共0篇 平均IF=NaN (-) 更多分析

    加载中

    logo
    Changes in cross-sectional area of psoas major muscle in unilateral sciatica caused by disc herniation. Dangaria T R,Naesh O Spine STUDY DESIGN:A clinical prospective cohort study of 15 healthy volunteers and 25 patients with unilateral sciatica from single-level disc herniation. OBJECTIVES:To detect any changes in the cross-sectional area of the psoas major muscle in patients with single-level (lateral to mediolateral) disc herniation causing unilateral sciatica. SUMMARY OF BACKGROUND DATA:The exact role of the psoas major muscle in the origin of low back pain and sciatica has not been clarified. METHODS:Fifteen healthy volunteers and 25 patients with unilateral sciatica from single-level disc herniation were subjected to magnetic resonance imaging of the lumbar spine. The cross-section area of the psoas major muscle on either side was recorded, and differences were noted. In patients, the cross-section area of either side was compared with and duration of sciatica was related to changes in the cross-section area. RESULTS:Insignificant variation in the cross-section area of the psoas major was observed in volunteers. In the patient group, significant reduction in the cross-section area of the psoas major was observed at the level and the site of the disc herniation. A significant correlation between cross-section area of the psoas major and ipsilateral continuous sciatica was found. There was no relation between the reduction of the cross-section area and the amount of disc herniation. CONCLUSION:The cross-section area of the psoas major is ipsilaterally decreased in unilateral lumbar disc herniation. The reduction in cross-section area is positively correlated with the duration of continuous sciatica.
    Difficulties in estimating muscle forces from muscle cross-sectional area. An example using the psoas major muscle. Gatton M L,Pearcy M J,Pettet G J Spine Most biomechanical models use muscle cross-sectional area (CSA) as an indicator of maximum isometric muscle force. In general, there are multiple estimates of CSA for the same muscle. For example, numerous studies have estimated the CSA of the psoas major muscle using different subject populations and positions. However, few studies have combined the available information to obtain an overall estimate of CSA or investigated the effect different subject characteristics may have on CSA. In the present update, nine studies that reported psoas major CSA or physiologic CSA were compared with respect to subject characteristics, methodology, and results. Corrections to cadaveric data were made to adjust physiologic CSA to CSA. Comparison of reported values for living subjects indicated that females have smaller mean CSA than males for the psoas major muscle and that body size does not significantly influence muscle CSA in males. Areas derived from cadaveric data were smaller than similar studies on living subjects, possibly because of subject age, removal of tendinous and fatty components of fascicles, and lack of detailed data for fascicle angles in the supine position. Results indicate that researchers who use muscle CSA in biomechanical models should carefully assess the appropriateness of the data used, particularly in relation to potential sex differences and the influence of postural changes on CSA.
    Effects of resistance training with whole-body vibration on muscle fitness in untrained adults. Osawa Y,Oguma Y Scandinavian journal of medicine & science in sports The effects of resistance training (RT) combined with whole-body vibration (WBV) on muscle fitness, particularly muscle hypertrophy and neuromuscular performance, are not well understood. We investigated the effects of WBV in healthy, untrained participants after a 13-week RT course by performing magnetic resonance imaging and by measuring maximal isometric (with electromyography) and isokinetic knee extension strengths, isometric lumbar extension torque, countermovement-jump, knee extension endurance, and sit-ups. Thirty-two individuals (22-49 years old) were randomly assigned to RT groups with (RT-WBV, n=16) or without WBV (RT, n=16). Following the RT course, significantly higher increases in the cross-sectional areas of m. psoas major (vs baseline values) and erector spinae muscle (vs the RT group) were observed in the RT-WBV group (+10.7%, P<0.05; +8.7%, P<0.05) compared with the RT group (+3.8%, P=0.045; 0.0%). Higher increases from baseline were also observed in maximal isometric force, concentric knee extension torque, countermovement-jump, and maximal isometric lumbar extension torque in RT-WBV (+63.5%; +76.7%, +15.0%, and +51.5%, respectively; P<0.05) than in those of RT (+25.6%, P=0.001; +17.8%, P=0.18; +11.3%, P=0.001; and +26.4%, P<0.001, respectively). The WBV-induced increases in muscle hypertrophy and isometric lumbar extension torque suggest a potential benefit of incorporating WBV into slow-velocity RT programs involving exercises of long duration. 10.1111/j.1600-0838.2011.01352.x
    Prognostic value of sarcopenia in liver surgery. Cornet M,Lim C,Salloum C,Lazzati A,Compagnon P,Pascal G,Azoulay D Journal of visceral surgery Current knowledge indicates that malnutrition increases the rate of post-operative complications, particularly respiratory and infectious, after major surgery. Almost all liver surgery is performed in patients with cancer, a factor that increases the risk of malnutrition. The primary risk factors for post-operative complications are pre-operative hypo-albuminemia and a body mass index less than 20 kg/m(2). To improve the prediction of complications in these patients, some teams have suggested measurement of muscle thickness by computed tomography. Muscular mass can thus be quantified by measuring the total surface of the psoas muscle or the total surface of all muscles (i.e. external and internal oblique, transverse, psoas and paravertebral muscles) seen on an axial CT slice at L3. As well, data exist suggesting that sarcopenia is an independent predictive factor of post-operative morbidity and poor long-term survival after resection for cancer. Nonetheless, the literature on the subject is limited, there are no standardized definitions for sarcopenia, and the need of special software to calculate the surfaces limits its usefulness. Lastly, there are little if any data concerning the nutritional or pharmacologic means to treat sarcopenia. This update, based on a literature review, deals with the value and the prognostic impact of sarcopenia in surgery for liver tumors. The current definition of sarcopenia, validated internationally, the methods of measurement, and the consequences of sarcopenia on the outcome of liver resections are detailed in this review. 10.1016/j.jviscsurg.2015.08.001
    Association of MRI-defined lumbar paraspinal muscle mass and slip percentage in degenerative and isthmic spondylolisthesis: A multicenter, retrospective, observational study. Park Jae-Hyun,Kim Koh-Woon,Youn Yousuk,Kim Hyungsuk,Chung Won-Seok,Song Mi-Yeon,Cho Jae-Heung Medicine The objective of this study is to investigate the role of paraspinal muscles in the progression of different types of spondylolisthesis by examining the correlation between cross-sectional area (CSA) of lumbar paraspinal muscle and slip percentage (SP) in degenerative spondylolisthesis and isthmic spondylolisthesis.A multicenter retrospective analysis was carried out including 219 subjects diagnosed with lumbar spondylolisthesis. Using T2-weighted axial magnetic resonance imgaging, CSAs of the psoas major (PM), multifidus (MU), and erector spinae were measured and divided by L5 vertebral body (VB) CSA. SP was measured using sagittal T2-weighted images. Correlations between muscle CSA ratio and SP were calculated in each group. Regression analysis was performed to predict the influence of each muscle CSA/VB CSA ratio on SP.No significant correlation was found in the degenerative spondylolisthesis group between any of the muscle CSA ratios and SP. Both PM/VB ratio (r = -0.24, P = .021) and MU/VB ratio (r = -0.26, P = .012) were negatively correlated with SP in the isthmic spondylolisthesis group. MU had more influence on SP than PM in the isthmic spondylolisthesis group (regression coefficient MU/VB: -8.08, PM/VB: -4.34).Both PM and MU muscle CSA ratios were negatively correlated with SP in the isthmic group. MU had more influence on SP than PM. No muscles had any correlations with SP in the degenerative group. This discrepancy between the two groups suggests that exercise programs or interventions regarding the segmental stability of isthmic spondylolisthesis and degenerative spondylolisthesis should be distinguished in clinical practice.Clinical Research Information Service of Korea Centers for Disease control and Prevention, KCT0002588. Registered on 12 December 2017, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=10702. 10.1097/MD.0000000000018157
    Skeletal muscle volume loss among liver cirrhosis patients receiving levocarnitine predicts poor prognosis. Fujita Masashi,Abe Kazumichi,Hayashi Manabu,Takahashi Atsushi,Ohira Hiromasa Medicine Sarcopenia has a negative impact on the prognosis of patients with liver cirrhosis (LC). We investigated the significance of skeletal muscle volume and its changes in LC patients taking levocarnitine (L-carnitine).We retrospectively analyzed 51 LC patients taking L-carnitine from December 2012 to March 2019. Skeletal mass index was calculated as the left-right sum of the major × minor axis of psoas muscle at the third lumbar vertebra, divided by height squared (psoas muscle index [PMI]). Patients were classified into 2 groups (low and normal PMI) depending on PMI < 6.0 and < 3.4 cm/m for men and women, respectively. Changes in PMI per month during L-carnitine administration (ΔPMI/m) were calculated, and we classified the patients into 2 groups (severe and mild muscle atrophy) depending on ΔPMI/m below the lower quartile. We assessed overall survival (OS).At the start of L-carnitine administration, there were no significant differences in OS between groups with low and normal PMI. Multivariate analysis showed that ΔPMI/m (hazard ratio [HR], 0.007; P = .005) and L-carnitine administration period (HR, 0.956; P = .021) were significantly associated with OS. Patients with severe muscle atrophy had a significantly lower OS than those with mild muscle atrophy. There was the positive correlation relationship between ΔPMI/m and L-carnitine administration period.Among LC patients taking L-carnitine, progressive muscle volume loss was a predictor of poor prognosis. L-carnitine administration for longer may be able to prevent muscle volume loss and lead to a better prognosis in LC patients. 10.1097/MD.0000000000021061
