{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T12:25:54Z","timestamp":1793190354051,"version":"4.5.0"},"reference-count":67,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Health Sciences"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Screw-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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A 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\u2019s classification system was used for grading fatty infiltration in the paraspinal muscles.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Patients 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 (<jats:bold>\n                <jats:italic>p<\/jats:italic>\n              <\/jats:bold>\n              <jats:bold>\u2009=\u20090.008<\/jats:bold>), 1.116 (<jats:bold>\n                <jats:italic>p<\/jats:italic>\n              <\/jats:bold>\n              <jats:bold>\u2009=\u20090.001<\/jats:bold>) and 4.702 (<jats:bold>\n                <jats:italic>p<\/jats:italic>\n              <\/jats:bold>\n              <jats:bold>\u2009=\u20090.004<\/jats:bold>), respectively. In multivariate analysis fatty multifidus at L2-L3 level, elder age and male sex had ORs 1.428 (<jats:bold>\n                <jats:italic>p<\/jats:italic>\n              <\/jats:bold>\n              <jats:bold>\u2009=\u20090.043<\/jats:bold>), 1.109 (<jats:bold>\n                <jats:italic>p<\/jats:italic>\n              <\/jats:bold>\n              <jats:bold>\u2009=\u20090.003<\/jats:bold>), and 5.911 (<jats:bold>\n                <jats:italic>p<\/jats:italic>\n              <\/jats:bold>\n              <jats:bold>\u2009=\u20090.004<\/jats:bold>), respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Fatty 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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00586-025-08793-1","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T01:56:26Z","timestamp":1743299786000},"page":"2427-2437","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["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"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3036-0061","authenticated-orcid":false,"given":"Murat \u015eakir","family":"Ek\u015fi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arda","family":"Top\u00e7u","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma","family":"Topalo\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nursena","family":"Tanriverdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidar Cenk","family":"Ye\u015filyurt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umut Can","family":"Duymaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furkan","family":"Karaka\u015f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fclide","family":"Hazneci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arif","family":"Topal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"B\u00f6rekci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayfun","family":"Hakan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erhan","family":"\u00c7eliko\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emel Ece","family":"\u00d6zcan-Ek\u015fi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"8793_CR1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1177\/2192568217696688","volume":"8","author":"Z Buser","year":"2018","unstructured":"Buser Z, Ortega B, D\u2019Oro A, Pannell W, Cohen JR, Wang J, Golish R, Reed M, Wang JC (2018) Spine degenerative conditions and their treatments: National trends in the united States of America. Global Spine J 8:57\u201367. https:\/\/doi.org\/10.1177\/2192568217696688","journal-title":"Global Spine J"},{"key":"8793_CR2","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1001\/jama.2010.338","volume":"303","author":"RA Deyo","year":"2010","unstructured":"Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259\u20131265. https:\/\/doi.org\/10.1001\/jama.2010.338","journal-title":"JAMA"},{"key":"8793_CR3","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1177\/21925682221122762","volume":"14","author":"TK Williamson","year":"2024","unstructured":"Williamson TK, Owusu-Sarpong S, Imbo B, Krol O, Tretiakov