Preoperative and follow-up variations of psoas major muscle are related to S1 screw loosening in patients with degenerative lumbar spinal stenosis.
BMC musculoskeletal disorders
BACKGROUND:It was reported the paraspinal muscle played an important role in spinal stability. The preoperative paraspinal muscle was related to S1 screw loosening. But the relationship between preoperative and postoperative change of psoas major muscle (PS) and S1 pedicle screw loosening in degenerative lumbar spinal stenosis (DLSS) patients has not been reported. This study investigated the effects of preoperative and follow-up variations in the psoas major muscle (PS) on the first sacral vertebra (S1) screw loosening in patients with DLSS. METHODS:212 patients with DLSS who underwent lumbar surgery were included. The patients were divided into the S1 screw loosening group and the S1 screw non-loosening group. Muscle parameters were measured preoperatively and at last follow-up magnetic resonance imaging. A logistic regression analysis was performed to investigate the risk factors for S1 screw loosening. RESULTS:The S1 screw loosening rate was 36.32% (77/212). The relative total cross-sectional areas and relative functional cross-sectional areas (rfCSAs) of the PS at L2-S1 were significantly higher after surgery. The increased rfCSA values of the PS at L3-S1 in the S1 screw non-loosening group were significantly higher than those in the S1 screw loosening group. The regression analysis showed male, lower CT value of L1 and longer segment fusion were independent risk factors for S1 screw loosening, and postoperative hypertrophy of the PS was a protective factor for S1 screw loosening. CONCLUSIONS:Compared to the preoperative muscle, the PS size increased and fatty infiltration decreased after surgery from L2-3 to L5-S1 in patients with DLSS after short-segment lumbar fusion surgery. Postoperative hypertrophy of the PS might be considered as a protective factor for S1 screw loosening. MRI morphometric parameters and postoperative selected exercise of PS for DLSS patients after posterior lumbar fusion surgery might contribute to improvement of surgical outcome.
10.1186/s12891-024-07298-0
Relationship between the postoperative variations of paraspinal muscles and adjacent-segment degeneration in patients with degenerative lumbar spinal stenosis after posterior instrumented lumbar fusion.
Journal of neurosurgery. Spine
OBJECTIVE:This study aimed to quantify pre- and postoperative paraspinal muscular variation following posterior lumbar interbody fusion (PLIF) in patients with degenerative lumbar spinal stenosis (DLSS) and measure the association of this variation with adjacent-segment degeneration (ASD). METHODS:Data from 149 patients who underwent L4-S1 PLIF for DLSS were collected. Patients were divided into radiologically confirmed ASD and control groups according to follow-up radiological findings. MRI was performed before surgery and at the last follow-up. Muscular parameters including the relative cross-sectional area (rCSA), relative functional cross-sectional area (rFCSA), relative total cross-sectional area (rTCSA), and fatty infiltration (FI) of the multifidus (MF), erector spinae (ES), and psoas major (PM) muscles were measured on preoperative and follow-up L2-S1 MR images. Logistic regression was used to investigate risk factors for ASD. RESULTS:The rate of radiological ASD was 42.3% at the final follow-up (mean 25.71 ± 8.35 months). At surgical levels, the rFCSA and rTCSA of the MF and ES muscles decreased. The FI of the MF from L2-3 to L5-S1 and ES muscles at L5-S1 significantly increased after surgery, while the rFCSA and rTCSA of the PM muscle increased and its FI decreased. At adjacent levels, the rFCSA and rTCSA of the MF muscle and rTCSA of the ES muscle decreased and the FI of the MF muscle increased postoperatively (p < 0.05), but the rFCSA and rTCSA of the PM muscle increased and its FI decreased (p < 0.05). The FIs of the MF, ES, and PM muscles at adjacent levels significantly differed between the ASD and control groups. Logistic regression analysis indicated that higher BMI (p = 0.002) and FI of the PM muscle at adjacent levels (p = 0.025) were significant risk factors for ASD. CONCLUSIONS:The functional area decreased in the MF and ES muscles and increased in the PM muscle after L4-S1 PLIF. A compensatory postoperative decrease in FI of the PM muscle at the adjacent level was a protective factor for ASD in DLSS patients after PLIF.
10.3171/2023.11.SPINE23750
Degenerative lumbar scoliosis patients with proximal junctional kyphosis have lower muscularity, fatty degeneration at the lumbar area.
Yuan Lei,Zeng Yan,Chen Zhongqiang,Li Weishi,Zhang Xinling,Mai Shuo
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:To assess the lumbar muscle conditions on the incidence of proximal junctional kyphosis (PJK) after long-level correction and instrumentation surgery for degenerative lumbar scoliosis (DLS) patients with a minimum 2-year follow-up. METHODS:Eighty-four DLS patients undergoing long instrumented fusion surgery (≥ 5 vertebrae) were retrospectively studied. According to the occurrence of PJK at the final follow-up, patients were divided into the PJK group and the Non-PJK group. Patient characteristics, surgical variables and radiographic parameters were analyzed statistically. The lumbar muscularity (cross-sectional area of muscle-disc ratio × 100) and fatty degeneration (signal intensity of muscle-subcutaneous fat ratio × 100) were evaluated on magnetic resonance imaging . RESULTS:The prevalence of PJK was 20.24%. Gender, age at surgery, body mass index, uppermost instrumented vertebrae level, fusions extending to the sacrum, and levels fused were not significantly different between the groups. Lower bone mineral density, smaller functional cross-sectional area (FCSA) of paraspinal extensor muscles (PSE), higher lean muscle-fat index and total muscle-fat index of PSE, greater preoperative thoracolumbar kyphosis (TLK), smaller preoperative sacral slope (SS), larger preoperative sagittal vertical axis were identified in PJK group. Logistic regression analysis showed that osteoporosis, preoperative TLK > 15°, SS > 24°, FCSA of PSE > 138.75, and total muscle-fat index of PSE > 4.08 were independently associated with PJK. The final follow-up VAS score for back pain was higher, and SRS-22 subcategories of pain, function, self-image, and total score were significantly lower in the PJK group. CONCLUSION:Osteoporosis, lower lumbar muscularity and higher fatty degeneration, preoperative greater TLK and smaller SS were found to be strongly associated with the presence of PJK in DLS.
10.1007/s00586-020-06394-8
Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion.
Han Gengyu,Zou Da,Liu Zexiang,Zhang Bo,Gong Chunjie,Zhou Siyu,Li Wei,Sun Zhuoran,Li Weishi
BMC musculoskeletal disorders
BACKGROUND:The prognosis value of paraspinal muscle degeneration on clinical outcomes has been revealed. However no study has investigated the effect of the fat infiltration (FI) of paraspinal muscles on bone nonunion after posterior lumbar interbody fusion (PLIF). METHODS:Three hundred fifty-one patients undergoing PLIF for lumbar spinal stenosis with 1-year follow-up were retrospectively identified. Patients were categorized into bone union (n = 301) and bone nonunion (n = 50) groups based on dynamic X-ray at 1-year follow-up. The relative total cross-sectional area (rTCSA) and FI of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured on preoperative magnetic resonance imaging. RESULTS:The nonunion group had a significantly higher MF FI and a higher ES FI and a smaller MF rTCSA than the union group (p = 0.001, 0.038, 0.026, respectively). Binary logistic regression revealed that MF FI (p = 0.029, odds ratio [OR] = 1.04), lumbosacral fusion (p = 0.026, OR = 2193) and length of fusion (p = 0.001, OR = 1.99) were independent factors of bone nonunion. In subgroup analysis, in one or two-level fusion group, the patients with nonunion had a higher MF FI and a higher ES FI than those of the patients with union (all p < 0.05). Similarly, in lumbosacral fusion group, the patients with nonunion had a higher MF FI and a higher ES FI than those of the patients with union (all p < 0.05). The logistic regressions showed that MF FI remained an independent factor of bone nonunion both in the patients with one or two-level fusion (p = 0.003, OR = 1.074) and in the patients with lumbosacral fusion (p = 0.006, OR = 1.073). CONCLUSIONS:Higher fatty degeneration was strongly associated with bone nonunion after PLIF. Surgeons should pay attention to the FI of paraspinal muscles when performing posterior surgery for patients, especially those who need short-segment fusion or to extend fusion to S1.
10.1186/s12891-022-05178-z
Age-Dependent Differences of Paraspinal Muscle Endurance and Morphology in Chinese Community Population Without Chronic Low Back Pain.
Global spine journal
STUDY DESIGN:Cross-sectional study. OBJECTIVES:Our aim was to describe age-dependent changes of lumbar paraspinal muscle endurance and morphology in Chinese healthy population. We also explored the relationship between paraspinals endurance and morphology. METHODS:A total of 181 participants from Chinese community population without chronic low back pain were included. The participants were divided into three groups: young (20-39 years old, n = 29), middle (40-59 years old, n = 93), and elderly (≥ 60 years old, n = 59). The Ito test was performed to evaluate the isometric endurance of paraspinal muscles. The total cross-sectional area (TCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES) were measured at L1-L5 levels on magnetic resonance imaging. Physical activity level was evaluated using the physical activity index and comorbidities were assessed by the modified 5-item frailty index. RESULTS:The elderly group had a shorter performance time of endurance test than the young group and middle-aged group. Correlation analysis showed that age had a significant correlation with endurance test, the average MF TCSA, MF FI, ES TCSA and ES FI of L1-5. In addition, PAI had a significant correlation with endurance test and MF FI. In multiple linear regression analysis, paraspinals endurance was associated with MF FI, ES FI, physical activity level and comorbidities. CONCLUSION:Age-related decreases in paraspinals endurance and TCSA, and an increase in FI were revealed. Besides, paraspinal muscles FI, but not TCSA, was negatively associated with the endurance of paraspinals.
