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Purpose <p>This study examined whether the preoperative psoas muscle index (PMI) at the L3 level predicts 6-month recovery after chemonucleolysis for lumbar disc herniation. The primary 6-month endpoints were: (1) no or minimal pain; and (2) ≥ 75% improvement in the Oswestry Disability Index (ODI) from baseline.</p> Methods <p>This retrospective study included 209 patients (93 men and 116 women) who underwent chemonucleolysis with collagenase for lumbar disc herniation. Baseline characteristics, follow-up data, and the PMI at the L3 level were collected for all participants. Because of significant sex differences in PMI, we stratified participants into quartiles (Q1–Q4) and used generalized linear mixed models (GLMMs) to assess longitudinal changes in postoperative pain, functional disability, and mobility, as well as their interactions with PMI in men and women. Patients were further stratified based on whether they achieved an essentially pain-free status (numeric rating scale [NRS] ≤ 1) at 6-month postoperatively and whether their ODI improvement exceeded 75%. Student t tests were performed, and receiver operating characteristic (ROC) curves were constructed to evaluate the predictive accuracy of PMI and body mass index (BMI) for postoperative recovery outcomes.</p> Results <p>PMI was significantly associated with delayed postoperative recovery. Patients with low PMI showed less pain reduction and delayed functional recovery during the 6-month follow-up. Compared with the no-pain group, PMI was significantly lower in both sexes in the pain group (<i>P</i> &lt; 0.001), whereas BMI was lower only in males (<i>P</i> &lt; 0.05). PMI was significantly lower in both sexes in the group with ≤ 75% ODI improvement than in the group with &gt; 75% improvement (<i>P</i> &lt; 0.001). ROC curve analysis showed that PMI had high predictive accuracy for both postoperative NRS and ODI scores.</p> Conclusion <p>PMI was significantly associated with postoperative NRS and ODI after chemonucleolysis. Preoperative PMI assessment can help clinicians identify high-risk patients and tailor rehabilitation.</p>

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Predicting rehabilitation outcomes following collagenase chemonucleolysis for lumbar disc herniation using psoas muscle index

  • 期刊论文

  • 发表日期：

    2026年4月1日

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  • Bin Zhang,
  • Jing-Ru Ma,
  • Jun-Ying Zhang,
  • Quan-Yuan Chang,
  • Yan Xu,
  • Yang Zhang,
  • Yan Yuan

摘要

Purpose

This study examined whether the preoperative psoas muscle index (PMI) at the L3 level predicts 6-month recovery after chemonucleolysis for lumbar disc herniation. The primary 6-month endpoints were: (1) no or minimal pain; and (2) ≥ 75% improvement in the Oswestry Disability Index (ODI) from baseline.

Methods

This retrospective study included 209 patients (93 men and 116 women) who underwent chemonucleolysis with collagenase for lumbar disc herniation. Baseline characteristics, follow-up data, and the PMI at the L3 level were collected for all participants. Because of significant sex differences in PMI, we stratified participants into quartiles (Q1–Q4) and used generalized linear mixed models (GLMMs) to assess longitudinal changes in postoperative pain, functional disability, and mobility, as well as their interactions with PMI in men and women. Patients were further stratified based on whether they achieved an essentially pain-free status (numeric rating scale [NRS] ≤ 1) at 6-month postoperatively and whether their ODI improvement exceeded 75%. Student t tests were performed, and receiver operating characteristic (ROC) curves were constructed to evaluate the predictive accuracy of PMI and body mass index (BMI) for postoperative recovery outcomes.

Results

PMI was significantly associated with delayed postoperative recovery. Patients with low PMI showed less pain reduction and delayed functional recovery during the 6-month follow-up. Compared with the no-pain group, PMI was significantly lower in both sexes in the pain group (P < 0.001), whereas BMI was lower only in males (P < 0.05). PMI was significantly lower in both sexes in the group with ≤ 75% ODI improvement than in the group with > 75% improvement (P < 0.001). ROC curve analysis showed that PMI had high predictive accuracy for both postoperative NRS and ODI scores.

Conclusion

PMI was significantly associated with postoperative NRS and ODI after chemonucleolysis. Preoperative PMI assessment can help clinicians identify high-risk patients and tailor rehabilitation.