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Abstract
Background and Aims Morphological changes in paraspinal muscles may be associated with the analgesic outcome after epidural adhesiolysis, especially in elderly patients. The purpose of study was to evaluate whether cross-sectional area or fatty infiltration of the paraspinal muscles affects treatment results of epidural adhesiolysis.
Methods Patients with degenerative lumbar disease who underwent epidural adhesiolysis were enrolled in the analysis. Good analgesia was defined as ≥30% reduction in pain score at 6 months follow-up. A cross-sectional area and fatty infiltration rate of the paraspinal muscles were measured. The study population was divided based on age (by 65 years of age). Variables were compared between good and poor analgesia group.
Quantitative measurements of cross-sectional area (A) and fatty infiltration rate (B) of the paraspinal muscles on a magnetic resonance image at the level of L3–L4 disc
Epidurography pattern of percutaneous epidural adhesiolysis at the level of L4-L5 intervertebral foramen
Results Elderly patients showed poor analgesic outcome as fatty infiltration rate in the paraspinal muscles increased (p = 0.029), predominantly in female patients. However, cross-sectional area did not show any correlation with the analgesic outcome in patients younger than or older than 65 years (p= 0.397 and p = 0.349, respectively). Multivariate logistic regression analysis revealed that baseline pain scores <7 (OR = 4.055, 95% CI = 1.527–10.764, p = 0.005), spondylolisthesis (OR = 4.555, 95% CI = 1.237–16.776, p = 0.023), and ≥ 50% fatty infiltration of paraspinal muscles (OR = 6.691, 95% CI = 1.233–36.308, p = 0.028) were significantly associated with poor outcome in elderly patients.
Conclusions Fatty degeneration of paraspinal muscles correlates with poor pain outcome after epidural adhesiolysis in elderly patients. A paraspinal cross- sectional area was not associated with pain relief after the procedure.
IRB approval