10.1177/21925682221103507
The Effect of Paraspinal Muscle Degeneration on Distal Pedicle Screw Loosening Following Corrective Surgery for Degenerative Lumbar Scoliosis.
Leng Junsheng,Han Gengyu,Zeng Yan,Chen Zhongqiang,Li Weishi
Spine
MINI: A total of 137 degenerative lumbar scoliosis patients were divided into two groups. In group A (six or more fused levels), mean rFCSA of erector spinae <0.71 was an independent risk factor of LIV screw loosening. In Group B (four or five fused levels), paraspinal muscle degeneration had no influence on LIV screw loosening. STUDY DESIGN:A retrospective study. OBJECTIVE:The aim of this study was to evaluate the effect of degeneration of paraspinal muscles, including psoas muscles, erector spinae muscles, and multifidus muscles on pedicle screw loosening at lower instrumented vertebra (LIV) following corrective surgery for degenerative lumbar scoliosis (DLS). SUMMARY OF BACKGROUND DATA:The relation between paraspinal muscles and pedicle screw loosening in DLS patients has not been reported. METHODS:A total of 137 DLS patients underwent corrective surgery with at least 1-year follow-up were included. The patients were divided into two groups: Group A (68 patients) had six or more fused levels and Group B (69 patients) had four or five fused levels. Muscular parameters, including relative cross-sectional area (rCSA) and muscle-fat index (MFI), were measured on preoperative magnetic resonance imaging. rCSA and MFI were measured for both gross muscle (G) and functional muscle (F) as rGCSA, rFCSA, GMFI, and FMFI. Muscle ratio was calculated as rFCSA/rGCSA. Pedicle screw loosening was assessed on spine radiographs or CT at final follow-up. Clinical and radiological screw loosening were classified according to clinical significance. RESULTS:LIV screw loosening occurred in 77 patients at final follow-up. In Group A, patients with LIV screw loosening had significantly higher FMFI of psoas muscles and lower rFCSA and rGCSA of erector spinae. Logistic regression revealed that mean rFCSA of erector spinae <0.71 (odds ratio = 5.0, 95% confidence interval = 1.5-16.4) was an independent risk factor of LIV screw loosening. Mean muscle ratio of erector spinae was significantly lower in patients with clinical screw loosening compared with radiological screw loosening in univariate analysis. In Group B, all muscular parameters showed no significant difference. CONCLUSION:Degeneration of paraspinal muscles, especially psoas muscles and erector spinae, affected LIV screw loosening in six or more level fusion in corrective surgery for DLS, whereas the four- or five-level fusion had no this influence. LEVEL OF EVIDENCE:3.
10.1097/BRS.0000000000003336
Paraspinal Muscle Degeneration as an Independent Risk for Loss of Local Alignment in Degenerative Lumbar Scoliosis Patients After Corrective Surgery.
Global spine journal
STUDY DESIGN:Retrospective study. OBJECTIVES:To investigate the effect of paraspinal muscle degeneration on the maintenance of local and global alignment among degenerative lumbar scoliosis (DLS) patients after corrective surgery. METHODS:98 DLS patients with a mean follow-up period of 38.3 months after corrective surgery were included. The T1 pelvic angle (TPA), lumbar lordosis (LL), pelvic incidence were measured preoperatively, immediate postoperatively and at last follow-up. All patients were divided into LL maintenance group (n = 21) and LL loss group (n = 77). For patients with well-aligned correction (immediate postoperative TPA ≤ 20°, n = 73), they were divided into TPA maintenance group (last follow-up TPA ≤ 20°) and TPA loss group (last follow-up TPA > 20°). The relative gross cross-sectional area (rGCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured at L3, L4 and L5 on preoperative magnetic resonance imaging. RESULTS:MF rGCSA were significantly smaller in LL loss group than in LL maintenance group. Both MF rGCSA and PS rFCSA were significantly smaller and MF FI was significantly higher in TPA loss group than in TPA maintenance group. Binary logistic regression revealed that the MF rGCSA was an independent factor of LL loss; Large immediate postoperative TPA was an independent risk factor of TPA loss, but not the parameters of paraspinal muscles. CONCLUSION:The effect of paraspinal muscles in lower lumbar segments might be mainly focused on the maintenance of local alignment rather than the global alignment.
10.1177/21925682211022284
Risk factors for screw loosening in patients with adult degenerative scoliosis: the importance of paraspinal muscle degeneration.
Wang Wei,Li Weishi,Chen Zhongqiang
Journal of orthopaedic surgery and research
BACKGROUND:Paraspinal muscle is an important component to maintain spinal stability. But the relationship between the degeneration of paraspinal muscle and postoperative screw loosening in patients with adult degenerative scoliosis has not been studied. The objective of this study was to investigate risk factors for screw loosening in patients with adult degenerative scoliosis, including paraspinal muscle degeneration. METHODS:We investigated 93 patients with adult degenerative scoliosis who underwent spinal interbody fusion and pedicle screw fixation surgery. The lateral curvature was located in the lumbar spine and the follow-up time was ≥ 2 years. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a 1-mm or wider circumferential radiolucent line around the pedicle screw. We checked the cross-sectional area of paraspinal muscles, spinopelvic parameters, bone mineral density, number of fusion segment, and other factors. The potential risk factors for screw loosening were investigated by using binary logistical regression analysis. RESULTS:Fifty-seven patients showed screw loosening, which is 63.4% of total. Compared with patients in the non-loosening group, the cross-sectional area of erector spinae and psoas major muscle at L5 level were significantly smaller in patients with screw loosening (P < 0.05). Among these factors, the number of fused segments and relative erector spinae total cross-sectional area were independent risk factors for screw loosening. CONCLUSIONS:The degeneration of paraspinal muscle and the increase of fusion segment were independent factors for screw loosening in patients with adult degenerative scoliosis.
10.1186/s13018-021-02589-x
The predictive value of preoperative paraspinal muscle morphometry on complications after lumbar surgery: a systematic review.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:The effect of paraspinal muscles atrophy and fat infiltration (FI) on the complications of spinal surgery has not been established. METHODS:A review of the literature was conducted from a search of the PubMed, EMBASE, and Web of Science databases from inception through January 2021. The literature was searched and assessed by independent reviewers based on criteria that included an assessment of preoperative paraspinal muscle morphology in addition to measuring its relationship to surgical complications. All relevant papers were assessed for risk of bias according to the modified Newcastle Ottawa Scale and the Joanna Briggs Institute Critical Appraisal Tools. A narrative synthesis was conducted. RESULTS:The initial search yielded 5632 studies, of which 16 studies were included in the analysis. All included studies were at a low risk of bias. There existed strong evidence that the atrophy and FI of paraspinal muscles had an association with the development of bone nonunion (two high quality studies), pedicle screw loosening (two high quality studies), adjacent segment degeneration (three high quality studies) and proximal junctional kyphosis (five high quality studies) after lumbar surgery. Besides, there is also limited evidence for association between atrophy and FI of paraspinal extensor muscles and less local and global curve improvement. CONCLUSIONS:Strong evidence was found for an association between preoperative paraspinal muscle degeneration and multiple postoperative complications after lumbar surgery. However, the findings should be interpreted with caution due to the small quantity of the available literature and high heterogeneity among studies.
10.1007/s00586-021-07052-3
Role of the Paraspinal Muscles in the Sagittal Imbalance Cascade: The Effects of Their Endurance and of Their Morphology on Sagittal Spinopelvic Alignment.
The Journal of bone and joint surgery. American volume
BACKGROUND:The role of paraspinal muscle degeneration in the cascade of sagittal imbalance is still unclear. This study aimed to compare paraspinal muscle degeneration in the 4 stages of sagittal imbalance: sagittal balance (SB), compensated sagittal balance (CSB), decompensated sagittal imbalance (DSI), and sagittal imbalance with failure of pelvic compensation (SI-FPC). In addition, it aimed to compare the effects paraspinal muscle endurance and morphology on sagittal spinopelvic alignment in patients with lumbar spinal stenosis. METHODS:A cross-sectional study of 219 patients hospitalized with lumbar spinal stenosis was performed. The isometric paraspinal extensor endurance test and evaluation of atrophy and fat infiltration of the paraspinal extensor muscles and psoas major on magnetic resonance imaging were performed at baseline. Spinopelvic parameters including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and the sagittal vertical axis were measured. RESULTS:The patients with lumbar spinal stenosis were divided into 67 with SB, 85 with CSB, 49 with DSI, and 17 with SI-FPC. There were significant differences in paraspinal muscle endurance and morphology among the 4 groups. Furthermore, the SI-FPC group had poorer paraspinal muscle endurance than either the SB or the CSB group. In multiple linear regression analysis, paraspinal muscle endurance and the relative functional cross-sectional area of the paraspinal extensor muscles were the independent predictors of the sagittal vertical axis, and the relative functional cross-sectional area of the psoas major was the independent predictor of relative pelvic version. CONCLUSIONS:This study indicated that paraspinal muscle degeneration is not only an initiating factor in pelvic retroversion but also a risk factor for progression from a compensated to a decompensated stage. Specifically, the impairment of muscle endurance in the CSB stage may be the reason why patients experience failure of pelvic compensation. In addition, paraspinal muscle endurance and muscle morphology (relative functional cross-sectional area of the paraspinal extensor muscles and psoas major) had different clinical consequences. LEVEL OF EVIDENCE:Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
10.2106/JBJS.22.01175
The effect of paraspinal muscle on functional status and recovery in patients with lumbar spinal stenosis.
