{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:49:07Z","timestamp":1782924547220,"version":"3.54.5"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The purpose of this study was to analyze the correlation between the cross-sectional area (CSA) and density of lumbar core muscles and residual chronic low back pain (rCLBP) after Posterior Lumbar Interbody Fusion (PLIF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, patients who underwent PLIF surgery were stratified into two groups based on postoperative pain status: those with rCLBP and a non-pain control group (NrCLBP). Preoperative lumbar computed tomography (CT) measured the CSA and mean density (HU) of bilateral psoas major, quadratus lumborum, and posterior paraspinal muscles. Preoperative confounding factors, including Cobb angle, endplate injury, Modic changes, and Pfirrmann grade, were also included. Logistic regression analysis was used to identify independent risk factors for rCLBP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study ultimately included 46 rCLBP patients and 51 NrCLBP patients. Univariate analysis revealed that longer disease duration and larger Cobb angle were associated with a higher likelihood of rCLBP. However, this difference was not statistically significant in multivariate analysis. Multivariate logistic regression analysis revealed that lower CSA of the psoas major (OR\u2009=\u20091.215,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05) and paraspinal muscles (OR\u2009=\u20091.159,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05), and lower mean HU of the quadratus lumborum (OR\u2009=\u20091.197,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05) were independently associated with rCLBP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperatively reduced CSA of the psoas major and paraspinal muscles independently predicted increased risk of rCLBP. When assessing the impact of the quadratus lumborum, muscle density may serve as a more sensitive imaging biomarker. However, causality cannot be inferred from this retrospective design, and postoperative muscle recovery remains unassessed with preoperative CT-only data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1833183","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:54:41Z","timestamp":1782921281000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of lumbar core muscle morphology in residual chronic low back pain after PLIF: a retrospective analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiajia","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Orthopedics, ShangRao People\u2019s Hospital, Nanchang University","place":["Shangrao, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, ShangRao People\u2019s Hospital, Nanchang University","place":["Shangrao, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangwei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, ShangRao People\u2019s Hospital, Nanchang University","place":["Shangrao, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihuang","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, ShangRao People\u2019s Hospital, Nanchang University","place":["Shangrao, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, ShangRao People\u2019s Hospital, Nanchang University","place":["Shangrao, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, ShangRao People\u2019s Hospital, Nanchang University","place":["Shangrao, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, ShangRao People\u2019s Hospital, Nanchang University","place":["Shangrao, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guobao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, ShangRao People\u2019s Hospital, Nanchang University","place":["Shangrao, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1016\/j.spinee.2024.12.027","article-title":"Cost-utility of lumbar interbody fusion surgery: a systematic review","volume":"25","author":"Deshpande","year":"2025","journal-title":"Spine J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1016\/j.spinee.2021.03.027","article-title":"Adjacent segment pathology following posterior lumbar interbody fusion for lumbar degenerative spondylolisthesis: a comparison between minimally invasive and conventional open approach","volume":"21","author":"Mimura","year":"2021","journal-title":"Spine J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1007\/s00586-010-1374-1","article-title":"Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis","volume":"19","author":"Hara","year":"2010","journal-title":"Eur Spine J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2568","DOI":"10.1007\/s00586-020-06493-6","article-title":"Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures","volume":"29","author":"Li","year":"2020","journal-title":"Eur Spine J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"5437","DOI":"10.3390\/jcm13185437","article-title":"Efficiency of lidocaine intramuscular and intraosseous trigger point injections in the treatment of residual chronic pain after degenerative lumbar spinal stenosis decompression surgery","volume":"13","author":"Al-Zamil","year":"2024","journal-title":"J Clin Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1007\/s00586-020-06596-0","article-title":"Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies","volume":"30","author":"Meng","year":"2021","journal-title":"Eur Spine J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"4979231","DOI":"10.1155\/2022\/4979231","article-title":"Endoscopic techniques for lumbar interbody fusion: principles and context","volume":"2022","author":"Zheng","year":"2022","journal-title":"Biomed Res Int"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2092","DOI":"10.1016\/j.pain.2012.06.026","article-title":"The relationship between pain and depressive symptoms after lumbar spine surgery","volume":"153","author":"Skolasky","year":"2012","journal-title":"Pain"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1016\/j.spinee.2023.05.010","article-title":"Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery - a prospective observational study","volume":"23","author":"Angadi","year":"2023","journal-title":"Spine J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1097\/BRS.0000000000005303","article-title":"The role of the lumbar paravertebral muscles in the development of short-term residual pain after lumbar fusion surgery","volume":"50","author":"Sun","year":"2025","journal-title":"Spine"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.1016\/j.spinee.2022.05.013","article-title":"Association between muscle health and patient-reported outcomes after lumbar microdiscectomy: early results","volume":"22","author":"Song","year":"2022","journal-title":"Spine J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"163","DOI":"10.3171\/2016.7.SPINE151132","article-title":"How does back muscle strength change after posterior lumbar interbody fusion?","volume":"26","author":"Lee","year":"2017","journal-title":"J