P, Joujon-Roche R, Ahmad S, Bennett-Caso C, Schoenfeld AJ, Lebovic J, Vira S, Diebo B, Lafage R, Lafage V, Passias PG (2024) An economic analysis of early and late complications after adult spinal deformity correction. Global Spine J 14:789\u2013795. https:\/\/doi.org\/10.1177\/21925682221122762","journal-title":"Global Spine J"},{"key":"8793_CR4","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1097\/BRS.0000000000003336","volume":"45","author":"J Leng","year":"2020","unstructured":"Leng J, Han G, Zeng Y, Chen Z, Li W (2020) The effect of paraspinal muscle degeneration on distal pedicle screw loosening following corrective surgery for degenerative lumbar scoliosis. Spine (Phila Pa 1976) 45:590\u2013598. https:\/\/doi.org\/10.1097\/BRS.0000000000003336","journal-title":"Spine (Phila Pa 1976)"},{"key":"8793_CR5","doi-asserted-by":"publisher","unstructured":"Chang HK, Chang CC, Cheng YW, Wu CL, Tu TH, Wu JC, Huang WC (2024) The effect of osteopenia and osteoporosis on screw loosening in MIS-TLIF and dynamic stabilization. Global Spine J 21925682241290747. https:\/\/doi.org\/10.1177\/21925682241290747","DOI":"10.1177\/21925682241290747"},{"key":"8793_CR6","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1055\/s-0036-1578804","volume":"6","author":"PM Formby","year":"2016","unstructured":"Formby PM, Kang DG, Helgeson MD, Wagner SC (2016) Clinical and radiographic outcomes of transforaminal lumbar interbody fusion in patients with osteoporosis. Global Spine J 6:660\u2013664. https:\/\/doi.org\/10.1055\/s-0036-1578804","journal-title":"Global Spine J"},{"key":"8793_CR7","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1007\/s00402-011-1439-6","volume":"132","author":"ZX Wu","year":"2012","unstructured":"Wu ZX, Gong FT, Liu L, Ma ZS, Zhang Y, Zhao X, Yang M, Lei W, Sang HX (2012) A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws. Arch Orthop Trauma Surg 132:471\u2013476. https:\/\/doi.org\/10.1007\/s00402-011-1439-6","journal-title":"Arch Orthop Trauma Surg"},{"key":"8793_CR8","doi-asserted-by":"publisher","first-page":"E10","DOI":"10.3171\/2010.3.FOCUS1052","volume":"28","author":"CC Ko","year":"2010","unstructured":"Ko CC, Tsai HW, Huang WC, Wu JC, Chen YC, Shih YH, Chen HC, Wu CL, Cheng H (2010) Screw loosening in the dynesys stabilization system: radiographic evidence and effect on outcomes. Neurosurg Focus 28:E10. https:\/\/doi.org\/10.3171\/2010.3.FOCUS1052","journal-title":"Neurosurg Focus"},{"key":"8793_CR9","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1016\/j.jspd.2016.03.001","volume":"4","author":"T Yasuda","year":"2016","unstructured":"Yasuda T, Hasegawa T, Yamato Y, Kobayashi S, Togawa D, Banno T, Arima H, Oe S, Matsuyama Y (2016) Lumbosacral junctional failures after long spinal fusion for adult spinal Deformity-Which vertebra is the preferred distal instrumented vertebra? Spine Deform 4:378\u2013384. https:\/\/doi.org\/10.1016\/j.jspd.2016.03.001","journal-title":"Spine Deform"},{"key":"8793_CR10","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/s00586-009-0883-2","volume":"18","author":"KJ Cho","year":"2009","unstructured":"Cho KJ, Suk SI, Park SR, Kim JH, Choi SW, Yoon YH, Won MH (2009) Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis. Eur Spine J 18:531\u2013537. https:\/\/doi.org\/10.1007\/s00586-009-0883-2","journal-title":"Eur Spine J"},{"key":"8793_CR11","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1007\/s00586-008-0615-z","volume":"17","author":"KJ Cho","year":"2008","unstructured":"Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Lee TJ, Lee JJ, Lee JM (2008) Short fusion versus long fusion for degenerative lumbar scoliosis. Eur Spine J 17:650\u2013656. https:\/\/doi.org\/10.1007\/s00586-008-0615-z","journal-title":"Eur Spine J"},{"key":"8793_CR12","doi-asserted-by":"publisher","first-page":"102807","DOI":"10.1016\/j.bas.2024.102807","volume":"4","author":"PB Haldeman","year":"2024","unstructured":"Haldeman PB, Ward SR, Osorio J, Shahidi B (2024) An evidence based conceptual framework for the multifactorial Understanding of proximal junctional kyphosis. Brain Spine 4:102807. https:\/\/doi.org\/10.1016\/j.bas.2024.102807","journal-title":"Brain