Beyond BMI: L4–L5 visceral-to-subcutaneous fat ratio on CT predicts impaired wound healing after posterior lumbar fusion—A retrospective study - Report - MDSpire

Beyond BMI: L4–L5 visceral-to-subcutaneous fat ratio on CT predicts impaired wound healing after posterior lumbar fusion—A retrospective study

  • By

  • Jinwang Liu

  • Xiaoping Xu

  • Shaoxing Li

  • Hua Yu

  • June 15, 2026

  • 0 min

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Clinical Report: Assessing the L4–L5 Visceral-to-Subcutaneous Fat Ratio via CT

Overview

This study investigates the role of the visceral-to-subcutaneous fat area (VFA/SFA) ratio as a predictor of wound healing complications following posterior lumbar fusion (PLF). The findings indicate that a higher VFA/SFA ratio is significantly associated with impaired wound healing within 30 days post-surgery.

Background

Obesity is a known risk factor for postoperative complications in spine surgery, yet traditional metrics like body mass index (BMI) do not adequately reflect fat distribution. The VFA/SFA ratio, which can be measured via CT imaging, may provide a more accurate assessment of regional fat distribution and its impact on surgical outcomes. Understanding this relationship is crucial for improving patient care and reducing complications.

Data Highlights

MeasureImpaired Healing (n=59)Good Healing (n=467)p-value
BMI (kg/m²)25.4 ± 4.023.1 ± 3.8< 0.001
VFA/SFA Ratio1.063 ± 0.2460.895 ± 0.259< 0.001

Key Findings

  • Impaired wound healing occurred in 11.2% of patients post-PLF.
  • Patients with impaired healing had a significantly higher BMI and VFA/SFA ratio compared to those with good healing.
  • Each 0.1 increase in VFA/SFA ratio was associated with an adjusted odds ratio of 1.32 for impaired wound healing.
  • The AUC for VFA/SFA was 0.70, indicating its predictive value beyond BMI.
  • Incorporating VFA/SFA into clinical models improved the AUC from 0.70 to 0.77.

Clinical Implications

The VFA/SFA ratio can serve as a valuable preoperative metric for assessing the risk of wound healing complications in patients undergoing PLF. This information may assist clinicians in identifying high-risk patients and tailoring perioperative management strategies accordingly.

Conclusion

The study establishes the VFA/SFA ratio as an independent predictor of impaired wound healing after PLF, highlighting its potential utility in preoperative risk assessment.

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  6. Hernia — Adipose Tissue Distribution in Patients with Primary and Recurrent Incisional Hernias
  7. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update - PMC
  8. New Definition for Postoperative Spine Infection (PSI): From the Workgroup of the Musculoskeletal Infection Society (MSIS) and the European Bone & Joint Infection Society (EBJIS) - PubMed
  9. Frontiers | Visceral fat: the hidden culprit behind thoracolumbar surgery infections
  10. A Novel MRI-Based Lumbar Subcutaneous Adipose Classification for Predicting Surgical Site Infection and Adverse Events after Lumbar Fusion - Shiyong Wang, Xiaojin Wu, Waimei Zhu, Xiangdong Gong, Rubin Yao, Haitao Hu, Rudong Chen, Honglai Zhang, Zemin Wang, Wanzhong Yang, Rong Ma, Wei Guo, Kaishun Yang, Zhaohui Ge, 2026
  11. Construction and validation of a nomogram predictive model for assessing the risk of surgical site infections following posterior lumbar fusion surgery | Scientific Reports
  12. Risk factors for surgical site infections after spinal surgery: a systematic review and meta-analysis | European Spine Journal | Springer Nature Link

Original Source(s)

Beyond BMI: L4–L5 visceral-to-subcutaneous fat ratio on CT predicts impaired wound healing after posterior lumbar fusion—A retrospective study

  • by Jinwang Liu, Xiaoping Xu, Shaoxing Li, Hua Yu

  • June 15, 2026

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