Wang Wei,Sun Zhuoran,Li Weishi,Chen Zhongqiang
Journal of orthopaedic surgery and research
PURPOSE:To investigate the association of paraspinal muscle quantity and quality with functional status in patients with lumbar spinal stenosis (LSS) and explore whether degeneration of paraspinal muscle could predict patients' functional recovery. METHODS:The data of 69 patients (26 males, 43 females; mean age 60.6 ± 9.4 years) with LSS was reviewed. The total cross-sectional area (tCSA), functional cross-sectional area (fCSA), and fatty infiltration (FI) of paraspinal muscle were measured. The Oswestry Disability Index (ODI) scores were used to reflect patients' functional status. Correlations between measurements of paraspinal muscle and ODI scores were investigated by the Pearson correlation analysis. The multiple linear regression analysis was used to explore the correlation between change of ODI and other potential influence factors. Receiver operating characteristic curve was used to find out the most optimum cut-off value for predicting functional recovery. RESULTS:The pre-operation ODI was significantly associated with multifidus muscle (MF) fCSA (r = - 0.304, p = 0.012), while the post-operation ODI was significantly correlated to MF FI (r = 0.407, p < 0.01). Preoperative MF FI was an independent influence factor for change of ODI. The best cut-off value of preoperative MF FI to predict improvement of functional status (change of ODI > 50%) was 33%. CONCLUSION:The preoperative degeneration of MF was significantly associated with patients' functional status. Preoperative MF FI was a good predictor for assessing improvement of patients' functional status. Evaluation of paraspinal muscle before operation could be helpful for surgeons to predict patients' functional status and recovery.
10.1186/s13018-020-01751-1
Correlations between paraspinal extensor muscle endurance and clinical outcomes in preoperative LSS patients and clinical value of an endurance classification.
Journal of orthopaedic translation
Background:Few study has investigated how paraspinal muscle endurance deteriorates in lumbar spinal stenosis (LSS) patients. In addition, little information is available on the relationship between clinical outcomes and the endurance of paraspinal muscles. Objective:To explore the correlation between paraspinal extensor muscle endurance, quality of life (QOL) and sagittal spinopelvic alignment. Besides, we attempted to propose a paraspinal extensor muscle endurance test (PEMET) classification for identifying the severity of clinical symptoms and sagittal imbalance in LSS patients. Methods:171 hospitalized LSS patients and 100 healthy controls from the community were prospectively enrolled in this study. The paraspinal extensor endurance test was performed at baseline according to Ito test. The LSS patients were stratified into three groups based on the performance time of endurance test: grade I (<10s); grade II (10-60s); and grade III (>60s). Clinical measures of QOL included the visual analog scale scores (VAS) for back pain and leg pain and the Oswestry Disability Index (ODI). Sagittal alignment was analysed by standing posteroanterior and lateral whole spine X-ray in LSS patients. Results:The LSS group had a significantly shorter performance time of the endurance test than the control group. The paraspinal muscle endurance significantly correlated with VAS-back, VAS-leg, ODI, pelvic tilt, lumbar lordosis and sagittal vertical axis (SVA; all < 0.05). In binary logistic regression, the performance time of the endurance test was an independent factor of both poor functional status (ODI >40; = 0.005, OR = 0.985) and global sagittal imbalance (SVA >50 mm; = 0.019, OR = 0.985). Based on PEMET classification, moving from the grade III group to the grade I group, there was progressive worsening in VAS-back and ODI (all adjusted < 0.05). Moreover, the grade I group had significantly greater VAS- leg, less LL and greater SVA than the other two groups (all adjusted < 0.05). Conclusion:Paraspinal muscle endurance was associated with QOL and sagittal spinopelvic alignment in LSS patients. A PEMET classification system has been constructed and has shown a correlation with QOL and sagittal imbalance. Translational potential statement:The PEMET classification system proposed in this study could be available for identifying the severity of clinical symptoms and sagittal imbalance during preoperative evaluation in LSS patients.
10.1016/j.jot.2022.08.005
The difference of paraspinal muscle between patients with lumbar spinal stenosis and normal middle-aged and elderly people, studying by propensity score matching.
Frontiers in endocrinology
Objective:The purpose of this study was to elaborate the characteristics of paraspinal muscles in lower lumbar, to compare the differences of paraspinal muscle between patients with lumbar spinal stenosis and normal people and to explore the influencing factors of paraspinal muscle degeneration in patients with lumbar spinal stenosis. Method:The 39 pairs of patients and normal people were selected by propensity score matching. The differences of multifidus muscle and erection spine muscle parameters between the two groups were compared by independent-samples t-test and the relationship between age, paraspinal muscle degeneration and other factors in patients with lumbar spinal stenosis was analyzed by Pearson or Spearman correlation analysis. Result:The general conditions of the two groups (patients with lumbar spinal stenosis and normal people) were well matched. There were significant differences in the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle at L3 level. The fatty infiltration and relative signal intensity of multifidus muscle at L4 level and the relative signal intensity of multifidus muscle at L5 level were also significantly different. For male, the relative fatty cross sectional area, the fatty infiltration and relative signal intensity of multifidus muscle in patients were higher than those in healthy peers. For female, the relative signal intensity of multifidus muscle in patients was higher, too. In patients group, age was significantly correlated with the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle and erector spinae muscle. Weight and BMI were significantly correlated with the relative total cross-sectional area of erector spinae muscle. The fatty infiltration increased more significantly with age in patients than that in normal people. Conclusion:The change rules of paraspinal muscles in patients with lumbar spinal stenosis are similar to those in normal people. The degeneration of paraspinal muscle in patients with lumbar spinal stenosis was more severe than that in normal people, mostly in multifidus muscle. The paraspinal muscle degeneration was related to age in patients, and the effect of age on atrophy of paraspinal muscle was greater than that of normal people.
10.3389/fendo.2022.1080033
Does paraspinal muscle morphometry predict functional status and re-operation after lumbar spinal surgery? A systematic review and meta-analysis.
European radiology
OBJECTIVES:Whether paraspinal muscle degeneration is related to poor clinical outcomes after lumbar surgery is still indistinct, which limits its clinical application. This study aimed to evaluate the predictive value of paraspinal muscle morphology on functional status and re-operation after lumbar spinal surgery. METHODS:A review of the literature was conducted using a total of 6917 articles identified from a search of PubMed, EMBASE, and Web of Science databases through September 2022. A full-text review of 140 studies was conducted based on criteria including an objective assessment of preoperative paraspinal muscle morphology including multifidus (MF), erector spinae (ES), and psoas major (PS) in addition to measuring its relationship to clinical outcomes including Oswestry disability index (ODI), pain and revision surgery. Meta-analysis was performed when required metrics could be calculated in ≥ three studies, otherwise vote counting model was a good alternative to show the effect direction of evidence. The standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. RESULTS:A total of 10 studies were included in this review. Of them, five studies with required metrics were included in the meta-analysis. The meta-analysis suggested that higher preoperative fat infiltration (FI) of MF could predict higher postoperative ODI scores (SMD = 0.33, 95% CI 0.16-0.50, p = 0.0001). For postoperative pain, MF FI could also be an effective predictor for persistent low back pain after surgery (SMD = 0.17, 95% CI 0.02-0.31, p = 0.03). However, in the vote count model, limited evidence was presented for the prognostic effects of ES and PS on postoperative functional status and symptoms. In terms of revision surgery, there was conflicting evidence that FI of MF and ES could predict the incidence of revision surgery in the vote count model. CONCLUSION:The assessment of MF FI could be a viable method to stratify patients with lumbar surgery by the risk of severe functional disability and low back pain. KEY POINTS:• The fat infiltration of multifidus can predict postoperative functional status and low back pain after lumbar spinal surgery. • The preoperative evaluation of paraspinal muscle morphology is conducive for surgeons.
10.1007/s00330-023-09548-6
Evaluation of the association between osteoporotic vertebral compression fractures and psoas major/paraspinal muscle mass and ADC measured on MRI.
Skeletal radiology
OBJECTIVE:Evaluate magnetic resonance imaging factors associated with osteoporotic vertebral compression fractures. MATERIALS AND METHODS:We retrospectively reviewed 457 patients' records. Age, sex, and body mass index were recorded. Two blinded readers measured psoas major and paraspinal muscle areas at the L3 vertebral body level on transverse T2-weighted magnetic resonance images and the mean apparent diffusion coefficient values of the non-fractured vertebrae from Th12 to L5. Inter-reader reliability for continuous variables was assessed by intraclass correlation coefficients. RESULTS:We evaluated 210 patients (103 [49.0%] men). The osteoporotic vertebral compression fractures group was older and had lower BMI and smaller psoas major and paraspinal muscle areas than the group without vertebral compression fractures (p < 0.001). The mean apparent diffusion coefficient was weakly correlated with paraspinal muscle area in the osteoporotic vertebral compression fractures group. The intraclass correlation coefficient value was 0.83, and the intraclass correlation coefficients of the psoas major and paraspinal muscles were 0.94 and 0.97, respectively. Multivariate analysis revealed that decreased psoas major and paraspinal muscle areas and increased mean apparent diffusion coefficient values were significantly associated with the presence of osteoporotic vertebral compression fractures (all p < 0.05). Psoas major and paraspinal muscle areas showed relatively high predictive accuracy (57%, 61%). CONCLUSION:Psoas major and paraspinal muscle areas at the L3 level and the mean apparent diffusion coefficient value of non-fractured vertebrae from the Th12 to L5 level were associated with osteoporotic vertebral compression fractures. This may contribute to detecting the potential risk of healthy individuals developing osteoporotic vertebral compression fractures.
10.1007/s00256-023-04461-x
Musculoskeletal rehabilitation in osteoporosis: a review.