Spine"},{"key":"8793_CR13","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1007\/s00701-021-05073-x","volume":"164","author":"YI Yun","year":"2022","unstructured":"Yun YI, Jeon I, Kim SW, Yu D (2022) Risk factors for adjacent segment disease requiring reoperation after posterior lumbar interbody fusion with screw fixation: focus on paraspinal muscle, facet joint, and disc degeneration. Acta Neurochir (Wien) 164:913\u2013922. https:\/\/doi.org\/10.1007\/s00701-021-05073-x","journal-title":"Acta Neurochir (Wien)"},{"key":"8793_CR14","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.2214\/AJR.18.20441","volume":"212","author":"MY Chang","year":"2019","unstructured":"Chang MY, Park Y, Ha JW, Zhang HY, Lee SH, Hong TH, Lee SH (2019) Paraspinal lean muscle mass measurement using spine MRI as a predictor of adjacent segment disease after lumbar fusion: A propensity Score-Matched Case-Control analysis. AJR Am J Roentgenol 212:1310\u20131317. https:\/\/doi.org\/10.2214\/AJR.18.20441","journal-title":"AJR Am J Roentgenol"},{"key":"8793_CR15","doi-asserted-by":"publisher","first-page":"190","DOI":"10.3171\/2020.6.SPINE20238","volume":"34","author":"PG Duan","year":"2021","unstructured":"Duan PG, Mummaneni PV, Guinn JMV, Rivera J, Berven SH, Chou D (2021) Is the goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion? J Neurosurg Spine 34:190\u2013195. https:\/\/doi.org\/10.3171\/2020.6.SPINE20238","journal-title":"J Neurosurg Spine"},{"key":"8793_CR16","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1186\/s13018-022-03186-2","volume":"17","author":"G Han","year":"2022","unstructured":"Han G, Zou D, Li X, Zhang S, Li Z, Zhou S, Li W, Sun Z, Li W (2022) Can fat infiltration in the multifidus muscle be a predictor of postoperative symptoms and complications in patients undergoing lumbar fusion for degenerative lumbar spinal stenosis? A case-control study. J Orthop Surg Res 17:289. https:\/\/doi.org\/10.1186\/s13018-022-03186-2","journal-title":"J Orthop Surg Res"},{"key":"8793_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2024.05.010","author":"G Han","year":"2024","unstructured":"Han G, Fan Z, Yue L, Zou D, Zhou S, Qiu W, Sun Z, Li W (2024) Paraspinal muscle endurance and morphology (PMEM) score: a new method for prediction of postoperative mechanical complications after lumbar fusion. Spine J Doi. https:\/\/doi.org\/10.1016\/j.spinee.2024.05.010","journal-title":"Spine J Doi"},{"key":"8793_CR18","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1186\/s13018-021-02589-x","volume":"16","author":"W Wang","year":"2021","unstructured":"Wang W, Li W, Chen Z (2021) Risk factors for screw loosening in patients with adult degenerative scoliosis: the importance of paraspinal muscle degeneration. J Orthop Surg Res 16:448. https:\/\/doi.org\/10.1186\/s13018-021-02589-x","journal-title":"J Orthop Surg Res"},{"key":"8793_CR19","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1186\/s12891-024-07298-0","volume":"25","author":"S Zhou","year":"2024","unstructured":"Zhou S, Xu F, Sun Z, Jiang S, Li Z, Han G, Li W (2024) Preoperative and follow-up variations of Psoas major muscle are related to S1 screw loosening in patients with degenerative lumbar spinal stenosis. BMC Musculoskelet Disord 25:418. https:\/\/doi.org\/10.1186\/s12891-024-07298-0","journal-title":"BMC Musculoskelet Disord"},{"key":"8793_CR20","doi-asserted-by":"crossref","unstructured":"Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res:78\u201383","DOI":"10.1097\/00003086-199407000-00014"},{"key":"8793_CR21","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-024-08341-3","author":"MS Eksi","year":"2024","unstructured":"Eksi MS, Oztas UO, Topaloglu F, Yesilyurt SC, Duymaz UC, Osama M, Ozcan-Eksi EE (2024) Erector spinae could be the game changer in surgical decision-making in patients with lumbar spondylolisthesis: a cross-sectional analysis of an age-, sex-, subtype-, level-matched patients with similar spinopelvic parameters received surgical or Conservative management. Eur Spine J. https:\/\/doi.org\/10.1007\/s00586-024-08341-3","journal-title":"Eur Spine J"},{"key":"8793_CR22","doi-asserted-by":"publisher","first-page":"6504","DOI":"10.1007\/s00330-022-08775-7","volume":"32","author":"G