The role of lumbar core muscle morphology in residual chronic low back pain after PLIF: a retrospective analysis
Front Surg. 2026 Jul 1;13:1833183. doi: 10.3389/fsurg.2026.1833183. eCollection 2026.
ABSTRACT
BACKGROUND: 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).
METHODS: 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.
RESULTS: 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 = 1.215, P < 0.05) and paraspinal muscles (OR = 1.159, P < 0.05), and lower mean HU of the quadratus lumborum (OR = 1.197, P < 0.05) were independently associated with rCLBP.
CONCLUSION: 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.
PMID:42459974 | PMC:PMC13371312 | DOI:10.3389/fsurg.2026.1833183