{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T02:29:12Z","timestamp":1781144952199,"version":"3.54.1"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,10]]},"abstract":"\n OBJECT<\/jats:title>\n Improved objective assessments of perioperative risk after spine surgery are necessary to decrease postoperative morbidity and mortality rates. Morphometric analysis has proven utility in predicting postoperative morbidity and mortality in surgical disciplines. The aim of the present study was to evaluate whether morphometrics can be applied to the cases of patients undergoing lumbar spine surgery.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a retrospective review of the perioperative course of 395 patients who underwent lumbar surgery at their institution from 2013 to 2014. Preoperative risk factors such as age, diabetes, smoking, coronary artery disease, and body mass index (BMI) were recorded. Preoperative MRI was used to measure the psoas muscle area at the L-4 vertebra and paraspinal muscle area at the T-12 vertebra. Primary outcomes included unplanned return to the operating room, 30- and 90-day readmissions, surgical site infection, wound dehiscence, new neurological deficit, deep vein thrombosis, pulmonary embolism, myocardial infarction, urinary tract infection, urinary retention, hospital-acquired pneumonia, stroke, and prolonged stay in the intensive care unit.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The overall rate of adverse events was 30%, the most common event being urinary retention (12%). Greater age (p = 0.015) and tobacco usage (p = 0.026) were both significantly associated with complications for all patients, while diabetes, coronary artery disease, and high BMI were not. No surgery-related characteristics were associated with postoperative morbidity, including whether surgery required instrumentation, whether it was a revision, or the number of vertebral levels treated. Using multivariate regression analysis, male and female patients with the lowest psoas tertile had an OR of 1.70 (95% CI 1.04\u20132.79, p = 0.035) for having postoperative complications. Male patients in the lowest psoas tertile had an OR of 2.42 (95% CI 1.17\u20135.01, p = 0.016) for having a postoperative complication. The paraspinal muscle groups did not provide any significant data for postoperative morbidity, even after multivariate analysis.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The morphometric measurement of psoas muscle size may be a sensitive predictive tool compared with other risk factors for perioperative morbidity in male patients undergoing lumbar surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.7.focus15257","type":"journal-article","created":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T03:41:45Z","timestamp":1443670905000},"page":"E5","source":"Crossref","is-referenced-by-count":62,"title":["Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery"],"prefix":"10.3171","volume":"39","author":[{"given":"Hesham Mostafa","family":"Zakaria","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lonni","family":"Schultz","sequence":"additional","affiliation":[{"name":"Public Health Sciences, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feras","family":"Mossa-Basha","sequence":"additional","affiliation":[{"name":"Radiology, Neuroscience Institute, Henry Ford Health System, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent","family":"Griffith","sequence":"additional","affiliation":[{"name":"Radiology, Neuroscience Institute, Henry Ford Health System, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Chang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15257","series-title":"Curr Opin Anaesthesiol","first-page":"330","article-title":"The implication of frailty on preoperative risk assessment","volume":"27","author":"Amrock","year":"2014"},{"key":"b2-focus15257","series-title":"J Surg Res","first-page":"76","article-title":"Paraspinous muscle as a predictor of surgical outcome","volume":"192","author":"Canvasser","year":"2014"},{"key":"b3-focus15257","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010"},{"key":"b4-focus15257","series-title":"J Gastrointest Surg","first-page":"2123","article-title":"Impact of sarcopenia on outcomes following intra-arterial therapy of hepatic malignancies","volume":"17","author":"Dodson","year":"2013"},{"key":"b5-focus15257","series-title":"Interact Cardiovasc Thorac Surg","first-page":"667","article-title":"Frailty assessment in thoracic surgery","volume":"18","author":"Dunne","year":"2014"},{"key":"b6-focus15257","series-title":"Ann