Berikol","year":"2022","unstructured":"Berikol G, Eksi MS, Aydin L, Borekci A, Ozcan-Eksi EE (2022) Subcutaneous fat index: a reliable tool for lumbar spine studies. Eur Radiol 32:6504\u20136513. https:\/\/doi.org\/10.1007\/s00330-022-08775-7","journal-title":"Eur Radiol"},{"key":"8793_CR23","doi-asserted-by":"publisher","first-page":"e171","DOI":"10.1016\/j.wneu.2023.11.066","volume":"182","author":"M Wang","year":"2024","unstructured":"Wang M, Yuan H, Lei F, Zhang S, Jiang L, Yan J, Feng D (2024) Abdominal fat is a reliable indicator of lumbar intervertebral disc degeneration than body mass index. World Neurosurg 182:e171\u2013e177. https:\/\/doi.org\/10.1016\/j.wneu.2023.11.066","journal-title":"World Neurosurg"},{"key":"8793_CR24","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1007\/s00256-021-03957-8","volume":"51","author":"EE Ozcan-Eksi","year":"2022","unstructured":"Ozcan-Eksi EE, Kara M, Berikol G, Orhun O, Turgut VU, Eksi MS (2022) A new radiological index for the assessment of higher body fat status and lumbar spine degeneration. Skeletal Radiol 51:1261\u20131271. https:\/\/doi.org\/10.1007\/s00256-021-03957-8","journal-title":"Skeletal Radiol"},{"key":"8793_CR25","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159\u2013174","journal-title":"Biometrics"},{"key":"8793_CR26","doi-asserted-by":"publisher","first-page":"357","DOI":"10.3340\/jkns.2015.58.4.357","volume":"58","author":"JB Kim","year":"2015","unstructured":"Kim JB, Park SW, Lee YS, Nam TK, Park YS, Kim YB (2015) The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc 58:357\u2013362. https:\/\/doi.org\/10.3340\/jkns.2015.58.4.357","journal-title":"J Korean Neurosurg Soc"},{"key":"8793_CR27","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1097\/BRS.0b013e31816b1eff","volume":"33","author":"Y Tokuhashi","year":"2008","unstructured":"Tokuhashi Y, Matsuzaki H, Oda H, Uei H (2008) Clinical course and significance of the clear zone around the pedicle screws in the lumbar degenerative disease. Spine (Phila Pa 1976) 33:903\u2013908. https:\/\/doi.org\/10.1097\/BRS.0b013e31816b1eff","journal-title":"Spine (Phila Pa 1976)"},{"key":"8793_CR28","doi-asserted-by":"publisher","first-page":"E1024","DOI":"10.1097\/BRS.0000000000002047","volume":"42","author":"T Banno","year":"2017","unstructured":"Banno T, Hasegawa T, Yamato Y, Kobayashi S, Togawa D, Oe S, Mihara Y, Matsuyama Y (2017) Prevalence and risk factors of Iliac screw loosening after adult spinal deformity surgery. Spine (Phila Pa 1976) 42:E1024\u2013E1030. https:\/\/doi.org\/10.1097\/BRS.0000000000002047","journal-title":"Spine (Phila Pa 1976)"},{"key":"8793_CR29","doi-asserted-by":"publisher","first-page":"100327","DOI":"10.1016\/j.xnsj.2024.100327","volume":"18","author":"A Filley","year":"2024","unstructured":"Filley A, Baldwin A, Ben-Natan AR, Hansen K, Arora A, Xiao A, Hammond D, Chen C, Tweedt I, Rohde J, Link T, Berven S, Sawyer A (2024) The influence of osteoporosis on mechanical complications in lumbar fusion surgery: a systematic review. N Am Spine Soc J 18:100327. https:\/\/doi.org\/10.1016\/j.xnsj.2024.100327","journal-title":"N Am Spine Soc J"},{"key":"8793_CR30","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1016\/j.spinee.2024.02.018","volume":"24","author":"ND Agaronnik","year":"2024","unstructured":"Agaronnik ND, Giberson-Chen C, Bono CM (2024) Using advanced imaging to measure bone density, compression fracture risk, and risk for construct failure after spine surgery. Spine J 24:1135\u20131152. https:\/\/doi.org\/10.1016\/j.spinee.2024.02.018","journal-title":"Spine J"},{"key":"8793_CR31","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.2147\/CIA.S462731","volume":"19","author":"Y Zhang","year":"2024","unstructured":"Zhang Y, Wu Q, Han M, Yang C, Kang F, Li J, Hu C, Chen X (2024) Frailty is a risk factor for postoperative complications in older adults with lumbar degenerative disease: A prospective cohort study. Clin Interv Aging 19:1117\u20131126. https:\/\/doi.org\/10.2147\/CIA.S462731","journal-title":"Clin Interv Aging"},{"key":"8793_CR32","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1007\/s00586-021-06985-z","volume":"31","author":"K