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The impact of preoperative multifidus muscle morphology on surgical outcomes in lumbar degenerative spondylolisthesis: a retrospective cohort study.

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Title: The impact of preoperative multifidus muscle morphology on surgical outcomes in lumbar degenerative spondylolisthesis: a retrospective cohort study.
Alternate Title: El impacto de la morfología preoperatoria del músculo multífido en los resultados quirúrgicos de la espondilolistesis degenerativa lumbar: un estudio de cohorte retrospectivo.
Authors: García-Ramos, C.1, Pérez-Oliva, J.1, Carreón-Cerda, C.1,2, Solorio-Pineda, S.1, Hernández-Moctezuma, D.1, Álvarez-Ramírez, C.1, Alpízar-Aguirre, A.1, Reyes-Sánchez, A.1 alereyes@inr.gob.mx
Source: Acta Ortopédica Mexicana. May/Jun2026, Vol. 40 Issue 3, p164-171. 8p.
Subjects: Spinal fusion, Back muscles, Spondylosis, Cohort analysis, Treatment effectiveness, Fatty degeneration
Abstract (English): Introduction: the multifidus muscle is a key stabilizer of the lumbar spine. While its deterioration has been associated with degenerative spinal conditions, the specific impact of its preoperative morphology on surgical outcomes remains unclear. The objective of this study is to evaluate the relationship between preoperative multifidus muscle morphology (cross-sectional area and fatty degeneration) and clinical-surgical outcomes following lumbar fusion surgery. Material and methods: a retrospective cohort study of 99 patients aged 40-65 years with L4-L5 degenerative spondylolisthesis undergoing lumbar fixation and arthrodesis (2022-2024). Preoperative MRIs assessed cross-sectional area multifidus (CSAM) and fatty degeneration. Three spine surgeons performed measurements with substantial interobserver reliability (κ = 0.80). Clinical outcomes (ODI, Roland Morris, SF-36, VAS), surgical variables, and complications were analyzed. Results: the cohort (31.31% male, 68.69% female; mean age 59.15 ± 8.78 years) showed significant positive correlations between CSAM and intraoperative blood loss (r = 0.249, p = 0.013) and postoperative complications (r = 0.217, p = 0.031). Fatty degeneration demonstrated no significant association with complications (p = 0.214) or clinical improvement. All patient groups showed significant clinical improvement at 12 months postoperatively regardless of fatty infiltration severity. Conclusions: larger multifidus muscle volume correlates with increased surgical complexity, while fatty degeneration does not predict complications or clinical outcomes. These findings highlight the importance of comprehensive muscle morphology assessment in preoperative planning. A retrospective cohort study was conducted. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Introducción: el músculo multífido es un estabilizador clave de la columna lumbar. Aunque su deterioro se ha asociado con patologías degenerativas, el impacto específico de su morfología preoperatoria en los resultados quirúrgicos permanece incierto. El objetivo de este estudio es evaluar la relación entre la morfología preoperatoria del músculo multífido (área transversal del multífido y la degeneración grasa) y los resultados clínico-quirúrgicos tras la artrodesis lumbar. Material y métodos: estudio retrospectivo de cohortes de 99 pacientes de 40-65 años con espondilolistesis degenerativa L4- L5 intervenidos (2022-2024). Se utilizaron resonancias magnéticas preoperatorias para valorar el área transversal del multífido (por sus siglas en inglés CSAM, crosssectional area multifidus) y degeneración grasa del multífidus. Tres cirujanos realizaron las mediciones con confiabilidad interobservadora sustancial (κ = 0.80). Se analizaron resultados clínicos (ODI, Roland Morris, SF-36, EVA), variables quirúrgicas y complicaciones. Resultados: la cohorte (31.31% hombres, 68.69% mujeres; edad media 59.15 ± 8.78 años) mostró correlaciones positivas significativas entre CSAM y sangrado intraoperatorio (r = 0.249, p = 0.013) y complicaciones postoperatorias (r = 0.217, p = 0.031). La degeneración grasa no mostró asociación significativa con complicaciones (p = 0.214) ni mejoría clínica. Todos los grupos mostraron mejoría clínica significativa a los 12 meses postoperatorios, independientemente de la severidad de la infiltración grasa. Conclusiones: un mayor volumen del músculo multífido se correlaciona con mayor complejidad quirúrgica, mientras que la degeneración grasa no predice complicaciones ni resultados clínicos. Estos hallazgos resaltan la importancia de la evaluación integral de la morfología muscular en la planificación preoperatoria. Se realizó un estudio de cohorte retrospectivo. [ABSTRACT FROM AUTHOR]
Copyright of Acta Ortopédica Mexicana is the property of Sociedad Mexicana de Ortopedia, AC and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: MedicLatina
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  Data: The impact of preoperative multifidus muscle morphology on surgical outcomes in lumbar degenerative spondylolisthesis: a retrospective cohort study.
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  Data: El impacto de la morfología preoperatoria del músculo multífido en los resultados quirúrgicos de la espondilolistesis degenerativa lumbar: un estudio de cohorte retrospectivo.
