{
    "abstract": "To identify independent risk factors for residual pain following posterior lumbar interbody fusion (PLIF) and assess if multifidus muscle fat infiltration (MFI) predicts persistent postoperative pain.\nA retrospective study of 336 patients (mean age: 67.18 \u00b1 8.73 years) undergoing PLIF for lumbar degenerative diseases between January 2021 and October 2023, with \u226512 months of follow-up. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were recorded preoperatively, and at 1 day, 1 month, and 12-18 months postoperatively. Patients were divided into non-pain (VAS < 3, n = 180) and pain (VAS \u2265 3, n = 156) groups. Radiological parameters, including Hounsfield unit (HU) values, MFI, multifidus muscle index (MMI), spondylolisthesis, nonunion, and screw loosening, were assessed.\nBoth groups showed significant improvements in VAS and ODI (P < 0.05), yet 46.43% of patients reported VAS \u2265 3 at final follow-up. The pain group had higher rates of spondylolisthesis, multisegmental surgery, nonunion, and screw loosening (P < 0.05). MFI was the strongest correlate of pain, followed by surgical extent and nonunion. Multivariate regression identified higher MFI (OR = 1.094, P = 0.001), more fused segments (OR = 1.960, P = 0.015), lumbar spondylolisthesis (OR = 2.231, P = 0.018), and lower HU values (OR = 0.991, P = 0.015) as predictors of pain.\nMFI, lower HU values, greater surgical extent, and spondylolisthesis are independent predictors of postoperative pain after PLIF, emphasising the need for targeted preoperative and rehabilitation strategies.",
    "authors": [
        {
            "affiliation": "Department of Orthopedics, The Fourth Affiliated Hospital of Soochow University, Suzhou, China.",
            "firstname": "Zhanhong",
            "initials": "Z",
            "lastname": "Chen"
        },
        {
            "affiliation": "Department of Orthopedics, The Fourth Affiliated Hospital of Soochow University, Suzhou, China.",
            "firstname": "Weichen",
            "initials": "W",
            "lastname": "Xu"
        },
        {
            "affiliation": "Department of Orthopaedics, Lianyungang Second People's Hospital affiliated to Kangda College of Nanjing Medical University, Lianyungang 222003, China; Department of Orthopaedics, Xuzhou Medical University & The Second People's Hospital of Lianyungang, Lianyungang 222003, China.",
            "firstname": "Lihui",
            "initials": "L",
            "lastname": "Hong"
        },
        {
            "affiliation": "Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.",
            "firstname": "Wenxiang",
            "initials": "W",
            "lastname": "Tang"
        },
        {
            "affiliation": "Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.",
            "firstname": "Yanping",
            "initials": "Y",
            "lastname": "Niu"
        },
        {
            "affiliation": "Department of Orthopaedics, Lianyungang Second People's Hospital affiliated to Kangda College of Nanjing Medical University, Lianyungang 222003, China; Department of Orthopaedics, Xuzhou Medical University & The Second People's Hospital of Lianyungang, Lianyungang 222003, China. Electronic address: lvnanning123@163.com.",
            "firstname": "Nanning",
            "initials": "N",
            "lastname": "Lv"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2025. Published by Elsevier Inc.",
    "doi": "10.1016/j.wneu.2025.123998",
    "journal": "World neurosurgery",
    "keywords": [
        "Lumbar degenerative disease",
        "Multifidus fat infiltration",
        "Posterior lumbar interbody fusion",
        "Residual pain",
        "Risk factors"
    ],
    "methods": null,
    "publication_date": "2025-04-25",
    "pubmed_id": "40274015",
    "results": "Both groups showed significant improvements in VAS and ODI (P < 0.05), yet 46.43% of patients reported VAS \u2265 3 at final follow-up. The pain group had higher rates of spondylolisthesis, multisegmental surgery, nonunion, and screw loosening (P < 0.05). MFI was the strongest correlate of pain, followed by surgical extent and nonunion. Multivariate regression identified higher MFI (OR = 1.094, P = 0.001), more fused segments (OR = 1.960, P = 0.015), lumbar spondylolisthesis (OR = 2.231, P = 0.018), and lower HU values (OR = 0.991, P = 0.015) as predictors of pain.",
    "title": "Decoding the multifidus muscle: fat infiltration as a predictor of outcome after lumbar-lumbar fusion surgery.",
    "xml": "<Element 'PubmedArticle' at 0x7885049ee200>"
}