Varshneya","year":"2022","unstructured":"Varshneya K, Bhattacharjya A, Jokhai RT, Fatemi P, Medress ZA, Stienen MN, Ho AL, Ratliff JK, Veeravagu A (2022) The impact of osteoporosis on adult deformity surgery outcomes in medicare patients. Eur Spine J 31:88\u201394. https:\/\/doi.org\/10.1007\/s00586-021-06985-z","journal-title":"Eur Spine J"},{"key":"8793_CR33","doi-asserted-by":"publisher","first-page":"e976","DOI":"10.1016\/j.wneu.2020.06.107","volume":"141","author":"M Sharma","year":"2020","unstructured":"Sharma M, John K, Dietz N, Aljuboori Z, Madrigal FC, Adams S, Wang D, Ugiliweneza B, Drazin D, Boakye M (2020) Factors impacting outcomes and health care utilization in osteoporotic patients undergoing lumbar spine fusions: A marketscan database analysis. World Neurosurg 141:e976\u2013e988. https:\/\/doi.org\/10.1016\/j.wneu.2020.06.107","journal-title":"World Neurosurg"},{"key":"8793_CR34","doi-asserted-by":"publisher","first-page":"e360","DOI":"10.1016\/j.wneu.2021.02.021","volume":"149","author":"CK Lee","year":"2021","unstructured":"Lee CK, Choi SK, An SB, Ha Y, Yoon SH, Kim I, Kim KN (2021) Influence of osteoporosis following spine surgery on reoperation, readmission, and economic costs: an 8-Year nationwide Population-Based study in Korea. World Neurosurg 149:e360\u2013e368. https:\/\/doi.org\/10.1016\/j.wneu.2021.02.021","journal-title":"World Neurosurg"},{"key":"8793_CR35","doi-asserted-by":"publisher","first-page":"e0286110","DOI":"10.1371\/journal.pone.0286110","volume":"18","author":"ZQ Fan","year":"2023","unstructured":"Fan ZQ, Yan XA, Li BF, Shen E, Xu X, Wang H, Zhuang Y (2023) Prevalence of osteoporosis in spinal surgery patients older than 50 years: A systematic review and meta-analysis. PLoS ONE 18:e0286110. https:\/\/doi.org\/10.1371\/journal.pone.0286110","journal-title":"PLoS ONE"},{"key":"8793_CR36","doi-asserted-by":"publisher","first-page":"e0302291","DOI":"10.1371\/journal.pone.0302291","volume":"19","author":"M Luo","year":"2024","unstructured":"Luo M, Mei Z, Tang S, Huang J, Yuan K, Jiang L, Tang Z, Li K, Su M, Su C, Shi Y, Zhang Z, Chen J, Zheng Y, Bin P, Yuan Z, Xu G, Xiao Z (2024) The impact of sarcopenia on the incidence of postoperative outcomes following spine surgery: systematic review and meta-analysis. PLoS ONE 19:e0302291. https:\/\/doi.org\/10.1371\/journal.pone.0302291","journal-title":"PLoS ONE"},{"key":"8793_CR37","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.wneu.2024.07.074","volume":"190","author":"Z Wang","year":"2024","unstructured":"Wang Z, Zhao Z, Li Z, Gao J, Li Y (2024) Fatty infiltration in paraspinal muscles: predicting the outcome of lumbar surgery and postoperative complications. World Neurosurg 190:218\u2013227. https:\/\/doi.org\/10.1016\/j.wneu.2024.07.074","journal-title":"World Neurosurg"},{"key":"8793_CR38","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1016\/j.spinee.2016.03.010","volume":"16","author":"JY Kim","year":"2016","unstructured":"Kim JY, Ryu DS, Paik HK, Ahn SS, Kang MS, Kim KH, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU (2016) Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J 16:867\u2013875. https:\/\/doi.org\/10.1016\/j.spinee.2016.03.010","journal-title":"Spine J"},{"key":"8793_CR39","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1186\/s12891-022-05178-z","volume":"23","author":"G Han","year":"2022","unstructured":"Han G, Zou D, Liu Z, Zhang B, Gong C, Zhou S, Li W, Sun Z, Li W (2022) Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion. BMC Musculoskelet Disord 23:232. https:\/\/doi.org\/10.1186\/s12891-022-05178-z","journal-title":"BMC Musculoskelet Disord"},{"key":"8793_CR40","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1097\/01.brs.0000169451.76359.49","volume":"30","author":"RC Glattes","year":"2005","unstructured":"Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C 2nd (2005) Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976) 30:1643\u20131649. https:\/\/doi.org\/10.1097\/01.brs.0000169451.76359.49","journal-title":"Spine (Phila Pa 1976)"},{"key":"8793_CR41","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1007\/s00586-020-06394-8","volume":"30","author":"L