    Isokinetic training - its radiographic and inflammatory effects on chronic low back pain: A randomized controlled trial. Nambi Gopal,Abdelbasset Walid Kamal,Alsubaie Saud F,Moawd Samah A,Verma Anju,Saleh Ayman K,Ataalla Nahla N Medicine BACKGROUND:Isokinetic training (IKT) and core stabilization training (CST) are commonly used for balance training in musculoskeletal conditions. The knowledge about the effective implementation of these training protocols on radiological and biochemical effects in university football players with chronic low back pain (LBP) is lacking. OBJECTIVE:To find and compare the effects of isokinetic training and CST on radiological and biochemical effects in university football players with chronic LBP. DESIGN:Randomized, double-blinded controlled study. SETTING:University hospital. PARTICIPANTS:60 LBP participants were randomized into isokinetic group (IKT; n = 20), core stabilization group (CST; n = 20) and the control group (n = 20) and received respective exercises for 4 weeks. OUTCOME MEASURES:Radiological (muscle cross sectional area & muscle thickness) and biochemical (C-reactive protein, tumor necrosis factor -α, interleukin [IL]-2, IL-4, IL-6) values were measured at baseline and after 4 weeks (immediate effect). RESULTS:The reports of the IKT, CST and control group were compared between the groups. Four weeks following training IKT group shows more significant changes in muscle cross sectional area (Psoas Major, Quadratus Lumborum, Multifidus and Erector Spinae muscles) and muscle thickness (Multifidus) than CST and control groups (p < 0.001). Biochemical measures such as C-reactive protein, tumor necrosis factor -α, IL-2, IL-4 and IL-6 also show significant improvement in IKT group than the other 2 groups (P < .001). CONCLUSION:Training through Isokinetic is an effective treatment program than conventional exercise programs in the aspect of radiological and biochemical analysis in university football players with chronic LBP, which may also help to prevent further injury. The present study can be used to improve the physical therapist's knowledge and clinical decision skills on LBP in football players. 10.1097/MD.0000000000023555
    Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis. Cao Qin,Xiong Yan,Zhong Zibiao,Ye Qifa Annals of nutrition & metabolism BACKGROUND:Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. AIM:The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. METHODS:Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). RESULTS:Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14-1.63; p = 0.0008; I2 = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15-1.58; p = 0.0002; I2 = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14-1.73; p = 0.002; I2 = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28-2.09; p < 0.0001; I2 = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. CONCLUSIONS:All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking. 10.1159/000494887
    A 100-m Sprint Time Is Associated With Deep Trunk Muscle Thickness in Collegiate Male Sprinters. Fujita Shimpei,Kusano Seiya,Sugiura Yusaku,Sakuraba Keishoku,Kubota Atsushi,Sakuma Kazuhiko,Suzuki Yoshio,Hayamizu Kohsuke,Aoki Yuma,Sugita Masaaki Frontiers in sports and active living One reason athletes train their trunk muscles is that the body's trunk stability has been shown to prevent injury. However, the relationship between body trunk muscle thickness, particularly that of deep muscles, and athletic performance remains to be clarified. We aimed to explore the relationship between 100-m sprint performance and the sizes of the trunk stabilizing muscles, the psoas major muscle (PM), transversus abdominis (TA), and multifidus muscle (MM), in collegiate sprinters. Fourteen male sprinters belonging to a university athletics club participated in this study. The thicknesses of the TA and MM were measured using an ultrasonic diagnostic apparatus (ProSound C3; Aloka, Tokyo, Japan). The cross-sectional area of the PM was assessed by a magnetic resonance imaging apparatus (Vantage Elan; Toshiba Medical Systems, Tokyo, Japan). The relationship between these anthropometric parameters and the 100-m sprint time was analyzed by Spearman's correlation coefficient, multi- regression analysis, and the change-point regression model. The sizes (mean ± SD) of the muscles were: PM, 43.074 ± 7.35 cm; TA, 4.36 ± 0.72 mm; and MM, 3.99 ± 0.48 cm. The mean 100-m sprint time was 11.00 ± 0.48 s. Spearman's correlation analysis revealed that the 100-m sprint time had a significant moderate negative correlation with TA (ρ = -0.691, < 0.01) and a low negative but not significant correlation with MM (ρ = -0.327, = 0.28), whereas PM did not show a significant or in-negligible correlation. The change-point regression model found the change-points in the 100-m sprint time and the thickness of the TA and MM at 4.70 mm (95% CI: 4.00-5.43 mm) and 3.84 cm (95% CI: 3.28-4.31 cm), respectively. The sprint time decreased with an increase in the thickness of the muscles up to the change-points, whereas it did not change even if the muscles became thicker than the change-points. The change-points were consistently observed when the thickness of the muscles was normalized by body mass. Sprint performance for 100-m was found to be associated with TA and MM thickness in a biphasic manner. As muscle thickness increased, the sprint time decreased, followed by a plateau phase. 10.3389/fspor.2019.00032
    Preoperative Assessment of Muscle Mass Using Computerized Tomography Scans to Predict Outcomes Following Orthotopic Liver Transplantation. Esser Hannah,Resch Thomas,Pamminger Mathias,Mutschlechner Beatrix,Troppmair Jakob,Riedmann Marina,Gassner Eva,Maglione Manuel,Margreiter Christian,Boesmueller Claudia,Oberhuber Rupert,Weissenbacher Annemarie,Cardini Benno,Finkenstedt Armin,Zoller Heinz,Tilg Herbert,Öfner Dietmar,Schneeberger Stefan Transplantation BACKGROUND:Sarcopenia is an established risk factor predicting survival in chronically ill and trauma patients. We herein examine the assessment and clinical implication of sarcopenia in liver transplantation (LT). METHODS:Computerized tomography scans from 172 patients waitlisted for LT were analyzed by applying 6 morphometric muscle scores, including 2 density indices (psoas density [PD] and skeletal muscle density [SMD]) and 4 scores based on muscle area (total psoas area, psoas muscle index, skeletal muscle area, and skeletal muscle index). RESULTS:The prevalence of sarcopenia in our cohort ranged from 7.0% to 37.8%, depending on the score applied. Only sarcopenia as defined by the density indices PD and SMD (but not total psoas area, psoas muscle index, skeletal muscle area, or skeletal muscle index) revealed clinical relevance since it correlates significantly with postoperative complications (≥Grade III, Clavien-Dindo classification) and sepsis. Furthermore, sarcopenia predicted inferior patient and graft survival, with low muscle density (PD: <38.5 HU or SMD: <30 HU) representing an independent risk factor in a multivariate regression model (P < 0.05). Importantly, the widely used Eurotransplant donor risk index had a predictive value in nonsarcopenic patients but failed to predict graft survival in patients with sarcopenia. CONCLUSIONS:Sarcopenia revealed by low muscle density correlates with major complications following LT and acts as an independent predictor for patient and graft survival. Therefore, the application of a simple computerized tomography-morphologic index can refine an individual recipient's risk estimate in a personalized approach to transplantation. 10.1097/TP.0000000000002759
    Association between trunk and gluteus muscle size and long jump performance. Takahashi Katsuki,Wakahara Taku PloS one The present study aimed to examine the sizes of trunk and gluteus muscles in long jumpers and its relation to long jump performance. Twenty-three male long jumpers (personal best record in long jump: 653-788 cm) and 22 untrained men participated in the study. T1-weighted magnetic resonance images of the trunk and hip were obtained to determine the cross-sectional areas of the rectus abdominis, internal and external obliques and transversus abdominis, psoas major, quadratus lumborum, erector spinae and multifidus, iliacus, gluteus maximus, and gluteus medius and minimus. The cross-sectional areas of individual trunk and gluteus muscles relative to body mass were significantly larger in the long jumpers than in untrained men (P < 0.001, Cohen's d = 1.3-4.3) except for the gluteus medius and minimus. The relative cross-sectional area of the rectus abdominis of takeoff leg side was significantly correlated with their personal best record for the long jump (r = 0.674, corrected P = 0.004). Stepwise multiple regression analysis selected relative cross-sectional areas of the rectus abdominis and iliacus and the personal best record in 100-m sprint to predict the long jump distance (standard error of estimate = 22.6 cm, adjusted R2 = 0.763). The results of the multiple regression analysis demonstrated that the rectus abdominis and iliacus size were associated with long jump performance independently of sprint running capacity, suggesting the importance of these muscles in achieving high performance in the long jump. 10.1371/journal.pone.0225413
    Low Thoracic Skeletal Muscle Area Predicts Morbidity After Pneumonectomy for Lung Cancer. Madariaga Maria Lucia L,Troschel Fabian M,Best Till D,Knoll Sheila J,Gaissert Henning A,Fintelmann Florian J The Annals of thoracic surgery BACKGROUND:Sarcopenia represented by low psoas muscle area is associated with increased hospital length of stay (LOS), postoperative complications, and mortality. We studied whether thoracic skeletal muscle area (TSMA) derived from computed tomography (CT) predicts morbidity after pneumonectomy for lung cancer. METHODS:Consecutive patients who underwent pneumonectomy for lung cancer from 2005 to 2017 were retrospectively analyzed. TSMA was defined as the sum of muscle area at the level of the eighth and the 12th thoracic vertebral bodies on preoperative CT. Patients were stratified into sex-specific TSMA quartiles for univariate time-to-event analyses. The effect of continuous TSMA measurements on operative complications, hospital and intensive care unit (ICU) LOS, discharge disposition, and hospital readmission within 90 days was estimated using multivariable models adjusted for age, sex, body mass index, forced expiratory volume in 1 second, Zubrod score, and pneumonectomy type. RESULTS:Standard (n = 102, 78.5%) or high-risk (n = 28, 21.5%; extrapleural: n = 3, 2.3%; carinal: n = 9, 6.9%; completion: n = 16, 12.3%) pneumonectomy was performed in 130 patients (60.8 ± 10.6 years; 43.1% women). Major complications occurred in 33.1% (n = 43 of 130) and readmission in 17.7% (n = 23 of 130) of patients. In multivariable models, patients with high TSMA experienced fewer overall (odds ratio [OR], 0.87; P = .04) and cardiopulmonary (OR, 0.86; P = .04) complications, and fewer readmissions (OR, 0.78; P = .01). Associations with ICU LOS (hazard ratio, 1.08; P = .051) and hospital LOS (hazard ratio, 1.05; P = .18) did not reach significance. CONCLUSIONS:TSMA predicts adverse outcome after pneumonectomy for lung cancer. This marker, readily derived from standard chest CT, identifies patients at increased risk for postoperative complications and may help select patients appropriate for focused rehabilitation before pneumonectomy. 10.1016/j.athoracsur.2019.10.041
    Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy. Risk management and healthcare policy BACKGROUND AND AIM:Sarcopenia has been proven to be a risk factor after pancreatoduodenectomy (PD). We aimed to evaluate if decreased psoas muscle area and density shown in CT scan, as measures for sarcopenia, were associated with postoperative major complications and adverse outcomes in patients who underwent PD. PATIENTS AND METHODS:We analyzed 152 consecutive patients who underwent open PD. Total psoas area and muscle attenuation were measured on CT images at the level of the third lumbar vertebra. Total psoas area index (TPAI) was calculated, the cut-off values of TPAI were estimated and validated. The relationship between radiographic characters and outcomes was analyzed. RESULTS:The optimal cut-off values of TPAI were 4.78 cm/m for males and 3.46 cm/m for females. The values were validated by outcomes with significant differences in the rate of major complications, re-operation, length of stay, and total cost. The prevalence of TPAI-defined sarcopenia and sarcopenic overweight/obesity was 38.8% and 17.1% in total. In multivariate logistic regression, rate of major complications was associated with TPAI [OR=0.605, 95% CI (0.414, 0.883), =0.009], TPAI-defined sarcopenia [OR=8.256, 95% CI (2.890, 23.583), =0.000] and sarcopenic overweight/obesity [OR=7.462, 95% CI (2.084, 26.724), =0.002]; meanwhile, NRS2002-defined nutritional risk and GLIM-defined malnutrition did not show relationship with major complications. CONCLUSION:Both sarcopenia and sarcopenic overweight/obesity determined by new TPAI cut-off values were associated with a higher rate of major complications and adverse outcomes in Chinese patients undergoing open PD whereas usual nutritional assessment was not. 10.2147/RMHP.S257677