Surg","first-page":"255","article-title":"Analytic morphomics, core muscle size, and surgical outcomes","volume":"256","author":"Englesbe","year":"2012"},{"key":"b7-focus15257","series-title":"J Am Coll Surg","first-page":"271","article-title":"Sarcopenia and mortality after liver transplantation","volume":"211","author":"Englesbe","year":"2010"},{"key":"b8-focus15257","series-title":"N Engl J Med","first-page":"1677","article-title":"Clinical practice. Lowering cardiac risk in noncardiac surgery","volume":"345","author":"Fleisher","year":"2001"},{"key":"b9-focus15257","series-title":"J Gerontol A Biol Sci Med Sci","first-page":"M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried","year":"2001"},{"key":"b10-focus15257","series-title":"Lancet","first-page":"1749","article-title":"Preoperative assessment","volume":"362","author":"Garc\u00eda-Miguel","year":"2003"},{"key":"b11-focus15257","series-title":"Spine (Phila Pa 1976)","first-page":"1970","article-title":"Perioperative complications and mortality after spinal fusions: analysis of trends and risk factors","volume":"38","author":"Goz","year":"2013"},{"key":"b12-focus15257","series-title":"Langenbecks Arch Surg","first-page":"287","article-title":"Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery: a systematic review","volume":"399","author":"Hasselager","year":"2014"},{"key":"b13-focus15257","series-title":"J Vasc Surg","first-page":"912","article-title":"Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair","volume":"53","author":"Lee","year":"2011"},{"key":"b14-focus15257","series-title":"J Am Coll Surg","first-page":"901","article-title":"Frailty as a predictor of surgical outcomes in older patients","volume":"210","author":"Makary","year":"2010"},{"key":"b15-focus15257","series-title":"Pain Physician","first-page":"E35","article-title":"Comprehensive review of epidemiology, scope, and impact of spinal pain","volume":"12","author":"Manchikanti","year":"2009"},{"key":"b16-focus15257","series-title":"JAMA","first-page":"2110","article-title":"Preoperative assessment of the older patient: a narrative review","volume":"311","author":"Oresanya","year":"2014"},{"key":"b17-focus15257","series-title":"J Gastrointest Surg","first-page":"1478","article-title":"Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma","volume":"16","author":"Peng","year":"2012"},{"key":"b18-focus15257","series-title":"HPB (Oxford)","first-page":"439","article-title":"Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis","volume":"13","author":"Peng","year":"2011"},{"key":"b19-focus15257","series-title":"Bone Joint J","first-page":"807","article-title":"National trends in revision spinal fusion in the USA: patient characteristics and complications","volume":"96-B","author":"Rajaee","year":"2014"},{"key":"b20-focus15257","series-title":"Neurol Clin","first-page":"353","article-title":"Epidemiology and risk factors for spine pain","volume":"25","author":"Rubin","year":"2007"},{"key":"b21-focus15257","series-title":"Am J Med Sci","first-page":"395","article-title":"Frailty syndrome in geriatric medicine","volume":"344","author":"Ruiz","year":"2012"},{"key":"b22-focus15257","series-title":"J Surg Oncol","first-page":"169","article-title":"Analytic morphometric assessment of patients undergoing colectomy for colon cancer","volume":"108","author":"Sabel","year":"2013"},{"key":"b23-focus15257","series-title":"Surg Clin North Am","first-page":"149","article-title":"Operative risk stratification in the older adult","volume":"95","author":"Scandrett","year":"2015"},{"key":"b24-focus15257","series-title":"Dis Esophagus","first-page":"716","article-title":"Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer","volume":"26","author":"Sheetz","year":"2013"},{"key":"b25-focus15257","series-title":"J Neurosurg Anesthesiol","first-page":"21","article-title":"In-hospital complications and mortality after elective spinal fusion surgery in the united states: a study of the nationwide inpatient sample from 2001 to 2005","volume":"21","author":"Shen","year":"2009"},{"key":"b26-focus15257","series-title":"Ann Intern Med","first-page":"581","article-title":"Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians","volume":"144","author":"Smetana","year":"2006"},{"key":"b27-focus15257","series-title":"Spine J","first-page":"22","article-title":"Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients","volume":"12","author":"Street","year":"2012"},{"key":"b28-focus15257","series-title":"Spine (Phila Pa 