Yuan","year":"2021","unstructured":"Yuan L, Zeng Y, Chen Z, Li W, Zhang X, Mai S (2021) Degenerative lumbar scoliosis patients with proximal junctional kyphosis have lower muscularity, fatty degeneration at the lumbar area. Eur Spine J 30:1133\u20131143. https:\/\/doi.org\/10.1007\/s00586-020-06394-8","journal-title":"Eur Spine J"},{"key":"8793_CR42","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1007\/s00586-015-3768-6","volume":"24","author":"F Galbusera","year":"2015","unstructured":"Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ (2015) Pedicle screw loosening: a clinically relevant complication? Eur Spine J 24:1005\u20131016. https:\/\/doi.org\/10.1007\/s00586-015-3768-6","journal-title":"Eur Spine J"},{"issue":"Suppl 6","key":"8793_CR43","doi-asserted-by":"publisher","first-page":"S853","DOI":"10.1007\/s00586-013-3024-x","volume":"22","author":"P Berjano","year":"2013","unstructured":"Berjano P, Bassani R, Casero G, Sinigaglia A, Cecchinato R, Lamartina C (2013) Failures and revisions in surgery for sagittal imbalance: analysis of factors influencing failure. Eur Spine J 22(Suppl 6):S853\u2013858. https:\/\/doi.org\/10.1007\/s00586-013-3024-x","journal-title":"Eur Spine J"},{"key":"8793_CR44","doi-asserted-by":"publisher","first-page":"162","DOI":"10.2106\/00004623-199302000-00002","volume":"75","author":"RF McLain","year":"1993","unstructured":"McLain RF, Sparling E, Benson DR (1993) Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am 75:162\u2013167. https:\/\/doi.org\/10.2106\/00004623-199302000-00002","journal-title":"J Bone Joint Surg Am"},{"key":"8793_CR45","doi-asserted-by":"publisher","first-page":"200","DOI":"10.22603\/ssrr.2022-0198","volume":"7","author":"M Ogiri","year":"2023","unstructured":"Ogiri M, Nishida K, Park H, Rossi A (2023) Systematic literature review and Meta-Analysis on the clinical outcomes of spine surgeries in patients with concurrent osteoporosis. Spine Surg Relat Res 7:200\u2013210. https:\/\/doi.org\/10.22603\/ssrr.2022-0198","journal-title":"Spine Surg Relat Res"},{"key":"8793_CR46","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1177\/2192568219864341","volume":"10","author":"L Marie-Hardy","year":"2020","unstructured":"Marie-Hardy L, Pascal-Moussellard H, Barnaba A, Bonaccorsi R, Scemama C (2020) Screw loosening in posterior spine fusion: prevalence and risk factors. Global Spine J 10:598\u2013602. https:\/\/doi.org\/10.1177\/2192568219864341","journal-title":"Global Spine J"},{"key":"8793_CR47","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1007\/s00402-016-2487-8","volume":"136","author":"J Bredow","year":"2016","unstructured":"Bredow J, Boese CK, Werner CM, Siewe J, Lohrer L, Zarghooni K, Eysel P, Scheyerer MJ (2016) Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery. Arch Orthop Trauma Surg 136:1063\u20131067. https:\/\/doi.org\/10.1007\/s00402-016-2487-8","journal-title":"Arch Orthop Trauma Surg"},{"key":"8793_CR48","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1177\/21925682211017477","volume":"13","author":"L Yuan","year":"2023","unstructured":"Yuan L, Zhang X, Zeng Y, Chen Z, Li W (2023) Incidence, risk, and outcome of pedicle screw loosening in degenerative lumbar scoliosis patients undergoing Long-Segment fusion. Global Spine J 13:1064\u20131071. https:\/\/doi.org\/10.1177\/21925682211017477","journal-title":"Global Spine J"},{"key":"8793_CR49","doi-asserted-by":"publisher","first-page":"382","DOI":"10.14740\/jocmr2970w","volume":"9","author":"KA Alswat","year":"2017","unstructured":"Alswat KA (2017) Gender disparities in osteoporosis. J Clin Med Res 9:382\u2013387. https:\/\/doi.org\/10.14740\/jocmr2970w","journal-title":"J Clin Med Res"},{"key":"8793_CR50","doi-asserted-by":"publisher","unstructured":"Costachescu B, Niculescu AG, Grumezescu AM, Teleanu DM (2023) Screw Osteointegration-Increasing Biomechanical resistance to Pull-Out effect. Mater (Basel) 16. https:\/\/doi.org\/10.3390\/ma16165582","DOI":"10.3390\/ma16165582"},{"key":"8793_CR51","doi-asserted-by":"publisher","first-page":"050801","DOI":"10.1116\/6.0000414","volume":"15","author":"A Sarker","year":"2020","unstructured":"Sarker A, Leary