jamshaid M. Mir, Justin S. Smith, Renaud Lafage, Breton Line, Bassel G. Diebo, Alan H. Daniels, Jeffrey L. Gum, Themistocles S. Protopsaltis, D. Kojo Hamilton, Alex Soroceanu, Justin K. Scheer, Robert Eastlack, Michael P.
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    Can Chen, Yong Tang, Sen Yang, Wei Dai, Jiulin Tan, Xueke Yu, Chengmin Zhang, Fei Luo
    Journal of Orthopaedic Surgery and Research.2024;[Epub]     CrossRef
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    Frontiers in Surgery.2023;[Epub]     CrossRef
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    Can Chen, Sen Yang, Yong Tang, Xueke Yu, Chunhua Chen, Chengmin Zhang, Fei Luo
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    Neurospine.2023; 20(3): 908.     CrossRef
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Clinical Articles

Analysis of Factors Contributing to Postoperative Spinal Instability after Lumbar Decompression for Spinal Stenosis
Joo Chul Yang, Sung Gon Kim, Tae Wan Kim, Kwan Ho Park
Korean J Spine 2013;10(3):149-154.   Published online September 30, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.3.149

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Analysis of Factors Contributing to Postoperative Spinal Instability after Lumbar Decompression for Spinal Stenosis
Korean J Spine. 2013;10(3):149-154.   Published online September 30, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.3.149
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Analysis of Factors Contributing to Postoperative Spinal Instability after Lumbar Decompression for Spinal Stenosis
Korean J Spine. 2013;10(3):149-154.   Published online September 30, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.3.149
Close
Objective

Decompressive laminectomy is one of the most commonly used surgical methods for the treatment of spinal stenosis. We retrospectively examined the risk factors that induce spinal instability, including slippage (spondylolisthesis) and/or segmental angulation after decompressive laminectomy on the lumbar spine.

Methods

From January 1, 2006 to June 30, 2010, 94 consecutive patients underwent first-time single level decompressive laminectomy without fusion and discectomy. Of these 94 patients, 42 with a follow-up period of at least 2 years were selected. We measured the segmental angulation and slippage in flexion and extension dynamic lumbar radiographs. We analyzed the following contributing factors to spinal instability: age/sex, smoking history, disc space narrowing, body mass index (kg/m2), facet joint tropism, effect of the lordotic angle on lumbar spine, asymmetrical paraspinal muscle volume, and surgical method and level.

Results

Female patients, normal lordotic angle, and asymmetrical paraspinal muscle volume were factors more significantly associated with spondylolisthesis (p-value=0.026, 0.015, <0.01). Statistical results indicated that patients with facet tropism were more likely to have segmental angulation (p-value=0.046). Facet tropism and asymmetry of paraspinal muscle volume were predisposing factors to spinal instability (p-value=0.012, <0.01).

Conclusion

Facet joint tropism and asymmetry of paraspinal muscle volume are the most important factors associated with spinal instability; therefore, careful follow-up after decompressive laminectomy in affected patients is necessary.

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    Spine Surgery and Related Research.2025; 9(1): 30.     CrossRef
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    Andrei George Anghel, Jonas Garthmann, Baraa Alkahawagi
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    Kyohei Kin, Akira Kusumegi, Masashi Chinen, Shohei Okamoto, Toshiharu Mitsuhashi, Yuichi Takahashi, Kenki Nishida
    European Spine Journal.2025; 34(7): 3021.     CrossRef
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    Vwaire Orhurhu, Scott Brancolini, Danielle Zheng, Sean Snyder, David Jevotovsky, Harman Chopra, Sidharth Sahni, Nathan Li, Ryan D’Souza, Maria Evankovich, Brendan Lynch, Michael Farrell, Benedict Alter, Trent Emerick
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    Emel Ece Özcan-Ekşi, Ali Börekci, Murat Şakir Ekşi
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Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis
Dong Am Park, Seok Won Kim, Sung Myung Lee, Chang Il Ju, Chong Gue Kim, Suk Jung Jang
Korean J Spine 2012;9(4):321-325.   Published online December 31, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.4.321

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Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis
Korean J Spine. 2012;9(4):321-325.   Published online December 31, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.4.321
Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
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Include:
Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis
Korean J Spine. 2012;9(4):321-325.   Published online December 31, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.4.321
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Objective

Screw fixation via the paraspinal muscle sparing approach and by percutaneous screw fixation are known to diminish the risk of complications, such as, iatrogenic muscle injury as compared with the conventional midline approach. The purpose of this study was to evaluate tissue injury markers after these less traumatic screw fixation techniques for the treatment of L4-L5 spondylolisthesis.

Methods

Twenty-two patients scheduled for posterior lumbar interbody fusion (PLIF) at the L4-L5 segment for spondylolisthesis were prospectively studied. Patients were divided into two groups by screw fixation technique (Group I: paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery.

Results

Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7. No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3.

Conclusion

This study shows that percutaneous screw fixation procedure is the preferable minimally invasive technique in terms of minimizing muscle injury associated with L4-L5 spondylolisthesis.

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    The Egyptian Journal of Neurology, Psychiatry and Neurosurgery.2021;[Epub]     CrossRef
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