Pfeifer Michael,Sinaki Mehrsheed,Geusens Piet,Boonen Steven,Preisinger Elisabeth,Minne Helmut W,
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
Measures of musculoskeletal rehabilitation play an integral part in the management of patients with increased fracture risk because of osteoporosis or extraskeletal risk factors. This article delineates current scientific evidence concerning nonpharmacologic approaches that are used in conjunction with pharmacotherapy for prevention and management of osteoporosis. Fractures caused by osteoporotic fragility may be prevented with multidisciplinary intervention programs, including education, environmental modifications, aids, and implementation of individually tailored exercise programs, which are proved to reduce falls and fall-related injuries. In addition, strengthening of the paraspinal muscles may not only maintain BMD but also reduce the risk of vertebral fractures. Given the strong interaction between osteoporosis and falls, selection of patients for prevention of fracture should be based on bone-related factors and on risk factors for falls. Rehabilitation after vertebral fracture includes proprioceptive dynamic posture training, which decreases kyphotic posturing through recruitment of back extensors and thus reduces pain, improves mobility, and leads to a better quality of life. A newly developed orthosis increases back extensor strength and decreases body sway as a risk factor for falls and fall-related fractures. Hip fractures may be prevented by hip protectors, and exercise programs can improve strength and mobility in patients with hip fracture. So far, there is no conclusive evidence that coordinated multidisciplinary inpatient rehabilitation is more effective than conventional hospital care with no rehabilitation professionals involved for older patients with hip fracture. Further studies are needed to evaluate the effect of combined bone- and fall-directed strategies in patients with osteoporosis and an increased propensity to falls.
10.1359/JBMR.040507
The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test.
Hebert Jeffrey J,Koppenhaver Shane L,Teyhen Deydre S,Walker Bruce F,Fritz Julie M
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:The lumbar multifidus muscle provides an important contribution to lumbar spine stability, and the restoration of lumbar multifidus function is a frequent goal of rehabilitation. Currently, there are no reliable and valid physical examination procedures available to assess lumbar multifidus function among patients with low back pain. PURPOSE:To examine the inter-rater reliability and concurrent validity of the multifidus lift test (MLT) to identify lumbar multifidus dysfunction among patients with low back pain. STUDY DESIGN/SETTING:A cross-sectional analysis of reliability and concurrent validity performed in a university outpatient research facility. PATIENT SAMPLE:Thirty-two persons aged 18 to 60 years with current low back pain and a minimum modified Oswestry disability score of 20%. Study participants were excluded if they reported a history of lumbar spine surgery, lumbar radiculopathy, medical red flags, osteoporosis, or had recently been treated with spinal manipulation or trunk stabilization exercises. OUTCOME MEASURES:Concurrent measures of lumbar multifidus muscle function at the L4-L5 and L5-S1 levels were obtained with the MLT (index test) and real-time ultrasound imaging (reference standard). METHODS:The inter-rater reliability of the MLT was examined by measuring the level of agreement between two blinded examiners. Concurrent validity of the MLT was investigated by comparing clinicians' judgments with real-time ultrasound imaging measures of lumbar multifidus function. RESULTS:Inter-rater reliability of the MLT was substantial to excellent (κ=0.75 to 0.81, p≤.01) and free from errors of bias and prevalence. When performed at L4-L5 or L5-S1, the MLT demonstrated evidence of concurrent validity through its relationship with the reference standard results at L4-L5 (rbis=0.59-0.73, p≤.01). The MLT generally failed to demonstrate a relationship with the reference standard results from the L5-S1 level. CONCLUSIONS:Our results provide preliminary evidence supporting the reliability and validity of the MLT to assess lumbar multifidus function at the L4-L5 spinal level. Additional research examining the measurement properties and utility of this test should be undertaken before confident implementation with patients.
10.1016/j.spinee.2013.08.056
Impact of Multifidus Muscle Atrophy on the Occurrence of Secondary Symptomatic Adjacent Osteoporotic Vertebral Compression Fractures.
Calcified tissue international
To assess the potential influence of multifidus atrophy and fatty degeneration on the incidence of adjacent vertebral compression fractures within one year after the index fracture. In a retrospective cohort study, patients who underwent surgery for an OVCF were identified and baseline characteristics, fracture patterns and the occurrence of secondary adjacent fractures within one year were obtained by chart review. Multifidus muscle atrophy and fatty degeneration were determined on preoperative MRI or CT scans. In this analysis of 191 patients (mean age 77 years, SD 8, 116 female), OF type 3 was the most common type of OVCF (49.2%). Symptomatic adjacent OVCFs within one year after index fracture were observed in 23/191 patients (12%) at mean 12, SD 12 weeks (range 1-42 weeks) postoperatively. The mean multifidus muscle area was 264, SD 53 mm in patients with an adjacent vertebral fracture and 271, SD 92 mm in patients without a secondary fracture (p = 0.755). Mean multifidus fatty infiltration was graded Goutallier 2.2, SD 0.6 in patients with an adjacent fracture and Goutallier 2.2, SD 0.7 in patients without an adjacent fracture (p = 0.694). Pre-existing medication with corticosteroids was associated with the occurrence of an adjacent fracture (p = 0.006). Multifidus area and multifidus fatty infiltration had no significant effect on the occurrence of adjacent vertebral fractures within one year after the index fracture. Patients with a pre-existing medication with corticosteroids were more likely to sustain an adjacent fracture.
10.1007/s00223-021-00925-1
The association of reduced bone density with paraspinal muscle atrophy and adiposetissue in geriatric patients: a cross-sectional CT study
Ekin Elif Evrim,Altunrende Muhittin Emre
Turkish journal of medical sciences
Background/aim:The aim of the study is to examine the relationship among bone density, adipose tissue, and muscle mass withabdominal CT in geriatric patients. Materials and methods:The study is a retrospective cohort study of patients 65 years and over who underwent abdominal CT for anyreason between October 2017 and July 2018. Third lumbar vertebra density, fatty degeneration of the paraspinal muscle, subcutaneousadipose tissue, and mesenteric adipose tissue ratio were evaluated. Results:A total of 312 patients, 144 females and 168 males, were included in the study. Reduced bone density was found in 237 (76%)patients. Reduced bone density and muscle atrophy was more frequent in females (P < 0.001). Muscle atrophy was found to occur5.7 times more frequently in cases of reduced bone density (OR, 95% CI = 5.74 (3.27–10.09), P < 0.001). There was no significantrelationship found between reduced bone density and subcutaneous adipose tissue thickness or mesenteric adipose tissue ratio (P =0.073, P = 0.939, respectively). Conclusion:In the geriatric age group, reduced bone density and muscle atrophy were quite common and were significantly morefrequent in women. Furthermore, a strong association between reduced bone density and muscle atrophy was found. No relationshipwas found between reduced bone density and subcutaneous adipose tissue thickness–mesenteric adipose ratio.
10.3906/sag-1809-48
Prediction of Subsequent Vertebral Fracture After Acute Osteoporotic Fractures from Clinical and Paraspinal Muscle Features.
Calcified tissue international
To construct a nomogram based on clinical factors and paraspinal muscle features to predict vertebral fractures occurring after acute osteoporotic vertebral compression fracture (OVCF). We retrospectively enrolled 307 patients with acute OVCF between January 2013 and August 2022, and performed magnetic resonance imaging of the L3/4 and L4/5 intervertebral discs (IVDs) to estimate the cross-sectional area (CSA) and degree of fatty infiltration (FI) of the paraspinal muscles. We also collected clinical and radiographic data. We used univariable and multivariable Cox proportional hazards models to identify factors that should be included in the predictive nomogram. Post-OVCF vertebral fracture occurred within 3, 12, and 24 months in 33, 69, and 98 out of the 307 patients (10.8%, 22.5%, and 31.9%, respectively). Multivariate analysis revealed that this event was associated with percutaneous vertebroplasty treatment, higher FI at the L3/4 IVD levels of the psoas muscle, and lower relative CSA of functional muscle at the L4/5 IVD levels of the multifidus muscle. Area under the curve values for subsequent vertebral fracture at 3, 12, and 24 months were 0.711, 0.724, and 0.737, respectively, indicating remarkable accuracy of the nomogram. We developed a model for predicting post-OVCF vertebral fracture from diagnostic information about prescribed treatment, FI at the L3/4 IVD levels of the psoas muscle, and relative CSA of functional muscle at the L4/5 IVD levels of the multifidus muscle. This model could facilitate personalized predictions and preventive strategies.
10.1007/s00223-024-01209-0
Relationship between oseteoporosis with fatty infiltration of paraspinal muscles based on QCT examination.
Journal of bone and mineral metabolism
INTRODUCTION:To investigate the correlation between paraspinal muscles features and osteoporosis in lumbar spine. MATERIALS AND METHODS:A total of 367 subjects who underwent quantitative computed tomography (QCT) examination were enrolled in this study. QCT pro workstation was used to obtain the mean bone mineral density (BMD) of the lower lumbar spine. Fat fraction (FF) and cross-section area (CSA) of the paraspinal muscles at the corresponding levels were measured. All participants were divided into normal, osteopenia, and osteoporosis groups. One-way ANOVA and independent samples t tests were performed to compare differences between groups. Pearson and Spearman correlation coefficients and partial correlation analysis after controlling for confounding factors were used to analyze the correlation between BMD and paraspinal muscles measurements. RESULTS:Among the 367 participants included, 116 were in the normal group, 130 in the osteopenia group and 121 in the osteoporosis group. There were significant differences among the three groups for the mean and multifidus FF. BMD showed negative correlations with the FF of the paraspinal muscles. Multifidus and mean FF showed the best correlation (r = - 0.654, - 0.777). There were also significant differences in the mean and multifidus FF between different age groups, while after controlling for confounding factors, there was no correlation between age and FF of the paraspinal muscles. CONCLUSION:This preliminary study demonstrated the association of BMD with fatty infiltration of paraspinal muscles. Different muscles might have specific effects in different sex and age groups.