M, Fox K (2020) Metallic additive manufacturing for bone-interfacing implants. Biointerphases 15:050801. https:\/\/doi.org\/10.1116\/6.0000414","journal-title":"Biointerphases"},{"key":"8793_CR52","doi-asserted-by":"publisher","unstructured":"Borcherding K, Schmidmaier G, Hofmann GO, Wildemann B (2021) The rationale behind implant coatings to promote osteointegration, bone healing or regeneration. Injury 52 Suppl 2S106\u2013S111. https:\/\/doi.org\/10.1016\/j.injury.2020.11.050","DOI":"10.1016\/j.injury.2020.11.050"},{"key":"8793_CR53","doi-asserted-by":"publisher","unstructured":"Zhu Y, Liang H, Liu X, Wu J, Yang C, Wong TM, Kwan KYH, Cheung KMC, Wu S, Yeung KWK (2021) Regulation of macrophage polarization through surface topography design to facilitate implant-to-bone osteointegration. Sci Adv 7. https:\/\/doi.org\/10.1126\/sciadv.abf6654","DOI":"10.1126\/sciadv.abf6654"},{"key":"8793_CR54","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1038\/nri.2016.90","volume":"16","author":"SL Klein","year":"2016","unstructured":"Klein SL, Flanagan KL (2016) Sex differences in immune responses. Nat Rev Immunol 16:626\u2013638. https:\/\/doi.org\/10.1038\/nri.2016.90","journal-title":"Nat Rev Immunol"},{"key":"8793_CR55","first-page":"E985","volume":"19","author":"D Goubert","year":"2016","unstructured":"Goubert D, Oosterwijck JV, Meeus M, Danneels L (2016) Structural changes of lumbar muscles in Non-specific low back pain: A systematic review. Pain Physician 19:E985\u2013E1000","journal-title":"Pain Physician"},{"key":"8793_CR56","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1016\/j.spinee.2017.07.002","volume":"17","author":"TA Ranger","year":"2017","unstructured":"Ranger TA, Cicuttini FM, Jensen TS, Peiris WL, Hussain SM, Fairley J, Urquhart DM (2017) Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J 17:1729\u20131748. https:\/\/doi.org\/10.1016\/j.spinee.2017.07.002","journal-title":"Spine J"},{"key":"8793_CR57","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s007010050453","volume":"142","author":"G Matge","year":"2000","unstructured":"Matge G, Leclercq TA (2000) Rationale for interbody fusion with threaded titanium cages at cervical and lumbar levels. Results on 357 cases. Acta Neurochir (Wien) 142:425\u2013433 discussion 434. https:\/\/doi.org\/10.1007\/s007010050453","journal-title":"Acta Neurochir (Wien)"},{"key":"8793_CR58","doi-asserted-by":"publisher","first-page":"24","DOI":"10.3171\/spi.2004.1.1.0024","volume":"1","author":"PV Mummaneni","year":"2004","unstructured":"Mummaneni PV, Haid RW, Rodts GE (2004) Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2004. J Neurosurg Spine 1:24\u201330. https:\/\/doi.org\/10.3171\/spi.2004.1.1.0024","journal-title":"J Neurosurg Spine"},{"key":"8793_CR59","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1097\/01.brs.0000174559.13749.83","volume":"30","author":"JC Wang","year":"2005","unstructured":"Wang JC, Mummaneni PV, Haid RW (2005) Current treatment strategies for the painful lumbar motion segment: posterolateral fusion versus interbody fusion. Spine (Phila Pa 1976) 30:S33\u201343. https:\/\/doi.org\/10.1097\/01.brs.0000174559.13749.83","journal-title":"Spine (Phila Pa 1976)"},{"key":"8793_CR60","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1227\/01.neu.0000108423.87889.9e","volume":"54","author":"N Duggal","year":"2004","unstructured":"Duggal N, Mendiondo I, Pares HR, Jhawar BS, Das K, Kenny KJ, Dickman CA (2004) Anterior lumbar interbody fusion for treatment of failed back surgery syndrome: an outcome analysis. Neurosurgery 54:636\u2013643 discussion 643\u2013\u2009634. https:\/\/doi.org\/10.1227\/01.neu.0000108423.87889.9e","journal-title":"Neurosurgery"},{"key":"8793_CR61","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1111\/os.12048","volume":"5","author":"RJ Mobbs","year":"2013","unstructured":"Mobbs RJ, Loganathan A, Yeung V, Rao PJ (2013) Indications for anterior lumbar interbody fusion. Orthop Surg 5:153\u2013163. https:\/\/doi.org\/10.1111\/os.12048","journal-title":"Orthop Surg"},{"key":"8793_CR62","doi-asserted-by":"publisher","first-page":"e509","DOI":"10.1016\/j.wneu.2024.02.063","volume":"185","author":"A