{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:37:01Z","timestamp":1792787821314,"version":"4.5.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Ningxia Hui Autonomous Region Key Research and Development Planned Projects","award":["2023BEG02017"],"award-info":[{"award-number":["2023BEG02017"]}]},{"name":"Yunnan Provincial Department of Education","award":["2023J0907"],"award-info":[{"award-number":["2023J0907"]}],"id":[{"id":"https:\/\/ror.org\/02yrxdp92","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To establish a novel lumbar subcutaneous adipose classification (LSAC) based on sagittal MRI and determine its predictive value for surgical site infection (SSI) and postoperative adverse events (PAE) following posterior lumbar fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 1122 patients undergoing posterior lumbar interbody fusion was performed. Lumbar subcutaneous adipose distribution at the L3 endplate level was categorized into five types (Low, Cranial, Caudal, Cranial\u2013Caudal, and Diffuse). Surgical segment subcutaneous fat thickness (SFT), facet joint to lumbar dorsal fascia distance (FJ\u2013LDF), paraspinal muscle cross-sectional area, paraspinal muscle fat infiltration, and Modic changes were assessed. Associations between LSAC and SSI\/PAE were examined using multivariate logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      LSAC demonstrated excellent inter- and intra-observer reliability. Significant differences in patient characteristics were observed among the five types, with type 5 and type 2 showing higher BMI, diabetes and spondylolisthesis rate. SSI and PAE incidence were highest in type 5, followed by type 2. Multivariate analyses identified LSAC (OR 1.534,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.007), BMI (OR 1.156,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.010), transfusion (OR 1.002,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and smoking (OR 2.646,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.035) as independent predictors of SSI; and LSAC (OR 1.477,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002), age (OR 1.037,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.016), smoking (OR 2.607,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.007), and higher drainage volume (OR 1.001,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) as predictors of PAE. ROC curve demonstrated that LSAC was more sensitive than BMI and SFT to predict the SSI and PAE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The LSAC system provides a simple, reproducible method for quantifying lumbar subcutaneous fat distribution and outperforms traditional single adiposity indices such as BMI or SFT in predicting postoperative complications. Type 5 and type 2 represent high-risk phenotypes requiring enhanced perioperative optimization and surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261435942","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T04:38:54Z","timestamp":1773635934000},"page":"3400-3410","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel MRI-Based Lumbar Subcutaneous Adipose Classification for Predicting Surgical Site Infection and Adverse Events after Lumbar Fusion"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9112-660X","authenticated-orcid":false,"given":"Shiyong","family":"Wang","sequence":"first","affiliation":[{"name":"General Hospital of Ningxia Medical University"},{"name":"First Affiliated Hospital of Dali 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