Degree of paraspinal muscle fat infiltration predicts non-infectious poor wound healing following lumbar surgery

Xiong Shishuo; Xiang Rong; Zhang Yukai; Lan Qing; Guo Haiwei; Tian Han; Zhong Yelin; Zhang Yinyin; Guo Zehua; Lu Wenhao; Li Ying

doi:10.12307/2026.779

Abstract：BACKGROUND:Non-infectious poor wound healing following lumbar surgery is a significant clinical complication that prolongs hospitalization and increases the risk of reoperation.However,its predictive indicators remain unclear.Based on the hypothesis that paraspinal muscle degeneration may impede tissue repair by altering the local microenvironment,this study aimed to investigate the predictive value of preoperative paraspinal muscle fatty infiltration for non-infectious poor wound healing and its association with osteoporosis. OBJECTIVE:To quantify the degree of paraspinal muscle fatty infiltration using preoperative MRI and evaluate its predictive value for non-infectious poor wound healing after lumbar surgery. METHODS:A retrospective analysis was conducted on medical records of 4 368 patients who underwent traditional open posterior lumbar surgery at Third Affiliated Hospital of Guangzhou University of Chinese Medicine between 2019 and 2024.We screened 190 patients with a postoperative hospital stay of 15 days or longer.Based on postoperative wound healing and infection indicators,patients with non-infectious poor healing were identified from these 190 patients and placed in a poor healing group(41 patients).The remaining 4 178 surgical patients were screened and their medical records and blood tests were reviewed.Patients with good healing were selected and placed in a good healing group(40 patients).The non-infectious poor healing group was further divided into an osteoporosis group and a non-osteoporosis group.Preoperative lumbar MRI images were analyzed using ImageJ software to measure and calculate the cross-sectional area of the psoas major muscle and the percentage of fat infiltration in the erector spinae and multifidus muscles. RESULTS AND CONCLUSION:(1)No significant differences were observed in baseline characteristics such as gender,age,or diabetes status between the poor healing group and the good healing group(P>0.05).(2)There were significant differences in the functional cross-sectional area and fat infiltration percentage of the psoas major,erector spinae,and multifidus muscles between the poor healing group and the good healing group(P<0.05).(3)Logistic regression analysis showed that the fat infiltration percentage was an independent risk factor for poor wound healing.(4)Receiver operating characteristic curve analysis showed that the fat infiltration percentage had a high predictive value for poor wound healing(area under the curve>0.7).(5)One-way analysis of variance suggested that osteoporosis may be a risk factor for the degree of fatty infiltration of the L4 multifidus muscle(P<0.05).(6)The results indicate that the percentage of fatty infiltration of the paraspinal muscles is an important indicator for predicting poor wound healing in patients undergoing traditional posterior open lumbar spine surgery,providing a clinical reference.Osteoporosis has also been shown to be a risk factor for the degree of fatty infiltration of the L4 multifidus muscle.However,due to the small sample size in this subgroup,further clinical trials are needed to confirm whether osteoporosis affects non-infectious poor wound healing after lumbar spine surgery.