    Association of adipose tissue and skeletal muscle metrics with overall survival and postoperative complications in soft tissue sarcoma patients: an opportunistic study using computed tomography. Quantitative imaging in medicine and surgery BACKGROUND:To determine the relationship between adipose tissue and skeletal muscle measurements on computed tomography (CT) and overall survival and major postoperative complications in patients with soft-tissue sarcoma (STS). METHODS:The retrospective study included 137 STS patients (75 men, 62 women; mean age, 53 years, SD 17.7; mean BMI, 28.5, SD 6.6) who had abdominal CT exams. On a single CT image, at the L4 pedicle level, measurements of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area and attenuation were obtained using clinical PACS and specialized segmentation software. Clinical information was recorded, including STS characteristics (size, depth, grade, stage, and site), overall survival, and postoperative complications. The relationships between CT metrics and survival were analyzed using Cox proportional hazard models and those between CT metrics and postoperative complications using logistic regression models. RESULTS:There were 33 deaths and 41 major postoperative complications. Measured on clinical PACS, the psoas area (P=0.003), psoas index (P=0.006), psoas attenuation (P=0.011), and total muscle attenuation (P=0.023) were associated with overall survival. Using specialized software, psoas attenuation was also associated with overall survival (P=0.018). Adipose tissue metrics were not associated with survival or postoperative complications. CONCLUSIONS:In STS patients, CT-derived muscle size and attenuation are associated with overall survival. These prognostic biomarkers can be obtained using specialized segmentation software or routine clinical PACS. 10.21037/qims.2020.02.09
    Change in the dimensions of the lumbar area muscles after surgery: MRI analysis. Duman Fatma,Serarslan Yurdal,Ozturk Fatma,Yucekaya Bircan,Atci Nesrin Northern clinics of Istanbul OBJECTIVE:This study aims to assess the change in the dimensions of the lumbar muscles in patients with chronic lower back pain using Magnetic Resonance Imaging (MRI) and to determine pre/post effects of surgery. METHODS:We enrolled 28 individuals (13F/15M; age: 45.39±11.56 years) whose L2-S1 muscle measurements were obtained using MRI, before and at follow-up 6-12 months after surgery. The control group comprising 37 individuals (18F/19M; age: 34.41±10.72 years) who had no lumbar pathology but for whom retrospective archive images were available. In the axial MRI analysis, the cross-sections of m.multifidus, mm.erector spinae and m.psoas major on both sides were measured with the 'closed polygon' technique. RESULTS:The L2-3 and L4-5 levels of the m.multifidus on the right side, the L2-3, L4-5 and L5-S1 levels of the m.multifidus and the L5-S1 levels of the mm. erector spinae on the left side cross-sectional areas were significantly lower than the control group (p<0.05). The right-side m.multifidus and the left-side mm.erector spinae sectional areas were significantly lower than the pre-surgery values at the L5-S1 levels (p<0.05). CONCLUSION:This study demonstrated that chronic lower back pain causes atrophy in the lumbar muscles and established the existence and continuity of atrophy after surgery. 10.14744/nci.2020.45144
    Associations between the psoas major muscle index and the presence and severity of coronary artery disease. Imaizumi Tomoki,Shiga Yuhei,Idemoto Yoshiaki,Tashiro Kohei,Ueda Yoko,Yano Yuiko-Miyase,Norimatsu Kenji,Nakamura Ayumi,Kuwano Takashi,Iwata Atsushi,Miura Shin-Ichiro Medicine The associations between the presence and severity of coronary artery disease (CAD) and measurements of the psoas major muscle (PMM) as assessed by multidetector row coronary computed tomography angiography (MDCT) are not known.We enrolled 793 patients who were clinically suspected to have CAD or had at least one cardiac risk factor and had undergone MDCT. The number of significantly stenosed coronary vessels (VD) and measurements of the PMM index (PMMI) were determined using MDCT.PMMI in the CAD group was significantly lower than that in the non-CAD group in males, but not females. In addition, the levels of PMMI tended to increase as the number of VD decreased in males. When male patients were divided into 2 groups according to median value of age, that is, relatively younger (53.4 ± 9.2 years) and older (72.6 ± 5.7 years) groups, the presence of CAD was independently associated with PMMI in the younger group by a multiple logistic regression analysis. The cut-off level of PMMI that gave the greatest sensitivity and specificity for the diagnosis of CAD in younger males was 8.3 cm/m (sensitivity 0.441, specificity 0.752).In conclusion, PMMI may be an imaging marker for evaluating the presence and/or severity of CAD in males, and particularly in the non-elderly. 10.1097/MD.0000000000021086
    Sarcopenia assessed by the quantity and quality of skeletal muscle is a prognostic factor for patients undergoing cardiac surgery. Kiriya Yuriko,Toshiaki Nakajima,Shibasaki Ikuko,Ogata Koji,Ogawa Hironaga,Takei Yusuke,Tezuka Masahiro,Seki Masahiro,Kato Takashi,Lefor Alan Kawarai,Fukuda Hirotsugu Surgery today PURPOSE:Sarcopenia was assessed as a prognostic factor for patients undergoing cardiac surgery by evaluating the quantity and quality of skeletal muscle. METHODS:Sarcopenia was assessed by perioperative abdominal computed tomography using the total psoas muscle index (TPI) and intra-muscular adipose tissue content (IMAC). Patients were classified into high- (HT, n = 143) and low- (LT, n = 63) TPI groups and low- (LI, n = 122) and high- (HI, n = 84) IMAC groups. RESULTS:There were significantly more complications in the LT and HI groups than in the HT and LI groups. (HT 15.4% vs. LT 30.2%, P = 0.014) (LI 11.5% vs. HI 31.1%, P < 0.001). There were more respiratory complications in the LT group (HT 0% vs. LT 6.3%, P = 0.002) and more surgical site infections in the HI group than in the LI group (LI 0.8% vs. HI 7.1%, P = 0.014). A multivariable analysis showed that low TPI and high IMAC significantly predicted more major complications than other combinations (odds ratio [OR] 2.375; 95% confidence interval [CI] 1.152-5.783; P = 0.036, OR 3.973; 95% CI 1.737-9.088; P = 0.001). CONCLUSIONS:Sarcopenia is a risk factor for complications. The quantity and quality of muscle must be assessed to predict operative outcomes. CLINICAL TRIAL REGISTRATION NUMBER:UMIN000027077. 10.1007/s00595-020-01977-w
    Trunk Muscle Mass Measured by Bioelectrical Impedance Analysis Reflecting the Cross-Sectional Area of the Paravertebral Muscles and Back Muscle Strength: A Cross-Sectional Analysis of a Prospective Cohort Study of Elderly Population. Salimi Hamidullah,Ohyama Shoichiro,Terai Hidetomi,Hori Yusuke,Takahashi Shinji,Hoshino Masatoshi,Yabu Akito,Habibi Hasibullah,Kobayashi Akio,Tsujio Tadao,Kotake Shiro,Nakamura Hiroaki Journal of clinical medicine Trunk muscles play an important role in supporting the spinal column. A decline in trunk muscle mass, as measured by bioelectrical impedance analysis (TMM-BIA), is associated with low back pain and poor quality of life. The purpose of this study was to determine whether TMM-BIA correlates with quantitative and functional assessments traditionally used for the trunk muscles. We included 380 participants (aged ≥ 65 years; 152 males, 228 females) from the Shiraniwa Elderly Cohort (Shiraniwa) study, for whom the following data were available: TMM-BIA, lumbar magnetic resonance imaging (MRI), and back muscle strength (BMS). We measured the cross-sectional area (CSA) and fat-free CSA of the paravertebral muscles (PVM), including the erector spinae (ES), multifidus (MF), and psoas major (PM), on an axial lumbar MRI at L3/4. The correlation between TMM-BIA and the CSA of PVM, fat-free CSA of PVM, and BMS was investigated. TMM-BIA correlated with the CSA of total PVM and each individual PVM. A stronger correlation between TMM-BIA and fat-free CSA of PVM was observed. The TMM-BIA also strongly correlated with BMS. TMM-BIA is an easy and reliable way to evaluate the trunk muscle mass in a clinical setting. 10.3390/jcm10061187
    Impact of Total Psoas Area and Lean Muscular Area on Mortality after Endovascular Aortic Aneurysm Repair. Oliveira Vânia Constâncio,Oliveira Pedro,Moreira Mário,Correia Mafalda,Lima Pedro,Silva Joana Cruz,Pereira Ricardo Vale,Fonseca Manuel Annals of vascular surgery BACKGROUND:Sarcopenia has assumed growing relevance as a morbimortality predictor after major abdominal surgery. The aim of this study is to access total psoas muscle area (TPA) and lean muscle area (LMA) impact in morbimortality after elective endovascular abdominal aortic aneurysm repair (EVAR). METHODS:Asymptomatic patients submitted to aortic endoprosthesis implantation between January 1, 2014 and December 31, 2018 at our vascular surgery department were retrospectively evaluated. After exclusion criteria were applied, 105 patients were included in the study; preoperative computed tomography scans were evaluated using OSIRIX software (Bernex, Switzerland). Two observers independently calculated TPA at the most caudal level of the L3 vertebra and respective density, therefore calculating LMA. Patients were separated by tertiles with the lowest being considered sarcopenic and with higher muscle steatosis and compared with the higher tertiles. Patient demographics and intraoperative and postoperative period variables were collected. Charlson comorbidity index was calculated and surgical complications classified according to Clavien-Dindo. The intraclass correlation coefficient and Bland-Altman plot were made to characterize interobserver variability. Survival analysis was performed with the Kaplan-Meier method, and differences between survival curves were tested with the log-rank test. The effect of sarcopenia on patient survival was assessed using Cox proportional hazard models. RESULTS:Considering TPA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.03), whereas multivariate analyses showed increased likelihood of mortality (P = 0.039, hazard ratio (HR) 3.829). For LMA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.013), whereas multivariate analyses showed increased likelihood of mortality (P = 0.026, HR 4.153). When analyzing patients in the lowest tertile of both TPA and LMA, both univariate (P = 0.002) and multivariate (P = 0.018, HR 4.166) analyses reveled inferior survival. CONCLUSIONS:Our study reveals reduced survival in patients with low TPA and low LMA submitted to elective EVAR; these factors should probably be taken into consideration in the future for preoperative risk evaluation and surgical planning. 10.1016/j.avsg.2020.09.004