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  Data: <searchLink fieldCode="AR" term="%22García-Ramos%2C+C%2E%22">García-Ramos, C.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Pérez-Oliva%2C+J%2E%22">Pérez-Oliva, J.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Carreón-Cerda%2C+C%2E%22">Carreón-Cerda, C.</searchLink><relatesTo>1,2</relatesTo><br /><searchLink fieldCode="AR" term="%22Solorio-Pineda%2C+S%2E%22">Solorio-Pineda, S.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Hernández-Moctezuma%2C+D%2E%22">Hernández-Moctezuma, D.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Álvarez-Ramírez%2C+C%2E%22">Álvarez-Ramírez, C.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Alpízar-Aguirre%2C+A%2E%22">Alpízar-Aguirre, A.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Reyes-Sánchez%2C+A%2E%22">Reyes-Sánchez, A.</searchLink><relatesTo>1</relatesTo><i> alereyes@inr.gob.mx</i>
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  Data: <searchLink fieldCode="JN" term="%22Acta+Ortopédica+Mexicana%22">Acta Ortopédica Mexicana</searchLink>. May/Jun2026, Vol. 40 Issue 3, p164-171. 8p.
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  Data: <searchLink fieldCode="DE" term="%22Spinal+fusion%22">Spinal fusion</searchLink><br /><searchLink fieldCode="DE" term="%22Back+muscles%22">Back muscles</searchLink><br /><searchLink fieldCode="DE" term="%22Spondylosis%22">Spondylosis</searchLink><br /><searchLink fieldCode="DE" term="%22Cohort+analysis%22">Cohort analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Fatty+degeneration%22">Fatty degeneration</searchLink>
– Name: Abstract
  Label: Abstract (English)
  Group: Ab
  Data: Introduction: the multifidus muscle is a key stabilizer of the lumbar spine. While its deterioration has been associated with degenerative spinal conditions, the specific impact of its preoperative morphology on surgical outcomes remains unclear. The objective of this study is to evaluate the relationship between preoperative multifidus muscle morphology (cross-sectional area and fatty degeneration) and clinical-surgical outcomes following lumbar fusion surgery. Material and methods: a retrospective cohort study of 99 patients aged 40-65 years with L4-L5 degenerative spondylolisthesis undergoing lumbar fixation and arthrodesis (2022-2024). Preoperative MRIs assessed cross-sectional area multifidus (CSAM) and fatty degeneration. Three spine surgeons performed measurements with substantial interobserver reliability (κ = 0.80). Clinical outcomes (ODI, Roland Morris, SF-36, VAS), surgical variables, and complications were analyzed. Results: the cohort (31.31% male, 68.69% female; mean age 59.15 ± 8.78 years) showed significant positive correlations between CSAM and intraoperative blood loss (r = 0.249, p = 0.013) and postoperative complications (r = 0.217, p = 0.031). Fatty degeneration demonstrated no significant association with complications (p = 0.214) or clinical improvement. All patient groups showed significant clinical improvement at 12 months postoperatively regardless of fatty infiltration severity. Conclusions: larger multifidus muscle volume correlates with increased surgical complexity, while fatty degeneration does not predict complications or clinical outcomes. These findings highlight the importance of comprehensive muscle morphology assessment in preoperative planning. A retrospective cohort study was conducted. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label: Abstract (Spanish)
  Group: Ab
  Data: Introducción: el músculo multífido es un estabilizador clave de la columna lumbar. Aunque su deterioro se ha asociado con patologías degenerativas, el impacto específico de su morfología preoperatoria en los resultados quirúrgicos permanece incierto. El objetivo de este estudio es evaluar la relación entre la morfología preoperatoria del músculo multífido (área transversal del multífido y la degeneración grasa) y los resultados clínico-quirúrgicos tras la artrodesis lumbar. Material y métodos: estudio retrospectivo de cohortes de 99 pacientes de 40-65 años con espondilolistesis degenerativa L4- L5 intervenidos (2022-2024). Se utilizaron resonancias magnéticas preoperatorias para valorar el área transversal del multífido (por sus siglas en inglés CSAM, crosssectional area multifidus) y degeneración grasa del multífidus. Tres cirujanos realizaron las mediciones con confiabilidad interobservadora sustancial (κ = 0.80). Se analizaron resultados clínicos (ODI, Roland Morris, SF-36, EVA), variables quirúrgicas y complicaciones. Resultados: la cohorte (31.31% hombres, 68.69% mujeres; edad media 59.15 ± 8.78 años) mostró correlaciones positivas significativas entre CSAM y sangrado intraoperatorio (r = 0.249, p = 0.013) y complicaciones postoperatorias (r = 0.217, p = 0.031). La degeneración grasa no mostró asociación significativa con complicaciones (p = 0.214) ni mejoría clínica. Todos los grupos mostraron mejoría clínica significativa a los 12 meses postoperatorios, independientemente de la severidad de la infiltración grasa. Conclusiones: un mayor volumen del músculo multífido se correlaciona con mayor complejidad quirúrgica, mientras que la degeneración grasa no predice complicaciones ni resultados clínicos. Estos hallazgos resaltan la importancia de la evaluación integral de la morfología muscular en la planificación preoperatoria. Se realizó un estudio de cohorte retrospectivo. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of Acta Ortopédica Mexicana is the property of Sociedad Mexicana de Ortopedia, AC and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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