腹主动脉钙化与椎旁肌退变的相关性及其对后路腰椎椎间融合术后疗效的影响OA

Objective To investigate the relationship between abdominal aortic calcification(AAC)and paraspinal muscle degeneration,and to evaluate its clinical significance in patients undergoing posterior lumbar interbody fusion(PLIF)for degenerative lumbar diseases.Methods This single-center retrospective cohort study included 150 patients who underwent single-level PLIF between January 2020 and January 2024 at Yichang Central People's Hospital.Based on lateral lumbar radiographs using the Kauppila score,patients were divided into an AAC group(n=100)and a non-AAC group(n=50).The functional cross-sectional area(fCSA)and fat infiltration(FI)rate of the paraspinal muscles at the L4 vertebral level were measured preoperatively.Low back pain visual analog scale(VAS)and Oswestry Disability Index(ODI)scores were assessed preoperatively and at 1 year postoperatively.Univariate and multivariate linear regression analyses were used to examine the correlations.Robustness was verified using propensity score matching(PSM)and stratified trend tests.Results Patients in the AAC group were older,had a higher prevalence of hypertension,and exhibited significantly higher FI and significantly lower fCSA(all P<0.05).The AAC group also had significantly higher VAS and ODI scores both preoperatively and postoperatively(P<0.001).Univariate analysis revealed that the AAC score was positively correlated with FI(β=0.960,P<0.001)and negatively correlated with fCSA(β=-0.200,P=0.002).After adjusting for confounding factors,the AAC score remained independently positively correlated with FI(β=0.560,P=0.000 6)and independently negatively correlated with fCSA(β=-0.02,P=0.004 8).The AAC score was also an independent predictor of preoperative VAS and ODI.These associations remained robust after PSM.Stratified analysis demonstrated a significant dose-response relationship,with FI,VAS,and ODI increasing,and fCSA decreasing,across ascending AAC severity strata(all P for Trend<0.001).At the 1-year follow-up,the AAC group showed a significantly lower magnitude of ODI improvement and a lower rate of achieving the minimal clinically important difference(MCID).Conclusion There is a significant and independent correlation between AAC and paraspinal muscle degeneration.AAC may promote fat infiltration and atrophy of the paraspinal muscles by compromising local lumbar blood supply,thereby negatively impacting clinical outcomes.Vascular factors may play an important role in the mechanism of muscle degeneration associated with spinal degenerative diseases.AAC could serve as a potential imaging marker for preoperative risk assessment,providing a reference for developing individualized treatment strategies.