10.1007/s00774-022-01311-z
Computed Tomography Measured Psoas Cross Sectional Area Is Associated With Bone Mineral Density Measured by Dual Energy X-Ray Absorptiometry.
Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry
Dual-energy X-ray absorptiometry (DEXA) is the gold standard for osteoporosis screening and diagnosis. However, abdominal conventional computed tomography (CT) scan is widely available and multiple studies validated its use as a screening tool for osteoporosis compared to DEXA. The aim of this study was to determine the reliability of measuring core muscle size at the L3-L4 intervertebral disk space and estimate the relationship between core muscle size and bone mineral density (BMD) measured by DEXA. Retrospective chart review was performed on patients who underwent a DEXA scan for osteoporosis and a conventional abdominal CT scan within one-year apart. Total cross-sectional area (CSA) and Hounsfield Unit (HU) density of core muscles (psoas, paraspinal, and abdominal wall muscles) were measured. The association between psoas, paraspinal, abdominal, and central muscle CSA and Bone Mineral density (BMD) at L3, L4, total Lumbar Spine (LS), and right (R) and left (L) hip was estimated in crude and adjusted for age and sex linear regression models. Sixty patients (37 females, 23 males) met the inclusion criteria. The average interval between DEXA and abdominal CT scans was 3.6 months (range 0.1-10.2). Psoas muscle density was significantly positively associated with R hip BMD in both crude and adjusted models (β = 20.2, p = 0.03; β = 18.5, p = 0.01). We found a significant positive linear association between psoas muscle CSA and HU density with BMD of LS, R, and L hip in both crude and adjusted models. The strongest significant positive linear association was observed between total abdominal CSA and R hip BMD in crude and age and sex adjusted (ß = 85.3, p = 0.01; ß = 63.9, p = 0.02, respectively). CT scans obtained for various clinical indications can provide valuable information regarding BMD. This is the first study investigating association between BMD with central muscle density and CSA, and it demonstrated their significant positive the association.
10.1016/j.jocd.2022.04.001
Lumbar posterior group muscle degeneration: Influencing factors of adjacent vertebral body re-fracture after percutaneous vertebroplasty.
Frontiers in medicine
Objective:The purpose of the study was to explore the influencing factors of adjacent vertebral re-fracture after percutaneous vertebroplasty (PVP) for osteoporosis vertebral compression fractures (OVCFs). Methods:We retrospectively analyzed the clinical data of 55 patients with adjacent vertebral re-fracture after PVP operation for OVCFs in our hospital from January 2016 to June 2019, they were followed up for 1 year and included in the fracture group. According to the same inclusion and exclusion criteria, we collected the clinical data of 55 patients with OVCFs without adjacent vertebral re-fracture after PVP in the same period and included them in the non-fracture group. We performed univariate and multivariate logistic regression analysis on the influencing factors of adjacent vertebral re-fracture in patients with OVCFs after PVP. Results:There were significant differences in body mass index (BMI), bone mineral density (BMD) -value, amount of bone cement injected, bone cement leakage, history of glucocorticoid use, cross-sectional area (CSA), cross-sectional area asymmetry (CSAA), fat infiltration rate (FIR), and fat infiltration rate asymmetry (FIRA) of lumbar posterior group muscles [multifidus (MF) and erector spinae (ES)] between the two groups ( < 0.05). There was no significant difference in sex, age, or time from the first fracture to operation, the CAS, CSAA, FIR, and FIRA of psoas major (PS) between the two groups ( > 0.05). Multivariate logistic regression showed that a higher dose of bone cement, greater CSAA and FIR of multifidus, and higher CSAA of erector spinae were independent risk factors for recurrent fractures of adjacent vertebrae after PVP. Conclusion:There are many risk factors for recurrent vertebral fracture after PVP in patients with OVCFs, and degeneration of paraspinal muscles (especially posterior lumbar muscles) may be one of the risks.
10.3389/fmed.2022.1078403
Paraspinal muscle control in people with osteoporotic vertebral fracture.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
The high risk of sustaining subsequent vertebral fractures after an initial fracture cannot be explained solely by low bone mass. Extra-osseous factors, such as neuromuscular characteristics may help to explain this clinical dilemma. Elderly women with (n = 11) and without (n = 14) osteoporotic vertebral fractures performed rapid shoulder flexion to perturb the trunk while standing on a flat and short base. Neuromuscular postural responses of the paraspinal muscles at T6 and T12, and deep lumbar multifidus at L4 were recorded using intramuscular electromyography (EMG). Both groups demonstrated bursts of EMG that were initiated either before or shortly after the onset of shoulder flexion (P < 0.05). Paraspinal and multifidus onset occurred earlier in the non-fracture group (50-0 ms before deltoid onset) compared to the fracture group (25 ms before and 25 ms after deltoid onset) in the flat base condition. In the short base condition, EMG amplitude increased significantly above baseline earlier in the non-fracture group (75-25 ms before deltoid onset) compared to the fracture group (25-0 ms before deltoid onset) at T6 and T12; yet multifidus EMG increased above baseline earlier in the fracture group (50-25 ms before deltoid) compared to the non-fracture group (25-0 ms before deltoid). Time to reach maximum amplitude was shorter in the fracture group. Hypothetically, the longer time to initiate a postural response and shorter time to reach maximum amplitude in the fracture group may indicate a neuromuscular contribution towards subsequent fracture aetiology. This response could also be an adaptive characteristic of the central nervous system to minimise vertebral loading time.
10.1007/s00586-006-0276-8
Fatty infiltration of the multifidus muscle independently increases osteoporotic vertebral compression fracture risk.
BMC musculoskeletal disorders
BACKGROUND:Vertebral compression fractures decrease daily life activities and increase economic and social burdens. Aging decreases bone mineral density (BMD), which increases the incidence of osteoporotic vertebral compression fractures (OVCFs). However, factors other than BMD can affect OVCFs. Sarcopenia has been a noticeable factor in the aging health problem. Sarcopenia, which involves a decrease in the quality of the back muscles, influences OVCFs. Therefore, this study aimed to evaluate the influence of the quality of the multifidus muscle on OVCFs. METHODS:We retrospectively studied patients aged 60 years and older who underwent concomitant lumbar MRI and BMD in the university hospital database, with no history of structurally affecting the lumbar spine. We first divided the recruited people into a control group and a fracture group according to the presence or absence of OVCFs, and further divided the fracture group into an osteoporosis BMD group and an osteopenia BMD group based on the BMD T-score of -2.5. Using images of lumbar spine MRI, the cross-sectional area and percentage of muscle fiber (PMF) of the multifidus muscle were obtained. RESULTS:We included 120 patients who had visited the university hospital, with 45 participants in the control group and 75 in the fracture group (osteopenia BMD: 41, osteoporosis BMD: 34). Age, BMD, and the psoas index significantly differed between the control and fracture groups. The mean cross-sectional area (CSA) of multifidus muscles measured at L4-5 and L5-S1, respectively, did not differ among the control, P-BMD, and O-BMD groups. On the other hand, the PMF measured at L4-5 and L5-S1 showed a significant difference among the three groups, and the value of the fracture group was lower than that of the control group. Logistic regression analysis showed that the PMF value, not the CSA, of the multifidus muscle at L4-5 and L5-S1 affected the risk of OVCFs, with and without adjusting for other significant factors. CONCLUSIONS:High percentage of fatty infiltration of the multifidus muscle increases the spinal fracture risk. Therefore, preserving the quality of the spinal muscle and bone density is essential for preventing OVCFs.
10.1186/s12891-023-06640-2
Prediction of proximal junctional kyphosis and failure after corrective surgery for adult spinal deformity: an MRI-based model combining bone and paraspinal muscle quality metrics.
The spine journal : official journal of the North American Spine Society
BACKGROUND:Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common complications observed after adult spinal deformity (ASD) surgery and major cause for unplanned reoperations. In addition to spinal alignment, osteoporosis and paraspinal muscle (PSM) degeneration are reportedly indispensable factors that account for PJK/PJF. PURPOSE:To investigate the utility of the preoperative risk assessment model using MRI-based skeletomuscular metrics in predicting PJK and/or PJF(PJK/PJF) after ASD correction. STUDY DESIGN:Retrospective case-control study. PATIENT SAMPLE:Consecutive series of 149 patients at a single academic institution. OUTCOME MEASURES:MRI-based measurements of vertebral bone quality at upper instrumented vertebra (VBQ-U) score and fat infiltration rate (FI%) of paraspinal muscle (PSM). METHODS:We performed a retrospective analysis of patients with ASD who underwent ≥5-segment fusion. The vertebral bone quality (VBQ) scoring system was used to assess the bone quality. The PSM quality including FI% and cross-sectional area (CSA) was evaluated. Multivariate logistic regression was performed to determine potential risk factors of PJK/PJF. RESULTS:Of 149 patients who underwent ASD surgery, PJK/PJF was found in 45(30.2%). Mean VBQ-U scores were 3.45±0.64 and 3.00±0.56 for patients with and without PJK/PJF (p<.001). Mean FI% of PSM was 27.9±12.8 and 20.7±13.3 for patients with and without PJK/PJF (p<.001). On multivariate analysis, the VBQ-U score and FI% of PSM were significant independent predictors of PJK/PJF. The AUC for the novel risk assessment model is 0.806, with a predictive accuracy of 86.7%. CONCLUSION:In patients undergoing ASD correction, paraspinal muscle and vertebral bone quality significantly outweigh radiographic alignment parameters in predicting PJK/PJF. The MRI-based risk assessment model offers a valuable tool for early assessing individualized risk for PJK/PJF.
10.1016/j.spinee.2024.08.010
Lumbar muscle volume in postmenopausal women with osteoporotic compression fractures: quantitative measurement using MRI.