1976)","first-page":"1207","article-title":"Low back pain hospitalization. Recent United States trends and regional variations","volume":"19","author":"Taylor","year":"1994"},{"key":"b29-focus15257","series-title":"Med Clin North Am","first-page":"1129","article-title":"Postoperative pulmonary complications","volume":"85","author":"Trayner","year":"2001"},{"key":"b30-focus15257","series-title":"J Am Geriatr Soc","first-page":"2383","article-title":"Risk prediction models for postoperative delirium: a systematic review and meta-analysis","volume":"62","author":"van Meenen","year":"2014"},{"key":"b31-focus15257","series-title":"JAMA Surg","first-page":"335","article-title":"Morphometric age and mortality after liver transplant","volume":"149","author":"Waits","year":"2014"},{"key":"b32-focus15257","series-title":"N Engl J Med","first-page":"2257","article-title":"Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis","volume":"356","author":"Weinstein","year":"2007"},{"key":"b33-focus15257","series-title":"JAMA","first-page":"2451","article-title":"Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort","volume":"296","author":"Weinstein","year":"2006"},{"key":"b34-focus15257","series-title":"N Engl J Med","first-page":"794","article-title":"Surgical versus nonsurgical therapy for lumbar spinal stenosis","volume":"358","author":"Weinstein","year":"2008"},{"key":"b35-focus15257","series-title":"Spine J","first-page":"265","article-title":"National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009","volume":"15","author":"Yoshihara","year":"2015"},{"key":"b1-focus15257","series-title":"Curr Opin Anaesthesiol","first-page":"330","article-title":"The implication of frailty on preoperative risk assessment","volume":"27","author":"Amrock","year":"2014"},{"key":"b2-focus15257","series-title":"J Surg Res","first-page":"76","article-title":"Paraspinous muscle as a predictor of surgical outcome","volume":"192","author":"Canvasser","year":"2014"},{"key":"b3-focus15257","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010"},{"key":"b4-focus15257","series-title":"J Gastrointest Surg","first-page":"2123","article-title":"Impact of sarcopenia on outcomes following intra-arterial therapy of hepatic malignancies","volume":"17","author":"Dodson","year":"2013"},{"key":"b5-focus15257","series-title":"Interact Cardiovasc Thorac Surg","first-page":"667","article-title":"Frailty assessment in thoracic surgery","volume":"18","author":"Dunne","year":"2014"},{"key":"b6-focus15257","series-title":"Ann Surg","first-page":"255","article-title":"Analytic morphomics, core muscle size, and surgical outcomes","volume":"256","author":"Englesbe","year":"2012"},{"key":"b7-focus15257","series-title":"J Am Coll Surg","first-page":"271","article-title":"Sarcopenia and mortality after liver transplantation","volume":"211","author":"Englesbe","year":"2010"},{"key":"b8-focus15257","series-title":"N Engl J Med","first-page":"1677","article-title":"Clinical practice. Lowering cardiac risk in noncardiac surgery","volume":"345","author":"Fleisher","year":"2001"},{"key":"b9-focus15257","series-title":"J Gerontol A Biol Sci Med Sci","first-page":"M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried","year":"2001"},{"key":"b10-focus15257","series-title":"Lancet","first-page":"1749","article-title":"Preoperative assessment","volume":"362","author":"Garc\u00eda-Miguel","year":"2003"},{"key":"b11-focus15257","series-title":"Spine (Phila Pa 1976)","first-page":"1970","article-title":"Perioperative complications and mortality after spinal fusions: analysis of trends and risk factors","volume":"38","author":"Goz","year":"2013"},{"key":"b12-focus15257","series-title":"Langenbecks Arch Surg","first-page":"287","article-title":"Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery: a systematic review","volume":"399","author":"Hasselager","year":"2014"},{"key":"b13-focus15257","series-title":"J Vasc Surg","first-page":"912","article-title":"Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair","volume":"53","author":"Lee","year":"2011"},{"key":"b14-focus15257","series-title":"J Am Coll Surg","first-page":"901","article-title":"Frailty as a predictor of surgical outcomes in older patients","volume":"210","author":"Makary","year":"2010"},{"key":"b15-focus15257","series-title":"Pain Physician","first-page":"E35","article-title":"Comprehensive review of epidemiology, scope, and impact of spinal pain","volume":"12","author":"Manchikanti","year":"2009"},{"key":"b16-focus15257","series-title":"JAMA","first-page":"2110","article-title":"Preoperative