    Feasibility of computed tomography-based assessment of skeletal muscle mass in hemodialysis patients. Takata Tomoaki,Motoe Aki,Tanida Katsumi,Taniguchi Sosuke,Ida Ayami,Yamada Kentaro,Hamada Shintaro,Ogawa Masaya,Yamamoto Marie,Mae Yukari,Iyama Takuji,Taniguchi Munehiro,Nakaoka Akihisa,Isomoto Hajime Journal of nephrology BACKGROUND:Sarcopenia is a major health issue especially in patients on maintenance hemodialysis. Low skeletal muscle mass is included in the diagnostic criteria for sarcopenia. The skeletal muscle mass is usually evaluated by modalities such as bioimpedance analysis (BIA) or dual-energy X-ray absorptiometry, however the assessment of skeletal muscle mass using computed tomography (CT) images has not been established. The purpose of the study was to investigate the feasibility of the assessment of skeletal muscle mass using CT images in hemodialysis patients. METHODS:Skeletal muscle mass index (SMI) was measured by BIA and psoas muscle index (PMI) was measured by cross-sectional CT images in 131 patients. The relationship between SMI and PMI and the diagnostic ability of PMI for low muscle mass were evaluated. Furthermore, the patients were followed up and long-term survival in patients with low and high PMI were compared. RESULTS:PMI measured at the L3 vertebral level was strongly correlated with SMI (r = 0.597, p < 0.001). Age, sex, and SMI were the influencing factors for PMI. Patients with low PMI showed higher incidence rates of mortality during the follow up. CONCLUSIONS:PMI assessed by CT image can be an alternative to BIA in patients on hemodialysis. 10.1007/s40620-020-00871-5
    Psoas muscle area and attenuation are highly predictive of complications and mortality after complex endovascular aortic repair. Kärkkäinen Jussi M,Oderich Gustavo S,Tenorio Emanuel R,Pather Keouna,Oksala Niku,Macedo Thanila A,Vrtiska Terri,Mees Barend,Jacobs Michael J Journal of vascular surgery OBJECTIVE:The present study evaluated the psoas muscle area and attenuation (radiodensity), quantified by computed tomography, together with clinical risk assessment, as predictors of outcomes after fenestrated and branched endovascular aortic repair (FBEVAR). METHODS:The present single-center study included 504 patients who had undergone elective FBEVAR for pararenal or thoracoabdominal aortic aneurysms. The clinical risk assessment included age, sex, comorbidities, body mass index, glomerular filtration rate, aneurysm size and extent, cardiac stress test results, ejection fraction, and American Society of Anesthesiologists (ASA) score. Preoperative computed tomography was used to measure the psoas muscle area and attenuation at the L3 level. The lean psoas muscle area (LPMA; area in cm multiplied by attenuation in Hounsfield units [HU]) was calculated by multiplying the area by the attenuation. The risk factors for 90-day mortality, major adverse events (MAEs), and long-term mortality were determined using multivariable analysis. MAEs included 30-day or in-hospital death, acute kidney injury, myocardial infarction, respiratory failure, paraplegia, stroke, and bowel ischemia. A novel risk stratification method was proposed according to the strongest predictors of mortality and MAEs on multivariable analysis. RESULTS:The 30-day mortality, 90-day mortality, and MAE rates were 2.0%, 5.6%, and 20%, respectively. The independent predictors of 90-day mortality were chronic obstructive pulmonary disease, chronic kidney disease, ASA score, and LPMA. The independent predictors of MAEs were aneurysm diameter, glomerular filtration rate, and LPMA. For long-term mortality, the independent predictors were chronic kidney disease, congestive heart failure, extent I-III thoracoabdominal aortic aneurysms, ASA score, and LPMA. The patients were stratified into three groups according to the ASA score and LPMA: low risk, ASA score II or LPMA >350 cmHU (n = 290); medium risk, ASA score III and LPMA ≤350 cmHU (n = 181); and high risk, ASA score IV and LPMA ≤350 cmHU (n = 33). The 90-day mortality and MAE rates were 1.7% and 16% in the low-, 7.2% and 24% in the medium-, and 30% and 33% in the high-risk patients, respectively (P < .001 and P = .02, respectively). Patients with ASA score IV and LPMA <200 cmHU, indicating sarcopenia (n = 14) had a 43% risk of death within 90 days. The 3-year survival estimates were 80% ± 3% for the low-, 70% ± 4% for the medium-, and 35% ± 9% for the high-risk patients (P < .001). The mean follow-up time was 3.1 ± 2.3 years. CONCLUSIONS:LPMA was a strong predictor of outcomes and the only independent predictor of both mortality and MAEs after FBEVAR. A high muscle mass was protective against complications, regardless of the ASA score. Risk stratification based on the ASA score and LPMA can be used to identify patients at excessively high operative risk. 10.1016/j.jvs.2020.08.141
    Effect of Resistance Training of Psoas Major in Combination With Regular Running Training on Performance in Long-Distance Runners. International journal of sports physiology and performance PURPOSE:The study determined whether the increase in the cross-sectional area (CSA) of psoas major, which is known as a hip-flexion muscle, by resistance training combined with running training improves the performance of long-distance runners. METHODS:Subjects were 8 well-trained male long-distance runners. The personal best time in a 5000-m race was 15:10.0 (0:20.5) (mean [SD]). Each subject performed resistance training twice per week with running training for 12 weeks. The authors used 3 resistance training regimens that would train the hip flexor muscles. Training intensity was a maximum of 10 repetitions. The training amount was 3 sets × 10 times during the first 4 weeks followed by 4 sets × 10 times during the last 8 weeks. The authors measured the CSA of psoas major using magnetic resonance imaging and the performance of long-distance runners using a constant velocity running test before (pre) and after (post) the training term. RESULTS:The combination training significantly (P < .01, d = 0.34) increased the CSA of psoas major (pre: 16.2 [1.5] cm2, post: 16.7 [1.4] cm2) and significantly (P < .01, d = 1.41) improved the duration of the constant velocity running test (pre: 500 [108] s, post: 715 [186] s). Moreover, multiple regression analysis showed that the pre to post change in the duration of the constant velocity exercise was significantly correlated with the change in CSA of the psoas major. CONCLUSION:The authors suggest that resistance training of psoas major with running training is correlated with an improvement in the performance of long-distance runners. 10.1123/ijspp.2020-0206
    Relationship between Vertebral Instability and the Cross-Sectional Area of Lumbar Muscles in Postmenopausal Acute Osteoporotic Vertebral Fractures. Spine surgery and related research INTRODUCTION:Vertebral instability (VI) in osteoporotic vertebral fractures (OVFs) varies from mild to severe. The relationship between the VI of OVFs and independent factors, such as bone mineral density (BMD) and lumbar muscle volume, is unclear. This study aimed to investigate whether BMD and the cross-sectional area (CSA) of lumbar muscles are related to VI in OVFs. METHODS:On the basis of the thoracolumbar lateral radiographs of 95 acute OVFs in postmenopausal women (mean age 80.6 years; range: 64-103 years), supine and standing vertebral collapse rates (CRsp and CRst, respectively) were determined. Subsequently, VI was defined as follows: VI=CRst-CRsp. Using axial T2-weighted magnetic resonance imaging (MRI), CSA of the psoas major, erector spinae, and multifidus muscles at the L3/4 intervertebral disc level were measured. The BMD of the lumbar spine and proximal femur (total hip) was measured for all participants using dual-energy X-ray absorptiometry. The patients were classified into group 1 (VI <20%) and group 2 (VI ≥20%). RESULTS:We observed a negative correlation between VI and CSA of the erector spinae muscle (r=-0.3962, P<0.0001). No significant correlations were observed between VI and BMD. The CSA of the erector spinae muscle in group 2 was significantly lower than that in group 1 (P=0.0002). No significant difference in the BMD or the CSA of the psoas major or multifidus muscles was observed between the two groups. A multivariable analysis of factors of VI was performed. Both age (odds ratio [OR], 1.099; 95% confidence interval [CI], 1.015-1.189; P=0.020) and the CSA of the erector spinae (OR, 0.996; 95% CI, 0.993-0.999; P=0.020) were significant predictors of high VI. CONCLUSIONS:Although the severity of OVFs was related to the CSA of the erector spinae muscle, it was not associated with BMD. 10.22603/ssrr.2021-0029
    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
    Sarcopenia, as Assessed by Psoas Cross-Sectional Area, Is Predictive of Adverse Postoperative Outcomes in Patients Undergoing Colorectal Cancer Surgery. Richards Simon J G,Senadeera Sajith C,Frizelle Frank A Diseases of the colon and rectum BACKGROUND:Frailty and sarcopenia are important concepts in surgical practice because of their association with adverse postoperative outcomes. Radiologically assessed psoas muscle mass has been proposed as a surrogate for sarcopenia and may be predictive of poor postoperative outcomes. OBJECTIVE:This study aimed to determine the association between sarcopenia, as assessed by psoas cross-sectional area, and postoperative outcomes in patients undergoing colorectal cancer surgery. DESIGN:This was a retrospective review of patient records from 2014 to 2016. SETTINGS:This study was conducted at a single tertiary center. PATIENTS:Patients undergoing elective resection of colorectal cancer were included. MAIN OUTCOME MEASURES:Sarcopenia was assessed using the total psoas index, calculated by measuring the cross-sectional area of the psoas muscle at the third lumbar vertebra and normalized for patient height. Preoperative and intraoperative variables, including the presence of preoperative sarcopenia, were evaluated as potential risk factors for adverse postoperative outcomes. RESULTS:Of 350 patients, 115 (32.9%) were identified as sarcopenic. Sarcopenia was associated with a significantly increased length of stay (13 days vs 7 days; OR, 1.31; 95% CI, 1.23-1.42; p < 0.01) and 1-year mortality (13.9% vs 0.9%; OR, 16.2; 95% CI, 4.34-83.4; p < 0.01). Sarcopenia was also associated with a significant increased risk of any complication (85.2% vs 34.5%; OR, 15.4; 95% CI, 8.39-29.7; p < 0.01) and of major complications (30.4% vs 8.9%; OR, 15.1; 95% CI, 7.16-33.2; p < 0.01). LIMITATIONS:This study was limited by its retrospective design and by being conducted in a single institution. Although reduced muscle mass is suggestive of sarcopenia, it does not assess a patient's physical function or other components of the frailty phenotype. CONCLUSION:Radiological sarcopenia is an important predictive risk factor for adverse postoperative outcomes in surgical patients. Computed tomography scans, which are routinely performed as part of staging, provide an opportunity to assess for sarcopenia preoperatively. See Video Abstract at http://links.lww.com/DCR/B201. LA SARCOPENIA, EVALUADA POR EL ÁREA TRANSVERSAL DE PSOAS, PREDICE RESULTADOS POSTOPERATORIOS ADVERSOS EN PACIENTES SOMETIDOS A CIRUGÍA DE CÁNCER COLORECTAL: La fragilidad y la sarcopenia son conceptos importantes en la práctica quirúrgica debido a su asociación con los resultados postoperatorios adversos. La masa muscular del psoas evaluada radiológicamente se ha propuesto como un sustituto de la sarcopenia y puede predecir resultados postoperatorios deficientes.Determinar la asociación entre la sarcopenia, según lo evaluado por el área transversal del psoas, y los resultados postoperatorios en pacientes sometidos a cirugía de cáncer colorrectal.Esta fue una revisión retrospectiva de los registros de pacientes de 2014 a 2016.Este estudio se llevo a cabo en un solo centro terciario.Se incluyeron pacientes sometidos a resección electiva de cáncer colorrectal.La sarcopenia se evaluó utilizando el índice de psoas total (TPI), calculado midiendo el área de la sección transversal del músculo psoas en la tercera vértebra lumbar y normalizado para la altura del paciente.Se evaluaron las variables preoperatorias e intraoperatorias, incluida la presencia de sarcopenia preoperatoria, como posibles factores de riesgo de resultados postoperatorios adversos.De 350 pacientes, 115 (32,9%) fueron identificados como sarcopénicos. La sarcopenia se asoció con un aumento significativo de la duración de la estancia (13 días frente a 7 días, OR 1.31, IC 95% 1.23-1.42, p < 0.01) y de la mortalidad al año (13.9% vs 0.9%, OR 16.2, IC 95% 4.34-83.4, p < 0.01). La sarcopenia también se asoció con un aumento significativo del riesgo de cualquier complicación (85.2% vs 34.5%, OR 15.4, IC 95% 8.39-29.7, p < 0.01) y de complicaciones mayores (30.4% vs 8.9%, OR 15.1 IC 95% 7.16-33,2, p < 0,01).Este estudio estuvo limitado por su diseño retrospectivo y por el hecho de que se realizó en una sola institución. Aunque la reducción de la masa muscular es un indicio de sarcopenia, no evalúa la función física del paciente ni otros componentes del fenotipo de fragilidad.La sarcopenia radiológica es un importante factor de riesgo predictivo para resultados postoperatorios adversos en pacientes quirúrgicos. Las tomografías computarizadas, que se realizan rutinariamente como parte de la estadificación, brindan la oportunidad de evaluar la sarcopenia antes de la operación. Consulte Video Resumen en http://links.lww.com/DCR/B201. (Traducción-Dr. Gonzalo Hagerman). 10.1097/DCR.0000000000001633
