The Goutallier Classification System: How does Paravertebral Adipose Degeneration Change in Patients with Symptomatic Lumbar Spinal Stenosis?

Giuseppe Corazzelli; Vincenzo Meglio; Sergio Corvino; Settimio Leonetti; Francesco Ricciardi; Alessandro D'Elia; Valentina Pizzuti; Marco Santilli; Gualtiero Innocenzi

doi:10.1097/BRS.0000000000004932

The Goutallier Classification System: How does Paravertebral Adipose Degeneration Change in Patients with Symptomatic Lumbar Spinal Stenosis?

Spine (Phila Pa 1976). 2024 Jan 23. doi: 10.1097/BRS.0000000000004932. Online ahead of print.

Authors

Giuseppe Corazzelli¹, Vincenzo Meglio¹, Sergio Corvino¹, Settimio Leonetti², Francesco Ricciardi², Alessandro D'Elia², Valentina Pizzuti², Marco Santilli³, Gualtiero Innocenzi²

Affiliations

¹ Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy.
² Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), Italy.
³ Department of Neurology, IRCCS Neuromed, Pozzilli, (IS), Italy.

PMID: 38258887
DOI: 10.1097/BRS.0000000000004932

Abstract

Study design: Retrospective, observational study.

Objective: To determine the relationship between the Goutallier Classification System (GS) and anthropometric, clinical, and radiological features in 168 patients with lumbar spinal stenosis (LSS).

Background: There is no agreement on a classification system that is both reliable and easy to use for describing the severity of fatty degeneration in the paravertebral muscles of the lower back in patients with symptomatic lumbar spinal stenosis. This study aimed to determine the statistical relationship between the GS and anthropometric, clinical, and radiological factors in 168 patients with LSS.

Methods: This study was conducted on 168 patients with LSS scheduled for elective decompressive surgery. A control group of 110 healthy individuals was enrolled. The study assessed paralumbar musculature fatty infiltration using GS on preoperative Magnetic Resonance Imagin (MRI). We evaluated the statistical association between patient age, Body Mass Index (BMI), preoperative Oswestry Disability Index (ODI) questionnaire, and cross-sectional areas (CSAs) of the dural sac and lumbar paraspinal muscles. Multivariate analysis was performed to adjust for confounding.

Results: This study enrolled 168 patients with symptomatic LSS (95 men, 73 women; mean±standard deviation; range); age: 67,81±9,38; (32,78 - 92,34) years; BMI: 28,29±3,36; (19,95 - 38,10) kg/m2. The control group was comprised of 110 healthy patients (61 men and 49 women). Age, sex, BMI, and ES-CSA were not significantly different between the two groups. We found a direct relationship between GS grade and age, and an inverse relationship between GS grade and DS-, LM-, ES-, and PM-CSAs. (Table 2 and Fig. 5). Univariate analyses showed the variables statistically related to a higher GS grade included patient age, (P<0.001), ODI (P=0.136), DS-CSA (P=0.011), LM-CSA (P< 0.001), ES-CSA (P<0.001), and PM-CSA (P<0.001). Multivariate least squares analysis showed the GS grade to be influenced by patient age (P=0.01), LM-CSA (P=0.002), ES-CSA (P=0.002), and PM-CSA (P=0.003).

Conclusions: GS shows great potential as a tool for evaluating fat infiltration in the paralumbar muscles. This measure does not correlate with the ODI and BMI, but is related to all radiological parameters and patient age. Further prospective studies are required to establish a link between preoperative and postoperative outcomes in the setting of paraspinal fat infiltration.