assessment of the older patient: a narrative review","volume":"311","author":"Oresanya","year":"2014"},{"key":"b17-focus15257","series-title":"J Gastrointest Surg","first-page":"1478","article-title":"Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma","volume":"16","author":"Peng","year":"2012"},{"key":"b18-focus15257","series-title":"HPB (Oxford)","first-page":"439","article-title":"Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis","volume":"13","author":"Peng","year":"2011"},{"key":"b19-focus15257","series-title":"Bone Joint J","first-page":"807","article-title":"National trends in revision spinal fusion in the USA: patient characteristics and complications","volume":"96-B","author":"Rajaee","year":"2014"},{"key":"b20-focus15257","series-title":"Neurol Clin","first-page":"353","article-title":"Epidemiology and risk factors for spine pain","volume":"25","author":"Rubin","year":"2007"},{"key":"b21-focus15257","series-title":"Am J Med Sci","first-page":"395","article-title":"Frailty syndrome in geriatric medicine","volume":"344","author":"Ruiz","year":"2012"},{"key":"b22-focus15257","series-title":"J Surg Oncol","first-page":"169","article-title":"Analytic morphometric assessment of patients undergoing colectomy for colon cancer","volume":"108","author":"Sabel","year":"2013"},{"key":"b23-focus15257","series-title":"Surg Clin North Am","first-page":"149","article-title":"Operative risk stratification in the older adult","volume":"95","author":"Scandrett","year":"2015"},{"key":"b24-focus15257","series-title":"Dis Esophagus","first-page":"716","article-title":"Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer","volume":"26","author":"Sheetz","year":"2013"},{"key":"b25-focus15257","series-title":"J Neurosurg Anesthesiol","first-page":"21","article-title":"In-hospital complications and mortality after elective spinal fusion surgery in the united states: a study of the nationwide inpatient sample from 2001 to 2005","volume":"21","author":"Shen","year":"2009"},{"key":"b26-focus15257","series-title":"Ann Intern Med","first-page":"581","article-title":"Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians","volume":"144","author":"Smetana","year":"2006"},{"key":"b27-focus15257","series-title":"Spine J","first-page":"22","article-title":"Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients","volume":"12","author":"Street","year":"2012"},{"key":"b28-focus15257","series-title":"Spine (Phila Pa 1976)","first-page":"1207","article-title":"Low back pain hospitalization. Recent United States trends and regional variations","volume":"19","author":"Taylor","year":"1994"},{"key":"b29-focus15257","series-title":"Med Clin North Am","first-page":"1129","article-title":"Postoperative pulmonary complications","volume":"85","author":"Trayner","year":"2001"},{"key":"b30-focus15257","series-title":"J Am Geriatr Soc","first-page":"2383","article-title":"Risk prediction models for postoperative delirium: a systematic review and meta-analysis","volume":"62","author":"van Meenen","year":"2014"},{"key":"b31-focus15257","series-title":"JAMA Surg","first-page":"335","article-title":"Morphometric age and mortality after liver transplant","volume":"149","author":"Waits","year":"2014"},{"key":"b32-focus15257","series-title":"N Engl J Med","first-page":"2257","article-title":"Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis","volume":"356","author":"Weinstein","year":"2007"},{"key":"b33-focus15257","series-title":"JAMA","first-page":"2451","article-title":"Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort","volume":"296","author":"Weinstein","year":"2006"},{"key":"b34-focus15257","series-title":"N Engl J Med","first-page":"794","article-title":"Surgical versus nonsurgical therapy for lumbar spinal stenosis","volume":"358","author":"Weinstein","year":"2008"},{"key":"b35-focus15257","series-title":"Spine J","first-page":"265","article-title":"National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009","volume":"15","author":"Yoshihara","year":"2015"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/4\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/4\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/4\/article-pE5.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:23:47Z","timestamp":1775895827000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/4\/article-pE5.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10]]},"references-count":70,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2015.7.focus15257","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10]]}}}