    Ultrasound method for estimating the cross-sectional area of the psoas major muscle. Takai Yohei,Katsumata Yoichi,Kawakami Yasuo,Kanehisa Hiroaki,Fukunaga Tetsuo Medicine and science in sports and exercise PURPOSE:The present study aimed to develop an ultrasonographic method for estimating the cross-sectional area of the psoas major muscle. METHODS:The muscle cross-sectional area (CSA(MRI)) and thickness (MT(MRI)) of the psoas major muscle at L4-L5 on the right and left sides of the body were measured using magnetic resonance imaging in 11 healthy sedentary men age 21 to 25 yr. Ultrasonographic images were obtained at the corresponding sites where CSA(MRI) and MT(MRI) measurements were performed. From the ultrasonographic images, the thickness of the psoas major muscle (MT(US)) was analyzed on both sides of the body. RESULTS:The interclass correlation coefficient of MT(US) measurements performed on two separated days was 0.951 for the right side and 0.971 for the left side. CSA(MRI) was significantly correlated to MT(MRI) (r = 0.934 for the right side and r = 0.910 for the left side). There was no significant difference between MT(MRI) (4.68 ± 0.39 cm for the right side and 4.73 ± 0.39 cm for the left side) and MT(US) (4.67 ± 0.40 cm for the right side and 4.72 ± 0.43 cm for the left side). The MT(US) was significantly correlated to MT(MRI) (r = 0.979 for the right side and r = 0.980 for the left side) and CSA(MRI) (r = 0.947 for the right side and r = 0.916 for the left side). CONCLUSION:The current results indicate that the psoas major muscle thickness determined by the ultrasonographic method is useful for estimating the cross-sectional area of the psoas major muscle. 10.1249/MSS.0b013e31821994cb
    Value of Lumbar MRI Parameters in the Evaluation of Postoperative Curative Effect on Patients with Lumbar Disc Herniation and Analysis of Risk Factors. Evidence-based complementary and alternative medicine : eCAM OBJECTIVE:For exploring the value of magnetic resonance imaging (MRI) parameters in the evaluation of postoperative curative effect on patients with lumbar disc herniation (LDH) and analyzing risk factors. METHODS:Totally 60 patients confirmed with LDH in our hospital between Jan. 2018 and Jan. 2020 were enrolled into the observation group (Obs group) given transforaminal endoscopic discectomy (TED). In addition, 60 individuals with low back pain but no LDH over the same time span were enrolled into the control group (Con group). The two groups were given lumbar MRI, and the cross-sectional area differences of bilateral psoas major muscle (BPMM) and multifidus muscle of the patients before and after therapy were evaluated. The visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) scores of the two groups before and after therapy were compared, and the associations of the cross-sectional area differences of BPMM and multifidus muscle with efficacy, VAS score, and JOA score were analyzed. According to MacNab criteria, the clinical efficacy on the patients was evaluated, on which the patients were grouped. In addition, logistic regression analysis was performed for analyzing risk factors of clinical efficacy, and receiver operating characteristic (ROC) curves were drawn for analyzing the value of risk factors with differences in clinical efficacy evaluation. RESULTS:The Obs group presented larger cross-sectional area differences of BPMM and multifidus muscle than the Con group (both < 0.05). At 6 months after surgery, the Obs group showed a superior rate of 83.33%. In this group, patients with a superior efficacy showed smaller cross-sectional area differences of BPMM and multifidus muscle before surgery and at 6 months after surgery and got lower VAS scores and higher JOA scores than those without a superior efficacy (all < 0.05). According to Pearson's correlation analysis, the cross-sectional area differences of BPMM and multifidus muscle before surgery and at 6 months after surgery were positively associated with VAS score and negatively associated with JOA score (both < 0.05). According to logistic regression analysis, the cross-sectional area differences of BPMM and multifidus muscle were risk factors impacting the patients' prognosis. ROC curve-based analysis revealed that the cross-sectional area differences could be adopted as evaluation indexes for clinical efficacy on patients. CONCLUSION:The cross-sectional area differences of BPMM and multifidus muscle can serve as reference indexes for evaluating the postoperative efficacy on patients with LDH. 10.1155/2021/4514704
    The Quantity and Quality of Lumbar Muscles and Lumbopelvic Parameters in Patients With Degenerative Spondylolisthesis. Ohyama Shuhei,Aoki Yasuchika,Inoue Masahiro,Nakajima Takayuki,Sato Yusuke,Fukuchi Hiroyuki,Sakai Takayuki,Ochi Shigehiro,Yanagawa Noriyuki,Ohtori Seiji Cureus Introduction Lumbar degenerative spondylolisthesis (DS) is one of the most common causes of low back pain. The lumbar muscles, such as the psoas major (PM), erector spinae (ES), and multifidus (MF) muscles, play an important role in the stability and functional movement of the lumbar spine. The quantities and qualities of these muscles may be related to the occurrence of DS and lumbopelvic parameters, such as lumbar lordosis (LL) and sacral slope (SS). However,the influence of lumbar muscles on DS and lumbopelvic alignment is not well understood. Methods Patients with L4 DS (DS group, n=25) and without DS (non-DS group, n=25) were included. Using sagittal reconstructed CT images of patients who visited our hospital for reasons other than low back disorders, LL, upper lumbar lordosis ([ULL] L1-L4), lower lumbar lordosis ([LLL] L4-S1), and SS were examined. To evaluate the quantity and quality of lumbar muscles, the gross cross-sectional area (GCSA), functional cross-sectional area (FCSA), and fat infiltration (FI) of the PM, ES, and MF muscles were measured by CT images. The lumbopelvic parameters, FCSA, GCSA, and FI of lumbar muscles were compared between the two groups. Then, each lumbar muscle parameter was analyzed for correlation with DS and lumbopelvic parameters. Results DS patients displayed significantly greater ULL and lower FI of the PM and ES muscles than non-DS patients (p=0.0078, 0.031, and 0.010, respectively). The FI of the ES muscle was significantly correlated with the presence of DS (p=0.010). The FCSA of the ES and MF muscles and the GCSA of the MF muscle showed a significant correlation with LL and SS in the non-DS group (p<0.05), but not in the DS group.. Conclusion ULL was greater in L4 DS patients, possibly related to the better quality of the ES muscle. All DS patients showed mild (grade I) spondylolisthesis, suggesting the possibility that lumbar muscle quality is better in patients with mild DS than in those without DS. The ES and MF muscles may play an important role in maintaining the lumbar lordotic angle in non-DS patients but not in DS patients. 10.7759/cureus.18428
    Increased serum CXCL10 levels are associated with clinical severity and radiographic progression in patients with lumbar disc degeneration. Clinica chimica acta; international journal of clinical chemistry BACKGROUND:Lumbar intervertebral degenerative disc disease (IDD) is a multifaceted progressive condition that commonly occurs in conjunction with lumbar disc herniation (LDH). CXCL10 mRNA appears to be increased in both IDD and LHD. OBJECTIVE:This study was performed to identify the relationship between serum CXCL10 levels and disease severity in patients with IDD. METHODS:136 IDD patients with low back pain, 127 asymptomatic volunteers and 120 healthy controls were enrolled. Serum CXCL10 protein concentrations were detected using commercial human CXCL10 ELISA Kits. Serum CXCL10 mRNA were examined using qRT-PCR. Clinical severity was assessed using the visual analog scale (VAS) and Oswestry Disability Index(ODI) scores. Radiographic severity was defined using the MRI-based Pfirrmann classification of disc degeneration. Receiver operating characteristic (ROC) curve analysis was used in estimating the correlation between CXCL10 and Pfirrmann grade. The cross-sectional area (CSA) of the lumbar multifidus muscle (LMM) and psoas major (PM) were calculated, and fat infiltration was evaluated by Ropponen-Kjaer criteria. RESULTS:Serum CXCL10 concentrations were markedly raised in IDD patients with low back pain in contrast to asymptomatic individuals and healthy controls. Serum CXCL10 levels were positively associated with Pfirrmann grade. ROC curve analysis indicated that serum CXCL10 correlated well with Pfirrmann grade. In addition, serum CXCL10 concentrations were significantly higher in IDD patients with LMM and PM degeneration compared with IDD patients without degeneration. Increased CXCL10 levels positively correlated with VAS and ODI scores, as well as decreased CSA and fat filtration of the LMM and PM. CONCLUSION:Increased serum CXCL10 levels correspond to clinical severity and radiographic progression in IDD patients. 10.1016/j.cca.2021.12.006
    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
    Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients. Ding Jun-Zhe,Kong Chao,Li Xiang-Yu,Sun Xiang-Yao,Lu Shi-Bao,Zhao Guo-Gunag 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 STUDY DESIGN:A retrospective study. OBJECTIVE:To evaluate the different degeneration patterns of paraspinal muscles in degenerative lumbar diseases and their correlation with lumbar spine degeneration severity. The degeneration characteristics of different paraspinal muscles in degenerative lumbar diseases remain unclear. METHODS:78 patients diagnosed with single-level degenerative lumbar spondylolisthesis (DLS) and 76 patients with degenerative lumbar kyphosis (DLK) were included as DLS and DLK groups. Paraspinal muscle parameters of psoas major (PS), erector spinae (ES) and multifidus muscle (MF) were measured, including fatty infiltration (FI) and relative cross-sectional area (rCSA), namely the ratio of the paraspinal muscle CSA to the CSA of the vertebrae of the same segment. Sagittal parameters including lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. The paraspinal muscle parameters and ES/MF rCSA ratio were compared between the two groups. Paraspinal muscles parameters including rCSA and FI were also compared between each segments from L1 to L5 in both DLS and DLK groups. In order to determine the influence of sagittal spinal alignment on paraspinal muscle parameters, correlation analysis was conducted between the MF, ES, PS rCSA and FI and the LL in DLS and DLK group. RESULT:MF atrophy is more significant in DLS patients compared with DLK. Also, MF fatty infiltration in the lower lumbar spine of DLS patients was greater compared to DLK patients. DLK patients showed more significant atrophy of ES and heavier ES fatty infiltration. MF FI was significantly different between all adjacent segments in both DLS and DLK groups. In DLS group, ES FI was significantly different between L2/L3 to L3/L4 and L4/L5 to L5/S1, while in DLK group, the difference of ES FI between all adjacent segments was not significant, and ES FI was found negatively correlated with LL. CONCLUSIONS:Paraspinal muscles show different degeneration patterns in degenerative lumbar diseases. MF degeneration is segmental in both DLS and DLK patients, while ES degenerated diffusely in DLK patients and correlated with the severity of kyphosis. MF degeneration is more significant in the DLS group, while ES degeneration is more significant in DLK patients. MF is the stabilizer of the lumbar spine segments, while the ES tends to maintain the spinal sagittal balance. 10.1007/s00586-021-07053-2