Huang Chi Wen C,Tseng Ing-Jy,Yang Shao-Wei,Lin Yen-Kuang,Chan Wing P
European radiology
OBJECTIVE:To investigate the relationship between paraspinal and psoas muscle volumes and acute osteoporotic or low-bone-mass compression fractures of the lumbar spine in postmenopausal women. METHODS:Patient data were retrieved retrospectively for postmenopausal women with L-spine magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry showing osteoporosis/low bone mass. Group 1 comprised eight women aged 60-80 years with MRI showing a single acute compression fracture. The age-matched group 2a (N = 12) and younger group 2b (N = 12) comprised of women whose MRIs showed no fractures. Cross-sectional MRIs of the paraspinal and psoas muscles and intramuscular fat volume for each muscle group were measured. Operator repeatability and reproducibility were obtained. RESULTS:Group 1 showed significantly smaller lean muscle volume for all muscle groups at L5/S1. Intramuscular fat volume was also smaller in most muscle groups in group 1, though only reaching statistical significance at variable muscle groups and levels. Measurements show both good intrarater repeatability and interrater reproducibility of lean muscle volume estimations (intraclass correlation coefficient (ICC), 0.999 for rater A and 0.997 for rater B; Cronbach's alpha 0.995) and intramuscular fat volume estimations (ICC, 0.995 for rater A and 0.982 for rater B; Cronbach's alpha was 0.981). CONCLUSIONS:This study provides the first quantitative evidence that compression fractures in postmenopausal women with underlying osteoporosis/low bone mass are associated with less paraspinal and psoas muscle volumes. Further longitudinal studies with larger cohorts are needed to verify this relationship. KEY POINTS:• The risk of osteoporotic compression fractures is higher in older women with smaller paraspinal muscle volume. • Older women show smaller paraspinal muscle volume and more intramuscular fat compared to younger controls.
10.1007/s00330-019-06034-w
Risk factors for residual back pain following percutaneous vertebral augmentation: the importance of paraspinal muscle fatty degeneration.
International orthopaedics
PURPOSE:Residual back pain (RBP) after percutaneous vertebral augmentation (PVA) still exists considerable, and it even affects daily life due to moderate or severe back pain. A variety of risk factors have been previously identified for developing residual back pain. However, there are conflicting reports regarding the association between sarcopenia and residual back pain. As such, the aim of this study was to investigate whether paraspinal muscle fatty degeneration is a predictor of residual back pain. METHODS:We retrospectively reviewed the medical records of patients with single-segment OVCF who underwent PVA from January 2016 to January 2022. Patients were divided into RBP group (86 patients) and control group (790 patients) according to whether the visual analog scale (VAS) score ≥ 4. The clinical and radiological data were analyzed. Paraspinal musculature fatty degeneration was measured using the Goutallier classification system (GCS) at the L4 - 5 intervertebral disc level. Univariate and multivariate logistic regression analyses were performed to identify risk factors. RESULTS:The results of multivariate logistical regression analysis revealed that posterior fascia injury (odds ratio (OR) = 5.23; 95% confidence interval (CI) 3.12-5.50; P < 0.001), as regards paraspinal muscle fatty degeneration, including Goutallier grading (OR = 12.23; 95% CI 7.81-23.41; P < 0.001), fCSA (OR = 3.06; 95% CI 1.63-6.84; P = 0.002), fCSA/CSA (%) (OR = 14.38; 95% CI 8.80-26.29; P < 0.001), and facet joint violation (OR = 8.54; 95% CI 6.35-15.71; P < 0.001) were identified as independent risk factors for RBP. CONCLUSIONS:Posterior fascia injury, paraspinal muscle fatty degeneration, and facet joint violation were identified as independent risk factors for RBP, with paraspinal muscle fatty degeneration playing an important role.
10.1007/s00264-023-05809-7
Risk factors of domino osteoporotic vertebral fractures is severe paraspinal muscle fatty degeneration.
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:Domino osteoporotic vertebral fractures (OVFs) involve multiple OVFs occurring simultaneously or sequentially, before healing of the initial OVFs. However, the risk factors and long-term clinical outcomes of domino OVFs are unclear. PURPOSE:To identify the risk factors associated with domino OVFs and to assess their impact on patients' quality of life (QOL). STUDY DESIGN/SETTING:Multicenter prospective observational cohort study. PATIENT SAMPLE:Patients (n = 190) treated conservatively for acute OVFs in 8 hospitals with 12-month follow-up. OUTCOME MEASURES:Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Multivariate analyses were performed to identify risk factors for domino OVFs. METHODS:All patients underwent magnetic resonance imaging (MRI) at 3 months to detect subsequent domino OVFs. Domino OVF group included initial domino OVFs (multiple acute OVFs at baseline) and subsequent domino OVFs at 3 months. Paraspinal muscle assessment was performed using the lumbar indentation value and Goutallier classification. Patient characteristics, bone quality, paravertebral muscle degeneration, nutritional status, radiographic parameters, and QOL scores were compared between the nondomino and domino OVF groups. RESULTS:We evaluated 50 (26.3%) patients with domino OVFs (34 with initial domino OVFs; 20 with subsequent domino OVFs). Walking ability was poorer in the domino than in the nondomino OVF group, from baseline to the 12 months follow-up. Groups with 3 or more adjacent domino OVFs showed worse VAS and ODI scores. Multivariate logistic regression analysis revealed that severe fatty degeneration of the paraspinal muscle was an independent risk factor for domino OVFs. CONCLUSIONS:Severe paraspinal muscle fatty degeneration is an independent risk factor for domino OVFs. Our study showed that the quality, rather than the quantity, of paraspinal muscles had an impact on domino OVFs. Early assessment of fatty degeneration in the paraspinal muscles is essential for predicting the development of domino OVFs.
10.1016/j.spinee.2024.08.009
Assessment of paraspinal muscle characteristics, lumbar BMD, and their associations in routine multi-detector CT of patients with and without osteoporotic vertebral fractures.
Sollmann Nico,Franz Daniela,Burian Egon,Löffler Maximilian T,Probst Monika,Gersing Alexandra,Schwaiger Benedikt,Pfeiffer Daniela,Kirschke Jan S,Baum Thomas,Riederer Isabelle
European journal of radiology
PURPOSE:To investigate paraspinal muscle characteristics and lumbar bone mineral density (BMD) and their associations in routine abdominal multi-detector computed tomography (MDCT) as well as the impact of osteoporotic vertebral fractures on such associations. METHOD:116 patients (69.7 ± 8.1 years, 72 males) who underwent routine abdominal MDCT (oncological staging and/or follow-up for tumor recurrence) were retrospectively included and assigned to a fracture and control group (age- and gender-matched), depending on the presence or absence of lumbar osteoporotic vertebral fractures. BMD was derived from lumbar vertebrae using a conversion equation, and the cross-sectional area (CSA), CSA ratio (CSA psoas muscles divided by CSA erector spinae muscles), and muscle attenuation were measured for the psoas and erector spinae muscles at the levels L2 and L4/5 without dedicated software. RESULTS:Males showed significantly higher BMD, CSA, and CSA ratios at the levels L2 and L4/5, while females had decreased erector spinae muscle attenuation at L4/5 (p < 0.05). No significant differences between patients with versus without fractures were observed except for BMD (68.5 ± 37.2 mg/ml vs. 91.4 ± 26.8 mg/ml; p < 0.01). Age-adjusted partial correlation testing revealed significant correlations of BMD and the CSA ratio at level L4/5 (r = 0.20; p = 0.03), but not with muscle attenuation (p > 0.05). CONCLUSIONS:Paraspinal muscle characteristics and lumbar BMD can be assessed seamlessly in routine abdominal MDCT without dedicated software. There are level-dependent interactions between paraspinal muscle characteristics as well as lumbar BMD. Vertebral fracture status was independent of paraspinal muscle characteristics.
10.1016/j.ejrad.2020.108867
Exploring the interplay between paraspinal muscular status and bone health in osteoporosis and fracture risk: a comprehensive literature review on computed tomography (CT) and magnetic resonance imaging (MRI) studies.
Quantitative imaging in medicine and surgery
Background and Objective:Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine are fundamental non-invasive tools to investigate the status of the bone and soft tissue in vivo. A novel and promising approach is to investigate the quality and quantity of paraspinal muscles even beyond the clinical question. The aim of the present review is to summarize current evidence on CT and MRI about the relationship between paraspinal muscular status and bone health in osteoporosis (OP) and fracture risk. Methods:Literature research was carried out on September 2023 using PubMed, Scopus, and Cochrane databases. Key Content and Findings:Research investigating the intricate interplay between musculature and bone health reveals that degenerating paraspinal muscles, characterized by shrinking and fatty infiltration, are associated with lower bone mineral density (BMD) and the development of OP. Additionally, research indicates that weaker paraspinal muscles are linked to a higher risk of fractures, including those at the spine. Conclusions:The findings suggest that paraspinal muscle health may be a significant factor in identifying individuals at risk for OP and fractures. Further investigation is needed to explore the potential of paraspinal muscles in preventing these conditions.
10.21037/qims-23-1770
Can paraspinal muscle degeneration be a reason for refractures after percutaneous kyphoplasty? A magnetic resonance imaging observation.
