1550. Does pre-operative muscle health impact pre-operative health related quality of life scores for patients with lumbar pathology?

Authors: Sohrab Virk; Avani Vaishnav, MBBS; Steven McAnany, MD; Todd Albert, MD; Sravisht Iyer, MD; Catherine Himo Gang, MPH; Sheeraz Qureshi, MD, MBA (New York, NY)


The purpose of the present study was to evaluate the health of lumbar musculature for patients that would eventually undergo an operation for lumbar pathology including disc herniations, lumbar spinal stenosis, neurogenic claudication and facet cysts.


We analyzed magnetic resonance imaging (MRI) to quantify muscle health using validated measures of cross sectional area using the lumbar indentation value (LIV) and lumbar muscle fatty atrophy using the Goutallier classification.  Goutallier classifications were performed on both the combined multifidus and erector spinae muscles as well as individually for the multifidus muscle. We performed a linear regression analysis to determine the relationship of pre-operative LIV and the HRQOLs listed. We also performed an ANOVA analysis to identify the relationship between Goutallier classification and HRQOLs listed and to identify differences in LIV/Goutallier classifications based upon pre-operative diagnosis.


A total of 95 patients were included within our analysis. The average age was 57.9+/-14.4 years old and there were 50 men and 45 women. There were 107 disc spaces operated on within this cohort. The most common pre-operative diagnosis was lumbar spinal stenosis (58 patients). We found that the average LIV was 16.1 +/- 7.5 mmThe only pre-operative score that had a statistically significant correlation to the Goutallier classification of the multifidus muscle was with PROMIS scores (p = 0.005). LIV had a positive correlation with PROMIS scores (p = 0.01) and an inverse relationship with the VAS leg score (p = 0.04).  


Muscle health contributes significantly to pre-operative disability as measured by various HRQOL scores. These findings further emphasize the relationship between lumbar degenerative conditions and muscle degeneration. Further research is required to understand how improving pre-operative muscle health might impact long term clinical outcomes after surgery for lumbar radiculopathy.