    Differences between junior and senior male sprinters in physiological variables associated with sprint performance. Yoshimoto Takaya,Takai Yohei,Tsuchie Hiroyasu,Chiba Yoshihiro,Kanehisa Hiroaki The Journal of sports medicine and physical fitness BACKGROUND:The physiological variables associated with sprint performance have been extensively studied. However, little information is available on how the corresponding physiological variables differ between junior and senior sprinters. This study aimed to examine this subject. METHODS:In addition to the maximal running velocity achieved while sprinting over 60-m, body composition, muscle thicknesses of the trunk and lower limbs, performance scores of four jumping tasks (countermovement, rebound, standing long, and standing five-step jumps), and 10-s maximal anaerobic pedaling power were determined in 17 junior and 22 senior male sprinters. RESULTS:In the junior and senior sprinters, most of the measured variables were significantly correlated with the maximal running velocity. Analysis of covariance showed that only the maximal pedaling power relative to the body mass was significantly different between the two groups in the regression equation slope of the relationship with maximal running velocity (0.20 for junior and 0.64 for senior sprinters). Additionally, multiple regression analysis revealed that while the standing five-step jump distance (40 %) and the size of the psoas major muscle (23 %) were selected as explanatory factors for maximal running velocity in the junior sprinters, maximal pedaling power relative to the body mass (63 %) was selected in the senior sprinters. CONCLUSIONS:This study suggests that the following physiological factors associated with sprint running performance differ between the junior and senior sprinters: the ability of repetitive jumping in the horizontal forward direction and muscularity of hip flexors in the junior sprinters versus the anaerobic capacity in senior sprinters. Therefore, coaches and athletes need to take into consideration that the physiological variables to be focused on are different for each generation. 10.23736/S0022-4707.22.13378-5
    Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Seyedhoseinpoor Tahere,Taghipour Mohammad,Dadgoo Mehdi,Sanjari Mohammad Ali,Takamjani Ismail Ebrahimi,Kazemnejad Anoshirvan,Khoshamooz Yasamin,Hides Julie The spine journal : official journal of the North American Spine Society BACKGROUND CONTEXT:Previous studies have proposed that there is a relationship between low back pain (LBP) and morphology and composition of paraspinal muscles. However, results have been conflicting, especially regarding fatty infiltration of muscles. PURPOSE:The primary goal of this study was to review and analyze results from imaging studies which investigated morphological and composition changes in the multifidus, erector spinae and psoas major muscles in people with LBP. STUDY DESIGN/SETTING:Systematic review with meta-analysis. PATIENT SAMPLE:A patient sample was not required OUTCOME MEASURES: This review did not have outcome measures. METHODS:PubMed, Scopus, Web of Sciences, EMBASE and ProQuest were searched for eligible studies up to 31st July 2020 (all languages). A systematic search of electronic databases was conducted to identify studies investigating the association between the morphology and fat content of lumbar muscles in people with LBP compared with a (no LBP) control group. 13,795 articles were identified. Based on the screening for inclusion/ exclusion, 25 were included. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. From the 25 articles, 20 were included in the meta-analysis. RESULTS:Results showed that the total cross-sectional area of the multifidus was smaller in people with LBP (Standardized mean difference, SMD = -0.24, 95% CI = -0.5 to 0.03). Combined SMDs showed a medium effect of LBP on increasing multifidus muscle fat infiltration (SMD = 0.61, 95% CI = 0.30 to 0.91). There were no LBP related differences identified in the morphology or composition of the lumbar erector spine and psoas major muscles. CONCLUSIONS:People with LBP were found to have somewhat smaller multifidus muscles with a significant amount of intramuscular fat infiltration. Varying sample size, age and BMI of participants, quality of studies and the procedures used to measure fat infiltration are possible reasons for inconsistencies in results of previous studies. 10.1016/j.spinee.2021.10.018
    CT psoas calculations on the prognosis prediction of emergency laparotomy: a single-center, retrospective cohort study in eastern Asian population. World journal of emergency surgery : WJES BACKGROUND:Emergency laparotomy (EL) has a high mortality rate. Clinically, frail patients have a poor tolerance for EL. In recent years, sarcopenia has been used as an important indicator of frailty and has received much attention. There have been five different calculation methods of psoas for computed tomography (CT) to measure sarcopenia, but lack of assessment of these calculation methods in Eastern Asian EL patients. METHODS:We conducted a 2-year retrospective cohort study of patients over 18 years of age who underwent EL in our institution. Five CT measurement values (PMI: psoas muscle index, PML3: psoas muscle to L3 vertebral body ratio, PMD: psoas muscle density, TPG: total psoas gauge, PBSA: psoas muscle to body face area ratio) were calculated to define sarcopenia. Patients with sarcopenia defined by the sex-specific lowest quartile of each measurement were compared with the rest of the cohort. The primary outcome was "ideal outcome", defined as: (1) No postoperative complications of Clavien-Dindo Grade ≥ 4; (2) No mortality within 30 days; (3) When discharged, no need for fluid resuscitation and assisted ventilation, semi-liquid diet tolerated, and able to mobilize independently. The second outcome was mortality at 30-days. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were used. RESULTS:Two hundred and twenty-eight patients underwent EL met the inclusion criteria, 192 (84.2%) patients had an ideal outcome after surgery; 32 (14%) patients died within 30 days. Multivariate analysis showed that, except PMD, each calculation method of psoas was independently related to clinical outcome (ideal outcome: PML3, P < 0.001; PMI, P = 0.001; PMD, P = 0.157; TPG, P = 0.006; PBSA, P < 0.001; mortality at 30-days: PML3, P < 0.001; PMI, P = 0.002; PMD, P = 0.088; TPG, P = 0.002; PBSA, P = 0.001). In ROC analysis, the prediction model containing PML3 had the largest area under the curve (AUC) value (AUC value = 0.922 and 0.920, respectively). CONCLUSION:The sarcopenia determined by CT psoas measurements is significantly related to the clinical outcome of EL. The calculation of CT psoas measurement is suitable for application in outcome prediction of EL. In the future, it is necessary to develop a scoring tool that includes sarcopenia to evaluate the risk of EL better. 10.1186/s13017-022-00435-x
    Effects of Spinal Stabilization Exercise on the Cross-sectional Areas of the Lumbar Multifidus and Psoas Major Muscles, Pain Intensity, and Lumbar Muscle Strength of Patients with Degenerative Disc Disease. Kim Seongho,Kim Hyungguen,Chung Jaeyeop Journal of physical therapy science [Purpose] The aim of this study was to evaluate the efficacy of using spinal stabilizing exercise to reduce atrophy of the multifidus and psoas major muscles, reduce the levels of pain and disability, and increase paraspinal muscle strength in patients with degenerative disc disease (DDD). [Subjects and Methods] In 33 patients (Age range: 25-65 years) diagnosed with DDD, spinal stabilization exercise was conducted for 8 weeks. The levels of pain and disability were measured before and after exercise using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Paraspinal muscular strength in four directions was evaluated with a CENTAUR 3D Spatial Rotation Device. Cross-sectional areas (CSAs) of both the left and right multifidus and the psoas major at the upper endplate of L4 were measured before and after exercise using computed tomography (CT). [Results] After 8 weeks of spinal stabilization exercise, the pain and lumbar disability in subjects decreased significantly from 6.12±1.24 to 2.43±1.14. The ODI score also improved from 20.18±7.14 to 8.81±5.73. In addition, paraspinal muscle strength increased significantly, while the CSAs of the left and right multifidus and psoas major widened as compared with the pre-exercise size. [Conclusion] Spinal stabilization exercise was effective for reducing pain and disability in DDD patients. It was an effective adjunct to aid rehabilitation in these cases. 10.1589/jpts.26.579
    Is the Lipid Content of the Psoas Major Correlated with Chronic Low Back Pain and Spinopelvic Alignment? A Magnetic Resonance Spectroscopic Study. Ogon Izaya,Takashima Hiroyuki,Morita Tomonori,Oshigiri Tsutomu,Terashima Yoshinori,Yoshimoto Mitsunori,Emori Makoto,Teramoto Atsushi,Takebayashi Tsuneo,Yamashita Toshihiko Asian spine journal STUDY DESIGN:Cross-sectional observational study. PURPOSE:This study aimed to analyze any potential associations of extramyocellular lipid (EMCL) and intramyocellular lipid (IMCL) contents with (1) the intensity of low back pain (LBP); (2) age, cross-sectional area (CSA), and fatty infiltration (FI) of the psoas major; and (3) spinopelvic parameters. OVERVIEW OF LITERATURE:The psoas major has clinically relevant function; however, the association of this muscle with chronic LBP is controversial. Magnetic resonance spectroscopy enables a detailed analysis of the composition of muscular fat tissues such as its EMCL and IMCL contents. METHODS:The study population comprised 40 patients (19 males, 21 females; mean age, 61.7±2.4 years). Possible correlations of LBP Visual Analog Scale (VAS) scores, age, CSA, FI, and spinopelvic parameters with EMCL and IMCL contents of the psoas major were assessed. RESULTS:No association was identified between the EMCL and IMCL contents and LBP VAS scores (r=0.05, p=0.79 and r=0.06, p=0.75, respectively). The EMCL content correlated with age (r=0.47, p<0.01), body mass index (BMI) (r=0.44, p<0.01), CSA (r=-0.59, p< 0.01), and FI (r=0.49, p<0.01). EMCL content showed a significant negative correlation with sacral slope (SS) (r=-0.43, p<0.05) and positive correlation with pelvic tilt (PT) (r=0.56, p<0.01). CONCLUSIONS:EMCL content correlated with age, BMI, CSA, and FI of the psoas major, while IMCL content had no correlation. This study found correlations between SS and PT and EMCL content of the psoas major, but no correlations were found between spinopelvic parameters and IMCL content of the psoas major. 10.31616/asj.2020.0042