Neurosurg Spine"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e2532781","DOI":"10.2214\/AJR.25.32781","article-title":"Defining reference values for skeletal muscle metrics on abdominal CT using data from healthy young adult populations: a systematic review and meta-analysis","volume":"225","author":"Ju","year":"2025","journal-title":"Am J Roentgenol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"4360","DOI":"10.1016\/j.clnu.2021.01.010","article-title":"Cut-off values of skeletal muscle index and psoas muscle index at L3 vertebra level by computerized tomography to assess low muscle mass","volume":"40","author":"Bahat","year":"2021","journal-title":"Clin Nutr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1017\/S0007114521001446","article-title":"The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: a systematic review","volume":"127","author":"Vangelov","year":"2022","journal-title":"Br J Nutr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.joca.2021.01.010","article-title":"Cartilaginous endplate avulsion is associated with modic changes and endplate defects, and residual back and leg pain following lumbar discectomy","volume":"29","author":"Feng","year":"2021","journal-title":"Osteoarthritis Cartilage"},{"key":"B17","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1097\/00007632-198902000-00008","article-title":"Spinal stability and intersegmental muscle forces. A biomechanical model","volume":"14","author":"Panjabi","year":"1989","journal-title":"Spine"},{"key":"B18","doi-asserted-by":"publisher","first-page":"3400","DOI":"10.3390\/jcm14103400","article-title":"Temporal patterns of risk factors for adjacent segment disease after lumbar fusion: 5 years or more and up to 15 years","volume":"14","author":"Soh","year":"2025","journal-title":"J Clin Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"5475","DOI":"10.1016\/j.clnu.2021.09.036","article-title":"Malnutrition-sarcopenia syndrome and all-cause mortality in hospitalized older people","volume":"40","author":"G\u00fcm\u00fc\u015fsoy","year":"2021","journal-title":"Clin Nutr"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afac164","article-title":"European Working group on sarcopenia in older people 2010 (EWGSOP1) and 2019 (EWGSOP2) criteria or slowness: which is the best predictor of mortality risk in older adults?","volume":"51","author":"Spexoto","year":"2022","journal-title":"Age Ageing"},{"key":"B21","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s13018-023-04479-w","article-title":"Factors associated with intervertebral cage subsidence in posterior lumbar fusion","volume":"19","author":"Liu","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1016\/j.spinee.2025.01.026","article-title":"Proteome analysis reveals paraspinal muscle fiber type changes in patients with degenerative lumbar scoliosis","volume":"25","author":"Kiram","year":"2025","journal-title":"Spine J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e942231","DOI":"10.12659\/MSM.942231","article-title":"Predictive factors for residual low back pain following percutaneous endoscopic lumbar discectomy in patients with lumbar disc herniation","volume":"30","author":"Hu","year":"2024","journal-title":"Med Sci Monit"},{"key":"B24","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.clnu.2022.12.006","article-title":"Association of CT-based diagnosis of sarcopenia with prognosis and treatment response in patients at risk of malnutrition - a secondary analysis of the effect of early nutritional support on frailty, functional outcomes, and recovery of malnourished medical inpatients trial (EFFORT) trial","volume":"42","author":"Baumgartner","year":"2023","journal-title":"Clin Nutr"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaf128","article-title":"Normative data for age-specific skeletal muscle area based on computed tomography in Korean population","volume":"54","author":"Shin","year":"2025","journal-title":"Age Ageing"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1016\/j.clnu.2019.10.003","article-title":"Computed tomography-based psoas skeletal muscle area and radiodensity are poor sentinels for whole L3 skeletal muscle values","volume":"39","author":"Rollins","year":"2020","journal-title":"Clin Nutr"},{"key":"B27","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1016\/j.spinee.2021.10.018","article-title":"Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis","volume":"22","author":"Seyedhoseinpoor","year":"2022","journal-title":"Spine J"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1016\/j.spinee.2017.04.025","article-title":"Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross-sectional study","volume":"17","author":"Goubert","year":"2017","journal-title":"Spine J"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1353087","DOI":"10.3389\/fendo.2024.1353087","article-title":"Advances in the interaction between lumbar intervertebral disc degeneration and fat infiltration of paraspinal muscles: critical summarization, classification, and perspectives","volume":"15","author":"Jiang","year":"2024","journal-title":"Front Endocrinol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e406","DOI":"10.1016\/j.wneu.2023.01.042","article-title":"Duration of back pain symptoms and its relationship to paralumbar muscle volume","volume":"172","author":"Fallon","year":"2023","journal-title":"World Neurosurg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/s13018-023-03596-w","article-title":"Correlation of psoas major muscle morphology with function and clinical symptoms in patients with symptomatic multilevel lumbar spinal stenosis","volume":"18","author":"Hou","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1007\/s00402-021-03754-x","article-title":"Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease","volume":"142","author":"Stanuszek","year":"2022","journal-title":"Arch Orthop Trauma Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"3593","DOI":"10.21037\/qims-23-1668","article-title":"Quantitative analysis of paravertebral muscle asymmetry and its correlation with spinal deformity in patients with degenerative lumbar scoliosis: a retrospective case-control study","volume":"14","author":"Chen","year":"2024","journal-title":"Quant Imaging Med Surg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1007\/s40279-014-0213-7","article-title":"The effect of exercise training on lower trunk muscle morphology","volume":"44","author":"Shahtahmassebi","year":"2014","journal-title":"Sports Med"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1833183\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:54:42Z","timestamp":1782921282000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1833183\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":34,"alternative-id":["10.3389\/fsurg.2026.1833183"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1833183","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"1833183"}}