Key Takeaways & Executive Findings
- •• Preoperative paraspinal muscle fat infiltration percentage, measured via MRI, is an independent risk factor for non-infectious poor wound healing after traditional open posterior lumbar surgery. • Fat infiltration percentages in the multifidus and erector spinae muscles have high predictive value (AUC > 0.7) for identifying patients at risk of poor wound healing. • Osteoporosis is associated with increased fat infiltration in the L4 multifidus muscle, suggesting a link between bone health and muscle degeneration. • The study provides a quantitative threshold (L4 multifidus >16.31%, L4 erector spinae >8.945%) for clinically significant fat infiltration that increases the risk of poor healing.
Abstract
BACKGROUND: Non-infectious poor wound healing following lumbar surgery is a significant clinical complication that prolongs hospitalization and increases the risk of reoperation. However, its predictive indicators remain unclear. Based on the hypothesis that paraspinal muscle degeneration may impede tissue repair by altering the local microenvironment, this study aimed to investigate the predictive value of preoperative paraspinal muscle fatty infiltration for non-infectious poor wound healing and its association with osteoporosis. OBJECTIVE: To quantify the degree of paraspinal muscle fatty infiltration using preoperative MRI and evaluate its predictive value for non-infectious poor wound healing after lumbar surgery. METHODS: A retrospective analysis was conducted on medical records of 4,368 patients who underwent traditional open posterior lumbar surgery at Third Affiliated Hospital of Guangzhou University of Chinese Medicine between 2019 and 2024. We screened 190 patients with a postoperative hospital stay of 15 days or longer. Based on postoperative wound healing and infection indicators, 41 patients with non-infectious poor healing were selected as the poor healing group. From the remaining 4,178 patients, 40 patients with good healing were selected as the good healing group. The poor healing group was further subdivided into osteoporosis and non-osteoporosis subgroups. Preoperative lumbar MRI images were collected, and Image J software was used to measure the cross-sectional area of the psoas major muscle and the percentage of fat infiltration in the erector spinae and multifidus muscles. RESULTS AND CONCLUSION: (1) There were no significant differences in gender, age, or diabetes between the poor healing and good healing groups (P > 0.05). (2) The functional cross-sectional area and fat infiltration percentage of the psoas major, erector spinae, and multifidus muscles were significantly different between the two groups (P < 0.05). (3) Logistic regression analysis showed that fat infiltration percentage was an independent risk factor for poor wound healing. (4) Receiver operating characteristic curve analysis showed that fat infiltration percentage had high predictive value for poor wound healing (area under the curve > 0.7). (5) One-way ANOVA indicated that osteoporosis was a risk factor for fat infiltration in the L4 multifidus muscle (P < 0.05). (6) The results indicate that paraspinal muscle fat infiltration percentage is an important predictor of non-infectious poor wound healing after traditional open posterior lumbar surgery, providing clinical reference. Osteoporosis was also confirmed as a risk factor for L4 multifidus fat infiltration, but due to the small subgroup sample size, whether osteoporosis affects non-infectious poor healing after lumbar surgery requires further clinical trials.
1. Introduction
Lumbar degenerative diseases are common in spinal surgery, and surgical treatments such as posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, and posterior fenestration discectomy are widely used clinically [1]. However, due to the specific nature of the surgical site, these patients often have prolonged hospital stays and a higher incidence of postoperative complications, with wound healing being particularly critical. Common factors leading to poor wound healing include fat liquefaction, infection, postoperative hematoma, and cerebrospinal fluid leakage [2]. In existing studies, non-infectious poor wound healing refers to wound dehiscence, necrosis, or scar hyperplasia excluding infection, encompassing fat liquefaction and hematoma [3], with a time frame of within 2 weeks postoperatively; it also includes non-healing (>1 month) or delayed healing (>14 days) [4]. The judgment criteria are mainly based on clinical manifestations (exudate nature, skin edge status, healing time) [5], as shown in Figure 1. Additionally, the deep location of the surgical wound and the inconvenience of dressing changes and cleaning make the management of such wounds particularly complex, posing a major challenge for spinal surgeons [6]. Effective screening of high-risk groups for postoperative wound healing difficulties has important clinical significance.
Studies have shown that elderly patients, due to aging, immune dysfunction, and gradual decline in organ function, along with prolonged fibroblast cell cycles and reduced self-repair capacity, significantly increase the risk of poor postoperative wound healing [7]. Notably, with aging, paraspinal muscles (such as the multifidus and erector spinae) undergo fatty infiltration and atrophy, which may affect the local microenvironment and impede tissue repair. This study hypothesizes that preoperative paraspinal muscle fat infiltration can predict non-infectious poor wound healing after lumbar surgery, and explores its association with osteoporosis.
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Xiong Shishuo, Xiang Rong, Zhang Yukai, Lan Qing, Guo Haiwei, Tian Han, Zhong Yelin, Zhang Yinyin, Guo Zehua, Lu Wenhao, Li Ying (2026). Degree of paraspinal muscle fat infiltration predicts non-infectious poor wound healing following lumbar surgery. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21416
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Frequently Asked Questions
What is the main finding of this study?
The study found that preoperative paraspinal muscle fat infiltration percentage, measured via MRI, is an independent risk factor for non-infectious poor wound healing after traditional open posterior lumbar surgery. Higher fat infiltration in the multifidus and erector spinae muscles significantly increases the risk of poor healing.
How was paraspinal muscle fat infiltration measured?
Fat infiltration was quantified using preoperative lumbar MRI (T1WI, T2WI, or T2WISTIR sequences) and Image J software. The percentage of fat infiltration was calculated as (fat infiltration area / total cross-sectional area of paraspinal muscles) × 100% at specific vertebral levels (L3, L4, L5 inferior endplate).
What are the clinical implications of this study?
The findings suggest that preoperative MRI assessment of paraspinal muscle fat infiltration can help identify patients at high risk for non-infectious wound healing problems, allowing for early intervention and personalized postoperative care. The identified thresholds (L4 multifidus >16.31%, L4 erector spinae >8.945%) provide practical cutoffs for risk stratification.
Is there a link between osteoporosis and paraspinal muscle fat infiltration?
The study found that osteoporosis is a risk factor for increased fat infiltration in the L4 multifidus muscle, suggesting a potential association between bone health and muscle degeneration. However, due to small subgroup sample sizes, further research is needed to confirm whether osteoporosis directly affects non-infectious poor healing after lumbar surgery.
What are the limitations of this study?
The study is retrospective and single-center, with a relatively small sample size for the poor healing group. The subgroup analysis for osteoporosis had limited power. Future prospective multicenter studies with larger cohorts are needed to validate these findings and establish causality.
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