Zhao He,He Yan,Yang Jun-Song,Bao Wei,Chen Jian,Liu Ji-Jun,Li Qing-Da,Liu Peng,Qian Bing,Zhao Yuan-Ting,Hao Ding-Jun
Journal of orthopaedic surgery and research
BACKGROUND:Vertebral augmentation (VA) techniques are used to treat acute osteoporotic vertebral compression fractures (OVCFs). However, the incidence of recurrent vertebral fractures after VA is controversial. Various factors have been discussed in the literature, but no convincing study on the quality of paraspinal muscles has been reported. The purposes of this study were to evaluate the changes in paraspinal muscles and discuss the relationship between paraspinal muscle degeneration and vertebral refractures after percutaneous kyphoplasty (PKP). METHODS:This retrospective study was conducted in patients who underwent PKP for an initial OVCF between July 2017 and August 2018. Patients were followed up and categorized in the refractured or non-refractured group. A final magnetic resonance imaging (MRI) scan and a preoperative MRI scan were used to determine the measurements. The paraspinal muscles at the mid-height level of the initial fractured vertebral body were measured using regions of interest (ROIs), including the cross-sectional area (CSA) and signal intensity (SI). The changes in the observed data were compared between the groups using rank-sum tests. RESULTS:Overall, 92 patients were enrolled in the study; 33 of them sustained vertebral refractures during the follow-up and the other 59 patients did not. There were no significant differences in terms of sex, age, preoperative bone mineral density, and body mass index between the groups (all, P > 0.05). The refractured group had a significantly higher decrease in the ROI-CSA and CSA/SI, and a higher increase in ROI-SI, compared with the preoperative data (all, P < 0.05). CONCLUSIONS:The quality of paraspinal muscles significantly decreased in patients with new OVCFs after PKP. This brings a new perspective to the study of postoperative recurrent fractures; patients and physicians need to pay more attention to the efficacy of bed rest and bracing.
10.1186/s13018-021-02623-y
Correlation Between Bone Mineral Density (BMD) and Paraspinal Muscle Fat Infiltration Based on QCT: A Cross-Sectional Study.
Calcified tissue international
To investigate the correlation between fatty infiltration of the paraspinal muscle and bone mineral density (BMD). In total, 367 subjects (182 men and 185 women) who underwent quantitative computed tomography (QCT) examination were enrolled in this study. A QCT Pro workstation was used to obtain the mean BMD of the lower lumbar spine (L3, L4, L5) and fat fraction (FF) of the paraspinal muscle (psoas and erector spinae) at the corresponding levels. The patient's age, sex, body mass index, number of previous vertebral fractures, physical activity level, and visual analog scale (VAS) score for lower back pain were recorded. For categorical variables, one-way ANOVA and independent-samples t tests were performed. Spearman and Pearson correlation coefficients were used to analyze the correlations among continuous variables. Influential factors were analyzed by multivariate linear regression analysis. Regarding the mean paraspinal muscle FF, there were significant differences between the different vertebral fracture groups (P < 0.05). Age and VAS score showed a positive correlation with the mean paraspinal muscle FF (r = 0.389, 0.454). BMD showed a negative correlation with the mean paraspinal muscle FF (r = - 0.721). The multiple linear regression analysis showed that vertebral fracture (β = 0.851, P = 0.021) and BMD (β = - 4.341, P = 0.004) were independent factors of the mean paraspinal muscle FF. This study demonstrated that an advanced age, a greater VAS score, a higher number of vertebral fractures, and a lower BMD may be associated with more severe fatty infiltration of the paraspinal muscle.
10.1007/s00223-022-00944-6
Low paraspinal lean muscle mass is an independent predictor of adjacent vertebral compression fractures after percutaneous kyphoplasty: A propensity score-matched case-control study.
Frontiers in surgery
Background:To investigate the relationship between paraspinal lean muscle mass and adjacent vertebral compression fracture (AVCF) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). Methods:The data of 272 patients who underwent two consecutive single-level PKP in our hospital from January 2017 to December 2019 were collected. 42 patients who met the inclusion and exclusion criteria were selected as AVCF group, and 42 propensity score-matched patients were selected as control group. There were 10 males and 32 females in each group; the ages were 75.55 ± 5.76 years and 75.60 ± 5.87 years, respectively. All patients underwent preoperative lumbar MRI. The total cross-sectional area (CSA), functional cross-sectional area (FCSA), cross-sectional area of vertebra index (CSA-VI), functional cross-sectional area of vertebra index (FCSA-VI) of the multifidus (MF), erector spinae (ES), psoas (PS), and paravertebral muscles (PVM) were measured. Other related parameters included preoperative bone mineral density (BMD), kyphotic angle (KA), anterior-to-posterior body height ratio (AP ratio), vertebral height restoration, and cement leakage into the disc. Logistic regression analysis was performed to find independent risk factors for AVCF using the parameters that were statistically significant in univariate analysis. Results:At L3 and L4 levels, the mean CSA, FCSA, and FCSA-VI of MF, ES, PVM and PS were significantly lower in the AVCF group. DeLong test indicated that the AUC of ES (0.806 vs. 0.900) and PVM (0.861 vs. 0.941) of FCSA-VI at L4 level were significantly greater than L3 level. In the AVCF group, patients had a significantly lower BMD (93.55 ± 14.99 HU vs. 106.31 ± 10.95 HU), a greater preoperative KA (16.02° ± 17.36° vs. 12.87° ± 6.58°), and a greater vertebral height restoration rate (20.4% ± 8.1% vs. 16.4% ± 10.0%, = 0.026). Logistic regression analysis showed that PVM with lower FCSA-VI at L4 level (OR 0.830; 95% CI 0.760-0.906) and lower BMD (OR 0.928; 95% CI 0.891-0.966) were independent risk factors for AVCF after PKP. Conclusions:Low paraspinal lean muscle mass is an independent risk factor for AVCF after PKP. Surgeons should pay attention to evaluate the status of paraspinal muscle preoperatively. Postoperative reasonable nutrition, standardized anti-osteoporosis treatment, and back muscle exercise could reduce the incidence of AVCF.
10.3389/fsurg.2022.965332
The association between lumbar paraspinal muscle functional cross-sectional area on MRI and regional volumetric bone mineral density measured by quantitative computed tomography.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
Osteosarcopenia is a common condition among elderly and postmenopausal female patients. Site-specific bone mineral density is more predictive of bone-related complications. Few studies have investigated muscle-bone associations. Our results demonstrated that in women, significant positive associations between paraspinal muscles FCSA and vBMD exist at different lumbosacral levels. These regional differences should be considered when interpreting bone-muscle associations in the lumbar spine. INTRODUCTION:There is increasing evidence between bone and muscle volume associations. Previous studies have demonstrated comorbidity between osteoporosis and sarcopenia. Recent studies showed that sarcopenic subjects had a fourfold higher risk of concomitant osteoporosis compared to non-sarcopenic individuals. Although site-specific bone mineral density (BMD) assessments were reported to be more predictive of bone-related complications after spinal fusions than BMD assessments in general, there are few studies that have investigated level-specific bone-muscle interactions. The aim of this study is to investigate the associations between muscle functional cross-sectional area (FCSA) on magnetic resonance imaging (MRI) and site-specific quantitative computed tomography (QCT) volumetric bone mineral density (vBMD) in the lumbosacral region among spine surgery patients. METHODS:We retrospectively reviewed a prospective institutional database of posterior lumbar fusion patients. Patients with available MRI undergoing posterior lumbar fusion were included. Muscle measurements and FCSA were conducted and calculated utilizing a manual segmentation and custom-written program at the superior endplate of the L3-L5 vertebrae level. vBMD measurements were performed and calculated utilizing a QCT pro software at L1-L2 levels and bilateral sacral ala. We stratified by sex for all analyses. RESULTS:A total of 105 patients (mean age 61.5 years and 52.4% females) were included. We found that female patients had statistically significant lower muscle FCSA than male patients. After adjusting for age and body mass index (BMI), there were statistically significant positive associations between L1-L2 and S1 vBMD with L3 psoas FCSA as well as sacral ala vBMD with L3 posterior paraspinal and L5 psoas FCSA. These associations were not found in males. CONCLUSIONS:Our results demonstrated that in women, significant positive associations between the psoas and posterior paraspinal muscle FCSA and vBMD exist in different lumbosacral levels, which are independent of age and BMI. These regional differences should be considered when interpreting bone and muscle associations in the lumbar spine.
10.1007/s00198-022-06430-x
The association between paraspinal muscle degeneration and osteoporotic vertebral compression fracture severity in postmenopausal women.
Journal of back and musculoskeletal rehabilitation
BACKGROUND:According to reports in the literature, osteoporotic vertebral compression fracture (OVCF) is associated with paraspinal muscle degeneration; however, the association between the severity of OVCF and paraspinal muscle degeneration is not clear. OBJECTIVE:The purpose of this study was to investigate the association between paraspinal muscle degeneration and OVCF severity in postmenopausal women. METHODS:Three hundred and seventy-six MRI images from 47 patients were collected and analyzed. Sagittal and axial coronal T2-weighted images were used to measure the fractured vertebra sagittal cross-sectional area (FSCSA), the adjacent normal vertebral body sagittal cross-sectional area (NSCSA), paraspinal muscle cross-sectional area (CSA), and the fat cross-sectional area (FCSA). The ratio of fractured vertebra compressed sagittal cross-sectional area (RCSA) and fatty infiltration ratio (FIR) was subsequently calculated. The formulas for RCSA and FIR calculations are as follows: RCSA = (NSCSA-FSCSA)/NSCSA; FIR = FCSA/CSA. RCSA and FIR represent the severity of OVCF and paraspinal muscle degeneration, respectively. RESULTS:The correlation between paraspinal muscle degeneration and OVCF severity was analyzed using the Pearson correlation, and multiple regression analysis was performed to explore related risk factors. OVCF severity was closely associated with paraspinal muscle degeneration (L3/4 FIR r= 0.704, P< 0.05; L4/5 FIR r= 0.578, P< 0.05; L5/S1 FIR r= 0.581, P< 0.05). Multiple regression analysis demonstrated that the risk factor for OVCF severity was L3/4 FIR (β= 0.421, P= 0.033). CONCLUSION:OVCF severity was associated with the FIR of paraspinal muscles, and L3/4 FIR was a predictive factor for OVCF severity in postmenopausal women.
