{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:00:44Z","timestamp":1792000844783,"version":"4.4.0"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>There are limited data about the influence of the lumbar paraspinal muscles on the maintenance of sagittal alignment after pedicle subtraction osteotomy (PSO) and the risk factors for sagittal realignment failure. The authors aimed to investigate the influence of preoperative lumbar paraspinal muscle quality on the postoperative maintenance of sagittal alignment after lumbar PSO.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients who underwent lumbar PSO with preoperative lumbar MRI and pre- and postoperative whole-spine radiography in the standing position were included. Spinopelvic measurements included pelvic incidence, sacral slope, pelvic tilt, L1\u2013S1 lordosis, T4\u201312 thoracic kyphosis, spinosacral angle, C7\u2013S1 sagittal vertical axis (SVA), T1 pelvic angle, and mismatch between pelvic incidence and L1\u2013S1 lordosis. Validated custom software was used to calculate the percent fat infiltration (FI) of the psoas major, as well as the erector spinae and multifidus (MF). A multivariable linear mixed model was applied to further examine the association between MF FI and the postoperative progression of SVA over time, accounting for repeated measures over time that were adjusted for age, sex, BMI, and length of follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Seventy-seven patients were recruited. The authors\u2019 results demonstrated significant correlations between MF FI and the maintenance of corrected sagittal alignment after PSO. After adjustment for the aforementioned parameters, the model showed that the MF FI was significantly associated with the postoperative progression of positive SVA over time. A 1% increase from the preoperatively assessed total MF FI was correlated with an increase of 0.92 mm in SVA postoperatively (95% CI 0.42\u20131.41, p &lt; 0.0001).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This study included a large patient cohort with midterm follow-up after PSO and emphasized the importance of the lumbar paraspinal muscles in the maintenance of sagittal alignment correction. Surgeons should assess the quality of the MF preoperatively in patients undergoing PSO to identify patients with severe FI, as they may be at higher risk for sagittal decompensation.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.3.spine231052","type":"journal-article","created":{"date-parts":[[2024,6,8]],"date-time":"2024-06-08T01:52:41Z","timestamp":1717811561000},"page":"332-340","source":"Crossref","is-referenced-by-count":5,"title":["Importance of the lumbar paraspinal muscles on the maintenance of global sagittal alignment after lumbar pedicle subtraction osteotomy"],"prefix":"10.3171","volume":"41","author":[{"given":"Thomas","family":"Caffard","sequence":"first","affiliation":[{"name":"Spine Care Institute,"},{"name":"Department of Orthopedic Surgery, University of Ulm, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artine","family":"Arzani","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krizia","family":"Amoroso","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Chiapparelli","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel J.","family":"Medina","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Sch\u00f6nnagel","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"},{"name":"Center for Musculoskeletal Surgery, University of Berlin, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Biostatistics Core, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Verna","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Finos","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Nathoo","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soji","family":"Tani","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"},{"name":"Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaston","family":"Camino-Willhuber","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali E.","family":"Guven","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arman","family":"Zadeh","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ek Tsoon","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Carrino","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Shue","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Dobrindt","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Ulm, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Zippelius","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Ulm, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Dalton","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"},{"name":"Department of Orthopedic Surgery, University Hospital Galway, Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"Sama","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico P.","family":"Girardi","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank P.","family":"Cammisa","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander P.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Spine Care Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"Eur Spine J","first-page":"1889","article-title":"Sagittal balance of the spine","volume":"28","author":"Le Huec JC","year":"2019","unstructured":"Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. 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