    Density and Fat Fraction of the Psoas, Paraspinal, and Oblique Muscle Groups are Associated with Lumbar Vertebral Bone Mineral Density in a Multi-Ethnic Community-Living Population: The Multi-Ethnic Study of Atherosclerosis. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research Low vertebral bone mass is a major risk factor for vertebral compression fractures. While sarcopenia has been shown to be associated with low bone mineral density (BMD), it is not known whether trunk musculature is directly associated with lumbar BMD, and whether exercise modifies this association. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we sought to determine the association of muscle density and fat fraction of the psoas, paraspinal, and oblique muscle groups with L3 lumbar volumetric BMD, and whether these associations were modified by exercise. We obtained L3 vBMD measurements, and fat and muscle measurements (in Hounsfield units (HU)) from abdominal CT scans spanning L2-L4 intervertebral disc spaces. Muscle density was defined as the mean HU value for a muscle group area. Fat fraction was calculated as the mean HU value for the muscle group fat area/total muscle group area(sq cm). Exercise data were self-reported (MET-min/wk). We utilized multivariable linear regression to evaluate these associations, stratified by gender, and adjusting for demographics, BMI, smoking status, impaired fasting glucose, and corticosteroid and anti-resorptive medication use. Among 1923 MESA participants, mean age was 62 ± 10, 49% were female, 40% White, 21% Black, 26% Hispanic/Latino and 13% Chinese. In fully adjusted analysis, for every 1 SD higher psoas fat fraction, there was a 3.19 SD lower L3 vBMD in men and 4.3 SD lower SD L3 vBMD in women (p < 0.001). For every 1 SD higher psoas density, there was a 0.2 SD higher L3 vBMD (p < 0.001) in men and 0.19 SD higher L3 vBMD (p < 0.001) in women. Findings were similar for paraspinal and oblique muscles. Intentional exercise did not modify these associations. In men and women, trunk muscle density was positively associated with higher lumbar BMD, suggesting a local association. Future studies are warranted to determine the temporality of this association. This article is protected by copyright. All rights reserved. 10.1002/jbmr.4634
    Psoas muscle index predicts osteoporosis and fracture risk in individuals with degenerative spinal disease. Kajiki Yuya,Tsuji Hironori,Misawa Haruo,Nakahara Ryuichi,Tetsunaga Tomoko,Yamane Kentaro,Oda Yoshiaki,Takao Shinichiro,Ozaki Toshifumi Nutrition (Burbank, Los Angeles County, Calif.) OBJECTIVES:Skeletal muscle loss and osteoporosis are major medical and socioeconomic concerns as the global population ages. Studies have reported that skeletal muscle mass correlates to bone mineral density (BMD). The psoas muscle index (PMI), measured as the L3 cross-sectional areas of the right and left psoas divided by the square of height, has a positive correlation with the total volume of skeletal muscle in the body. This study aimed to evaluate relationships between PMI and BMD and fracture risk estimated by the Fracture Risk Assessment Tool (FRAX). METHODS:Preoperatively acquired, plain computed tomography images at the L3 level were used to measure PMI in 87 people with degenerative spinal diseases. We evaluated the correlation between PMI and BMD and fracture risk estimated by FRAX. RESULTS:PMI was significantly correlated with BMD in the entire lumbar spine and femoral neck (r = 0.413 and 0.525, both P < 0.001). People with osteoporosis showed significantly lower PMI than those without (P < 0.05). PMI was also significantly correlated with FRAX score (r = -0.545, P < 0.001). Furthermore, based on the recommendation of osteoporosis treatment, participants were divided into two groups: FRAX ≥15% (R group) and FRAX <15% (C group). The R group showed significantly lower PMI than the C group (P < 0.001). Receiver operating characteristic curve analysis revealed that PMI has moderate accuracy in diagnosing osteoporosis and FRAX ≥15%. CONCLUSIONS:PMI was significantly associated with BMD and fracture risk. PMI measurement is straightforward and may increase the diagnosis rate of osteoporosis and fracture risk. 10.1016/j.nut.2021.111428
    Relationship between Displacement of the Psoas Major Muscle and Spinal Alignment in Patients with Adult Spinal Deformity. Oda Yoshiaki,Takigawa Tomoyuki,Ugawa Ryo,Shiozaki Yasuyuki,Misawa Haruo,Sugimoto Yoshihisa,Tanaka Masato,Ozaki Toshifumi Asian spine journal STUDY DESIGN:Cross sectional study. PURPOSE:To clarify the difference in position of the psoas muscle between adult spinal deformity (ASD) and lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE:Although it is known that the psoas major muscle deviates in ASD patients, no report is available regarding the difference in comparison with LSS patients. METHODS:This study investigates 39 patients. For evaluating spinal alignment, pelvic tilt (PT), pelvic incidence (PI), sacral slope, lumbar lordosis (LL), PI-LL, Cobb angle, and the convex side, the lumbar curves were measured. For measuring the position of the psoas major at the L4/5 disk level, magnetic resonance imaging was used. The displacements of psoas major muscle were measured separately in the anterior-posterior and lateral directions. We examined the relationship between the radiographic parameters and anterior displacement (AD) and lateral displacement (LD) of the psoas major muscle. RESULTS:AD was demonstrated in 15 cases with ASD and nine cases with LSS (>0.05). LD was observed in 13 cases with ASD and no cases with LSS (<0.01). The Cobb angle was significantly greater in cases with AD than in those without AD (=0.04). PT, LL, PI-LL, and Cobb angle were significantly greater in cases with LD (<0.05). All cases with LD had AD, but no case without AD had LD (<0.001). The side of greater displacement at L4/5 and the convex side of the lumbar curve were consistent in all cases. CONCLUSIONS:Despite AD being observed in LSS as well, LD was observed only in the ASD group. Radiographic parameters were worse when LD was seen, rather than AD. 10.4184/asj.2018.12.2.335
    Influence of spinopelvic alignment and morphology on deviation in the course of the psoas major muscle. Tanida Shimei,Fujibayashi Shunsuke,Otsuki Bungo,Masamoto Kazutaka,Matsuda Shuichi Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association BACKGROUND:In some people, the psoas major rises laterally or anteriorly at the L4/5 disc level and detaches from the most posterior aspect of the disc despite the absence of transitional vertebrae; this is called the "rising psoas sign." There are no reports of the relationship between spinopelvic parameters and rising psoas sign. The objective of this study was to investigate the relationship between spinopelvic parameters and deviations in the location and shape of psoas major muscle at the L4/5 disc level. METHODS:We investigated the preoperative location and shape of both psoas major muscles in 64 patients treated with lateral lumbar interbody fusion. Spinopelvic parameters were measured on X-ray films. The morphology of psoas major at the L4/5 disc level was investigated with magnetic resonance images. The morphological measurements were normalized by the anteroposterior diameter of the center of the L4 vertebral body, which was measured by computed tomography. The rising psoas sign was classified into 2 types: bilateral or unilateral. RESULTS:The pelvic incidence (PI) was significantly larger for the bilateral type than the others (normal and unilateral types) (60.2 ± 11.0 vs. 46.7 ± 8.7, p < 0.001). The PI correlated significantly with the normalized anteroposterior diameter of the pelvis (R = 0.66, p < 0.001). The receiver-operator characteristic curve showed an optimal cutoff value of PI = 54, with 75% sensitivity and 78.5% specificity. The coronal L1-4 Cobb angle was significantly larger in the unilateral type than the others (normal and bilateral types) (p < 0.0001). In the unilateral type, the Cobb angle in the recumbent position correlated significantly with the normalized distance of the lateral deviation of psoas major (R = 0.60, p = 0.0085). CONCLUSION:The rising psoas sign was related to a higher PI and lumbar scoliosis. It was firstly elucidated that the spinopelvic alignment and morphology influence the deviation of the course of the psoas major muscle. STUDY DESIGN:A retrospective morphological study. 10.1016/j.jos.2017.08.002
    The psoas muscle index as a predictor of mortality and morbidity of geriatric trauma patients: experience of a major trauma center in Kobe. Nishimura Takeshi,Naito Hiromichi,Fujisaki Noritomo,Ishihara Satoshi,Nakao Atsunori,Nakayama Shinichi Surgery today PURPOSE:An association between the prognoses of trauma and sarcopenia has not been well documented. The purpose of this study was to compare the outcomes of elderly Japanese trauma patients with sarcopenia and those without sarcopenia. METHODS:The medical records of patients aged ≧ 65 years old and Injury Severity Scores above 15 treated for trauma between 2010 and 2017 were reviewed, retrospectively. We measured the psoas muscle index (PMI), defined as the psoas muscle area at the third lumbar vertebra level divided by the body surface area. Patients of each gender with a PMI less than the lower interquartile range were included in the sarcopenia group. A questionnaire was mailed to the patients or their families to collect data on 1-year mortality and activities of daily living. RESULTS:There were 405 patients included in this study: 304 in the non-sarcopenia group (Group NS) and 101 in the sarcopenia group (Group S). Mortality was significantly higher in Group S than in Group NS (NS; 7.9% vs. S; 15.8%, OR, 2.20; 95% CI, 1.12-4.32; p = 0.027). Only 175 of the questionnaires were completed and the responses did not reveal any significant differences between the groups. CONCLUSIONS:Sarcopenia as defined by the PMI may be used as an indicator for mortality risk for geriatric trauma patients. 10.1007/s00595-020-01980-1
    Low psoas major muscle area as a risk factor for contralateral hip fracture following intertrochanteric fracture. Kawakami Takehiro,Imagama Takashi,Murakami Tomotoshi,Kaneoka Takehiro,Yamamoto Manabu Journal of musculoskeletal & neuronal interactions OBJECTIVE:This study aimed to investigate the relationship between the psoas major muscle area as a risk factor and subsequent contralateral hip fractures in patients with initial intertrochanteric fractures. METHODS:Of 136 treated for intertrochanteric fractures, 104 female patients had computed tomography done to assess their fractures at initial stage and had been followed up for more than 2 years. These patients were then divided into 2 groups: i.e. those who had a contralateral hip fracture (CF) (n=16) and those who did not (NF) (n=88) groups. We mainly assessed the relationship between the corrected psoas major muscle area (CPMA) at initial fracture and the occurrence of contralateral hip fracture. RESULTS:The CF group had significantly lower CPMA than the NF group (p=0.001). There was positive correlation between the CPMA and the period from the initial to the contralateral hip fracture in the CF group. The CPMA cutoff value of 480.98 mm2/m2, was showed sensitivity of 63.6% and specificity of 87.5% in receiver operating characteristic curve analysis for all patients. CONCLUSIONS:The lower CPMA was associated with the contralateral hip fracture within 2 years from initial intertrochanteric fracture. The low CPMA would be a risk factor for contralateral hip fracture.