10.3233/BMR-220059
Paraspinal muscle fatty degeneration as a predictor of progressive vertebral collapse in osteoporotic vertebral compression fractures.
Jeon Ikchan,Kim Sang Woo,Yu Dongwoo
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:Most osteoporotic vertebral compression fractures (OVCFs) are treated conservatively; however, in some patients, progressive vertebral body collapse leads to spinal deformity and cord compression. These complications are strongly associated with impaired performance activities of daily living and a poor quality of life. PURPOSE:To identify the role of the paraspinal muscle as a risk factor for progressive vertebral body collapse in patients with OVCF. STUDY DESIGN:This was a retrospective observational study. PATIENT SAMPLE:Fifty-five consecutive patients with OVCF who were treated conservatively from January 2018 to June 2020 in a single spine center and had a minimum follow-up of 6 months. OUTCOME MEASURES:A lateral plain radiograph in a neutral posture was taken when the patient was first diagnosed and at 1, 3, and 6 months after the first diagnosis. Vertebral height was measured at the point of maximal collapse of the affected vertebral body; vertebral collapse (%) was also measured. The cross-sectional area (CSA) and fatty degeneration of the paraspinal muscle were measured using the open-source software Image J. The visual analogue scale (VAS) scores were collected at the time of initial fracture diagnosis and at 1, 3, and 6 months. METHODS:The clinical and radiological data were analyzed. In the L4-5 intervertebral disc level, axial T2-weighted magnetic resonance imaging was used to measure the CSA and fatty degeneration of the paraspinal muscles. Correlation and multiple regression analyses were performed to analyze the risk factors associated with progressive vertebral body collapse. RESULTS:The vertebral collapse difference was strongly associated with paraspinal muscle fatty degeneration (r=0.684, p=.000) and body mass index (r=0.300, p=.026). Multiple linear regression analysis demonstrated that the risk factor for progression of vertebral collapse was paraspinal muscle fatty degeneration (β=0.724, p=.000). There was a statistically significant correlation between the progression in vertebral collapse and VAS score at 3 (r=0.402, p=.002) and 6 months (r=0.604, p=.000). CONCLUSIONS:In patients with OVCF, fatty degeneration of the paraspinal muscle was a predictive factor for progressive vertebral body collapse. This study suggests that more attention should be paid to patients with paraspinal sarcopenia among those with OVCFs.
10.1016/j.spinee.2021.07.020
Associations between Bone Mineral Density and Longitudinal Changes of Vertebral Bone Marrow and Paraspinal Muscle Composition Assessed Using MR-Based Proton Density Fat Fraction and T2* Maps in Patients with and without Osteoporosis.
Diagnostics (Basel, Switzerland)
Background: Proton-density fat fraction (PDFF) and T2* of the vertebrae, as well as the cross-sectional area (CSA) of the paraspinal musculature (PSM), have been suggested as biomarkers for bone fragility. The aim of this study was to longitudinally assess changes in PDFF, T2* and CSA of the PSM over 6 months in patients with and without osteoporosis. Methods: Opportunistic bone mineral density (BMD) measurements (BMD < 120 mg/cm3) were obtained from a CT acquired during the clinical routine work up in osteoporotic/osteopenic patients (n = 29, mean age 72.37 ± 10.12 years, 16 women). These patients were frequency-matched for age and sex to subjects with normal BMD values (n = 29). All study patients underwent 3T MR imaging at baseline and 6-month follow up, including spoiled gradient echo sequences for chemical shift encoding-based water-fat separation, from which T2* and PDFF values of the lumbar spine and the PSM were obtained. Moreover, the CSA of the PSM was assessed longitudinally. Changes in T2*, PDFF and CSA over 6 months were calculated for the vertebrae and PSM and associations with baseline BMD values were assessed. Results: The change in CSA of the PSM over 6 months was significantly lower in the osteoporotic/osteopenic group (−91.5 ± 311.7 mm2), compared to the non-osteoporotic group, in which the CSA increased (29.9 ± 164.0 mm2, p = 0.03). In a further analysis, patients with higher vertebral PDFF at baseline showed a significantly stronger increase in vertebral T2*, compared to those patients with lower vertebral PDFF at baseline (0.9 ± 1.6 ms vs. 0.0 ± 1.8 ms, p = 0.04). Moreover, patients with higher PSM PDFF at baseline showed a significantly stronger increase in vertebral T2*, compared to those patients with lower PSM PDFF at baseline (0.9 ± 2.0 ms vs. 0.0 ± 1.3 ms, p = 0.03). Conclusion: The PSM CSA decreased significantly longitudinally in patients with osteoporosis/osteopenia, compared to those without. Additionally, higher vertebral and PSM PDFF at baseline were associated with stronger changes in vertebral bone marrow T2*. Therefore, longitudinal PDFF and T2* mapping may be useful quantitative radiation-free tools for the assessment and prediction of muscle and bone health in patients with suspected osteoporosis/osteopenia.
10.3390/diagnostics12102467
Paraspinal muscle characteristics on MRI in degenerative lumbar spine with normal bone density, osteopenia and osteoporosis: a case-control study.
Han Gengyu,Zou Da,Liu Zexiang,Zhou Siyu,Li Wei,Gong Chunjie,Sun Zhuoran,Li Weishi
BMC musculoskeletal disorders
BACKGROUND:To investigate the difference of paraspinal muscles in patients with normal bone density, osteopenia and osteoporosis. METHODS:Patients undergoing surgery for lumbar spinal stenosis were included. Thirty-eight patients with osteoporosis were matched to patients with osteopenia and patients with normal bone density in a 1:1 manner according to WHO criteria. Dual-energy X-ray absorptiometry (DXA) scans and lumbar CT were performed preoperatively to measure the BMD of lumbar, femur and hip and HU values of L1-L4 respectively. The relative total cross-sectional area (rTCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured at L4-5 and L5-S level on preoperative MRI. RESULTS:Osteoporotic patients showed lower BMI, higher MF FI and higher ES FI when compared with normal bone density group (25.57 ± 3.71 vs 27.46 ± 3.11; 0.38 ± 0.1 vs 0.32 ± 0.08; 0.33 ± 0.1 vs 0.28 ± 0.08; all adjusted p < 0.05). Both the MF FI and ES FI were significantly correlated with lumbar T-score (r = - 0.223, p < 0.05; r = - 0.208, p < 0.05) and the averaged lumbar HU value (r = - 0.305, p < 0.01; r = - 0.239, p < 0.05). CONCLUSIONS:Osteoporosis and paraspinal muscle degeneration might interact with each other and coexist in patients with degenerative lumbar diseases. It is recommended that the paraspinal muscle degeneration should be considered simultaneously when finding a patient with low bone mass before surgery.
10.1186/s12891-022-05036-y
Paraspinal muscle endurance and morphology (PMEM) score: a new method for prediction of postoperative mechanical complications after lumbar fusion.
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:Although the relationships between paraspinal muscles and lumbar degenerative disorders have been acknowledged, paraspinal muscle evaluation has not been incorporated into clinical therapies. PURPOSE:We aimed to establish a novel paraspinal muscle endurance and morphology (PMEM) score to better predict mechanical complications after lumbar fusion. STUDY DESIGN:Prospective cohort study. PATIENT SAMPLE:A total of 212 patients undergoing posterior lumbar interbody fusion with at least 1 year of follow-up were finally included. OUTCOME MEASURES:Mechanical complications including screw loosening, pseudarthrosis and other complications like cage subsidence, and patient-reported outcomes were evaluated at last follow-up. METHODS:The PMEM score comprised 1 functional muscular parameter (the performance time of the endurance test) and 2 imaging muscular parameters (relative functional cross-sectional area [rFCSA] of paraspinal extensor muscles [PEM] and psoas major [PS] on magnetic resonance imaging). The score was established based on a weighted scoring system created by rounding β regression coefficients to the nearest integer in univariate logistic regression. The diagnostic performance of the PMEM score was determined by binary logistic regression model and receiver operating characteristic (ROC) curve with the area under the curve (AUC). Additionally, pairwise comparisons of ROC curves were conducted to compare the diagnostic performance of the PMEM score with conventional methods based on a single muscular parameter. Moreover, differences of mechanical complications and patient-reported outcomes among the PMEM categories were analyzed using Chi-square test with Bonferroni correction. RESULTS:The PMEM score, calculated by adding the scores for each parameter, ranges from 0 to 5 points. Patients with higher PMEM scores exhibited higher rates of mechanical complications (p<.001). Binary logistic regression revealed that the PMEM score was an independent factor of mechanical complications (p<.001, OR=2.002). Moreover, the AUC of the PMEM score (AUC=0.756) was significantly greater than those of the conventional methods including the endurance test (AUC=0.691, Z=2.036, p<.05), PEM rFCSA (AUC=.690, Z=2.016, p<.05) and PS rFCSA (AUC=0.640, Z=2.771, p<.01). In terms of the PMEM categories, a score of 0-1 was categorized as low-risk muscular state of mechanical complications; 2-3, as moderate; and 4-5, as high-risk state. Moving from the low-risk state to the high-risk state, there was a progressive increase in the rates of mechanical complications (13.8% vs 32.1% vs 72.7%; p<.001), and a decrease in the rates of clinically significant improvement of patient-reported outcomes (all p<.05). CONCLUSIONS:The PMEM score might comprehensively evaluate paraspinal muscle degeneration and exhibit greater ability in predicting mechanical complications than the conventional evaluations after lumbar fusion. Surgeons might develop individualized treatment strategy tailored to different muscle degeneration statuses reflected by the PMEM score for decreasing the risk of mechanical complications.
10.1016/j.spinee.2024.05.010