Swart","year":"2024","unstructured":"Swart A, Hamouda AM, Pennington Z, Mikula AL, Martini M, Lakomkin N, Shafi M, Nassr AN, Sebastian AS, Fogelson JL, Freedman BA, Elder BD (2024) Reduced bone density based on Hounsfield units after Long-Segment spinal fusion with Harrington rods. World Neurosurg 185:e509\u2013e515. https:\/\/doi.org\/10.1016\/j.wneu.2024.02.063","journal-title":"World Neurosurg"},{"key":"8793_CR63","doi-asserted-by":"publisher","first-page":"e0301726","DOI":"10.1371\/journal.pone.0301726","volume":"19","author":"F Mahmoudi Alami","year":"2024","unstructured":"Mahmoudi Alami F, Taghipour M, Talebi G, Sa\u2019adat P, Seyedhoseinpoor T, Rad HV, Khafri S (2024) Comparison of lumbar muscle morphology in patients with chronic nonspecific low back pain with and without clinical lumbar segmental instability. PLoS ONE 19:e0301726. https:\/\/doi.org\/10.1371\/journal.pone.0301726","journal-title":"PLoS ONE"},{"key":"8793_CR64","doi-asserted-by":"publisher","first-page":"613","DOI":"10.2519\/jospt.2018.7865","volume":"48","author":"DB Berry","year":"2018","unstructured":"Berry DB, Shahidi B, Rodriguez-Soto AE, Hughes-Austin JM, Kelly KR, Ward SR (2018) Lumbar muscle structure predicts operational postures in Active-Duty Marines. J Orthop Sports Phys Ther 48:613\u2013621. https:\/\/doi.org\/10.2519\/jospt.2018.7865","journal-title":"J Orthop Sports Phys Ther"},{"key":"8793_CR65","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1097\/BRS.0000000000001848","volume":"42","author":"B Shahidi","year":"2017","unstructured":"Shahidi B, Parra CL, Berry DB, Hubbard JC, Gombatto S, Zlomislic V, Allen RT, Hughes-Austin J, Garfin S, Ward SR (2017) Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976) 42:616\u2013623. https:\/\/doi.org\/10.1097\/BRS.0000000000001848","journal-title":"Spine (Phila Pa 1976)"},{"key":"8793_CR66","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1007\/s00264-023-05809-7","volume":"47","author":"X Gao","year":"2023","unstructured":"Gao X, Du J, Hao D, He B, Yan L (2023) Risk factors for residual back pain following percutaneous vertebral augmentation: the importance of paraspinal muscle fatty degeneration. Int Orthop 47:1797\u20131804. https:\/\/doi.org\/10.1007\/s00264-023-05809-7","journal-title":"Int Orthop"},{"key":"8793_CR67","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1097\/BRS.0000000000004477","volume":"48","author":"JM Getzmann","year":"2023","unstructured":"Getzmann JM, Ashouri H, Burgstaller JM, Valeri F, Winklhofer S, Ulrich NH, Guggenberger R (2023) The effect of paraspinal fatty muscle infiltration and cumulative lumbar spine degeneration on the outcome of patients with lumbar spinal Canal stenosis: analysis of the lumbar stenosis outcome study (LSOS) data. Spine (Phila Pa 1976) 48:97\u2013106. https:\/\/doi.org\/10.1097\/BRS.0000000000004477","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-025-08793-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-025-08793-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-025-08793-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T11:33:11Z","timestamp":1751369591000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-025-08793-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":67,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["8793"],"URL":"https:\/\/doi.org\/10.1007\/s00586-025-08793-1","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]},"assertion":[{"value":"31 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 November 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":": The study has been approved by IRB of the corresponding institution, where the study has been conducted (IRB no: 2024\/11\/846). All study protocol was planned and conducted according to the Declaration of Helsinki and its later amendments. Informed consent forms were obtained from the study participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and informed consent forms"}},{"value":"Authors declare that they have no conflict of interest related with the current study content. Murat \u015eakir Ek\u015fi, M.D. is academic consultant for Karmed & Biobone.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}