    Assessment of the Cross-Sectional Areas of the Psoas Major and Multifidus Muscles in Patients With Adult Spinal Deformity: A Case-Control Study. Banno Tomohiro,Yamato Yu,Hasegawa Tomohiko,Kobayashi Sho,Togawa Daisuke,Oe Shin,Mihara Yuki,Kurosu Kenta,Yamamoto Naoto,Matsuyama Yukihiro Clinical spine surgery STUDY DESIGN:This is a case-control study. OBJECTIVE:The present study aimed to compare the cross-sectional areas of the psoas major and multifidus muscles between elderly patients with adult spinal deformity (ASD) and age-matched and body weight-matched controls, and to evaluate the associations between the cross-sectional areas of these muscles and the severity of spinal deformity. SUMMARY OF BACKGROUND DATA:The study included 49 female kyphosis patients with mild scoliosis (Cobb angle <20 degrees; mean age, 70.9 y, group D). The control group (group C) included age-matched and body weight-matched female patients who underwent abdominal surgery (n=98; mean age, 71.7 y). MATERIALS AND METHODS:The cross-sectional areas of the bilateral psoas majors and multifidus muscles were calculated using preoperative L4/L5 axial computed tomography images. In group D, the following spinopelvic parameters were assessed: sagittal vertical axis, pelvic tilt, pelvic incidence, lumbar lordosis, and thoracic kyphosis. The relationships between the muscle cross-sectional areas and spinopelvic parameters were evaluated. RESULTS:The cross-sectional area of the multifidus muscle was lower in group D than in group C. However, the cross-sectional area of the psoas major muscle was not different between the 2 groups. In multiple regression analysis, the cross-sectional area of the multifidus muscle was significantly associated with all spinopelvic parameters. CONCLUSIONS:The cross-sectional area of the multifidus muscle might be lower in elderly patients with ASD than in controls. In the elderly population, the severity of sagittal spinal deformity might be correlated with the cross-sectional area of the multifidus muscle. Therefore, muscle imbalances between the flexors and extensors of the spine could participate in the pathology of ASD. 10.1097/BSD.0000000000000480
    Longitudinal study of risk factors for decreased cross-sectional area of psoas major and paraspinal muscle in 1849 individuals. Murata Yoichi,Nakamura Eiichiro,Tsukamoto Manabu,Nakagawa Toru,Takeda Masaru,Kozuma Mio,Kadomura Takayuki,Narusawa Kenichiro,Shimizu Kenji,Uchida Soshi,Hayashi Takeshi,Sakai Akinori Scientific reports This 10-year retrospective observational study investigated longitudinal losses in psoas major and paraspinal muscle area in 1849 healthy individuals (1690 male, 159 female) screened using computed tomography. Logistic regression analysis revealed significant decreases in psoas major and paraspinal muscle area at 10 years relative to the baseline area regardless of age or sex, starting at 30 years of age. Only aging [≥ 50 s (odds ratio [OR]: 1.72; 95% confidence interval [CI] 1.05-2.84; p = 0.03) and ≥ 60 s (OR: 2.67; 95% CI 1.55-4.60; p < 0.001)] was a risk factor for decreases in psoas major area. Age ≥ 60 years (OR: 2.05; 95% CI 1.24-3.39; p = 0.005), body mass index ≥ 25 kg/m (OR: 1.32; 95% CI 1.01-1.73; p = 0.04), and visceral fat ≥ 100 cm (OR: 1.61; 95% CI 1.20-2.15; p = 0.001) were risk factors for decreases in paraspinal muscle area. Physical activity ≥ 900 kcal/week (OR: 0.68; 95% CI 0.50-0.94; p = 0.02) attenuated paraspinal muscle area loss in male. Our study demonstrated that walking > 45 min daily (Calories = METs (walking: 3.0) × duration of time (h) × weight (60 kg) × 1.05) can reduce paraspinal muscle loss, which may in turn decrease the risk of falls, low-back pain, and sarcopenia. 10.1038/s41598-021-96448-8
    Prognostic value of psoas major muscle density in patients with breast cancer metastases to bone: a retrospective single-center cohort study. Yao Hana,Dohzono Sho,Sasaoka Ryuichi,Takamatsu Kiyohito,Nakamura Hiroaki Japanese journal of clinical oncology OBJECTIVE:Although sarcopenia is associated with poor prognosis for cancer patients, the relationship between muscle quantity and quality, and prognosis of breast cancer patients with bone metastases is unclear. This study aims to evaluate the association of muscle parameters, muscle area and density, and overall survival (OS) from the diagnosis of bone metastases in breast cancer patients with bone metastases. METHODS:This study retrospectively investigated the prognostic value of muscle area and density in 90 women who were diagnosed with breast cancer with bone metastases between September 2005 and June 2018. We measured psoas major muscle and paravertebral muscle area and density on single axial computed tomography images at the L3 level and subgrouped the patients into higher or lower groups for each muscle measurement, using median values as cutoffs. We evaluated associations between OS and muscle parameters, using a Cox proportional hazards model adjusted by age and prognostic score for bone metastases (modified Katagiri score). RESULTS:Median OS among patients with lower psoas major muscle density (25 months) was significantly shorter than in the higher psoas major muscle density group (61 months; hazard ratio: 1.79, 95% confidence interval: 1.01-3.16, P = 0.045). However, muscle area and paravertebral muscle density were not associated with OS in this setting. CONCLUSION:Lower psoas major muscle density was a predictor of poor prognosis in patients with breast cancer metastases to bone. The association between psoas major muscle density and prognosis allows wider research into interventions that can prevent loss of muscle density. 10.1093/jjco/hyab166
    A Crucial But Neglected Anatomical Factor Underneath Psoas Muscle and Its Clinical Value in Lateral Lumbar Interbody Fusion-The Cleft of Psoas Major (CPM). Ji Jianfei,Li Fangcai,Chen Qixin Orthopaedic surgery OBJECTIVE:To describe the anatomical feature positioned beneath the psoas muscle at the lateral aspect of the lower lumbar, and to create a new location system to identify the risk factors of lateral lumbar interbody fusion. METHODS:Six cadavers were dissected and analyzed. The anatomy and neurovascular distribution beneath the psoas major from L to S was observed and recorded, with particular focus on the L disc and below. The psoas major surface was divided homogeneously into four parts, from the anterior border of psoas major to the transverse process. The cranial-to-caudal division was from the lower edge of the psoas muscle attachment on the L vertebrae to the upper part of the S vertebrae, and was divided into five segments. Then a grid system was used to create 20 grids on the psoas major surface, from the anterior border of the muscle to the transverse process and from L to superior S , which was used to determine the anatomical structures' distribution and relationship beneath the psoas major. RESULTS:A cleft was identified beneath the psoas major, from the level of L downwards. It was filled with loose connective tissue and neurovascular structures. We termed it the cleft of psoas major (CPM). The sympathetic trunk, ascending lumbar vein, iliolumbar vessels, obturator nerve, femoral nerve and occasionally the great vessels are contained within the CPM, although there is significant interpersonal variation. The grid system on the psoas major surface helped to identify the anatomical structures in CPM. There was a considerably lower frequency of occurrence of neurovascular structures in the grids of I/II at the L level where can be considered the "safe zones" for the lateral lumbar interbody fusion. In contrast, the distribution of neurovascular structures at the L S level is dense, where the operation risk is high. CONCLUSION:The CPM exists lateral to the vertebral surface from L and below. Although the occurrence and distribution of neurovascular structures within the CPM is complex and varies greatly, it can provide a potential cavity for visualization during lateral lumbar interbody fusion. Using psoas major as a reference, this novel grid system can be used to identify the risk factors in CPM and thus identify a safe entry point for surgery. 10.1111/os.13180
    Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease. Archives of orthopaedic and trauma surgery INTRODUCTION:There is a growing number of publications highlighting sarcopenia and myosteatosis as poor prognosic factors for treatment results in oncological patients. The decrease in the cross-sectional area (CSA) of the multifidus muscle and muscle steatosis is associated with lumbar disc herniation and low back/limb pain. Nevertheless, no studies have analyzed the influence of the above parameters on patient satisfaction, pain decrease and return to daily activities. The aim of the study was to verify whether decreased preoperative CSA of the paraspinal and psoas major muscles and their fatty degeneration (myosteatosis) may influence the outcome of surgical treatment of lumbar disc disease (LDD). MATERIALS AND METHODS:One hundred and one patients with LDD undergoing open microdiscectomy were enrolled in the analysis. Relative cross-sectional areas (rCSA) of the paraspinal and psoas major muscles as well as their fatty degeneration were measured. Patients were assessed according to the validated Polish versions of the EURO EQ-5D, Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) 1 and 6 months postoperatively. The association between the variables was calculated using Pearson r and Spearman rank correlation. The Kruskal-Wallis test was used to compare the results between the groups with different rCSA of paraspinal and psoas major muscles and a different degree of paraspinal muscle myosteatosis. RESULTS:Fatty degeneration of the paraspinal muscles correlated with better outcomes 1 and 6 months postoperatively according to ODI (P = 0.003 and P = 0.027, respectively). Patients with higher rCSA of the paraspinal and psoas major muscles achieved better results on the EURO EQ-5D scale (P = 0.0289 and P = 0.0089, respectively). Higher rCSA of the paraspinal and psoas major muscles did not correlate with better outcomes measured using ODI, COMI and VAS scales (P ≥ 0.072). CONCLUSION:The degree of fatty degeneration of the paraspinal muscles correlates with better outcomes 1 and 6 months after microdiscectomy. 10.1007/s00402-021-03754-x
    Automated major psoas muscle volumetry in computed tomography using machine learning algorithms. Duong Felix,Gadermayr Michael,Merhof Dorit,Kuhl Christiane,Bruners Philipp,Loosen Sven H,Roderburg Christoph,Truhn Daniel,Schulze-Hagen Maximilian F International journal of computer assisted radiology and surgery PURPOSE:The psoas major muscle (PMM) volume serves as an opportunistic imaging marker in cross-sectional imaging datasets for various clinical applications. Since manual segmentation is time consuming, two different automated segmentation methods, a generative adversarial network architecture (GAN) and a multi-atlas segmentation (MAS), as well as a combined approach of both, were investigated in terms of accuracy of automated volumetrics in given CT datasets. MATERIALS AND METHODS:The bilateral PMM was manually segmented by a radiologist in 34 abdominal CT scans, resulting in 68 single 3D muscle segmentations as training data. Three different methods were tested for their ability to generate automated image segmentations: a GAN- and MAS-based approach and a combined approach of both methods (COM). Bilateral PMM volume (PMMV) was calculated in cm by each algorithm for every CT. Results were compared to the corresponding ground truth using the Dice similarity coefficient (DSC), Spearman's correlation coefficient and Wilcoxon signed-rank test. RESULTS:Mean PMMV was 239 ± 7.0 cm and 308 ± 9.6 cm, 306 ± 9.5 cm and 243 ± 7.3 cm for the CNN, MAS and COM, respectively. Compared to the ground truth the CNN and MAS overestimated the PMMV significantly (+ 28.9% and + 28.0%, p < 0.001), while results of the COM were quite accurate (+ 0.7%, p = 0.33). Spearman's correlation coefficients were 0.38, 0.62 and 0.73, and the DSCs were 0.75 [95%CI: 0.56-0.88], 0.73 [95%CI: 0.54-0.85] and 0.82 [95%CI: 0.65-0.90] for the CNN, MAS and COM, respectively. CONCLUSION:The combined approach was able to efficiently exploit the advantages of both methods (GAN and MAS), resulting in a significantly higher accuracy in PMMV predictions compared to the isolated implementations of both methods. Even with the relatively small set of training data, the segmentation accuracy of this hybrid approach was relatively close to that of the radiologist. 10.1007/s11548-021-02539-2
    Comment on "The psoas muscle index as a predictor of mortality and morbidity of geriatric trauma patients: experience of a major trauma center in Kobe." Safer Umut,Tasci Ilker,Binay Safer Vildan Surgery today 10.1007/s00595-020-02013-7