Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients

Abstract 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. Summary of background data 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.

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A Deep-Learning–Based, Fully Automated Program to Segment and Quantify Major Spinal Components on Axial Lumbar Spine Magnetic Resonance Imaging

Physical Therapy ◽

10.1093/ptj/pzab041 ◽

2021 ◽

Author(s):

Haotian Shen ◽

Jiawei Huang ◽

Qiangqiang Zheng ◽

Zhiwei Zhu ◽

Xiaoqiang Lv ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Deep Learning ◽

Lumbar Spine ◽

Magnetic Resonance ◽

Spinal Canal ◽

Erector Spinae ◽

Paraspinal Muscle ◽

Resonance Imaging ◽

Paraspinal Muscles ◽

Quantitative Measurements

Abstract Objective The paraspinal muscles have been extensively studied on axial lumbar magnetic resonance imaging (MRIs) for better understanding of back pain; however, the acquisition of measurements mainly relies on manual segmentation, which is time consuming. The study objective was to develop and validate a deep-learning–based program for automated acquisition of quantitative measurements for major lumbar spine components on axial lumbar MRIs, the paraspinal muscles in particular. Methods This study used a cross-sectional observational design. From the Hangzhou Lumbar Spine Study, T2-weighted axial MRIs at the L4–5 disk level of 120 participants (aged 54.8 y [SD = 15.0]) were selected to develop the deep-learning–based program Spine Explorer (Tulong). Another 30 axial lumbar MRIs were automatically measured by Spine Explorer and then manually measured using ImageJ to acquire quantitative size and compositional measurements for bilateral multifidus, erector spinae, and psoas muscles; the disk; and the spinal canal. Intersection-over-union and Dice score were used to evaluate the performance of automated segmentation. Intraclass coefficients (ICCs) and Bland–Altman plots were used to examine intersoftware agreements for various measurements. Results After training, Spine Explorer (Tulong) measures an axial lumbar MRI in 1 second. The intersections-over-union were 83.3% to 88.4% for the paraspinal muscles, 92.2% and 82.1% for the disk and spinal canal, respectively. For various size and compositional measurements of paraspinal muscles, Spine Explorer (Tulong) was in good agreement with ImageJ (ICC = 0.85 ~ 0.99). Impact Spine Explorer (Tulong) is automated, efficient, and reliable in acquiring quantitative measurements for the paraspinal muscles, the disk, and the canal, and various size and compositional measurements were simultaneously obtained for the lumbar paraspinal muscles. Such an automated program might encourage further epidemiological studies of the lumbar paraspinal muscle degeneration and enhance paraspinal muscle assessment in clinical practice.

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Association Between Deep Posterior Cervical Paraspinal Muscle Morphology and Clinical Features in Patients With Cervical Ossification of the Posterior Longitudinal Ligament

Global Spine Journal ◽

10.1177/2192568221989655 ◽

2021 ◽

pp. 219256822198965

Author(s):

Toru Doi ◽

Nozomu Ohtomo ◽

Fumihiko Oguchi ◽

Keiichiro Tozawa ◽

Hiroyuki Nakarai ◽

...

Keyword(s):

Clinical Features ◽

Fatty Infiltration ◽

Neck Disability Index ◽

Posterior Longitudinal Ligament ◽

Paraspinal Muscle ◽

Paraspinal Muscles ◽

Muscle Area ◽

Cross Sectional ◽

Study Results ◽

Neck Disability

Study Design: A retrospective observational study. Objective: To clarify the association of the paraspinal muscle area and composition with clinical features in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods: Consecutive patients with cervical OPLL who underwent cervical magnetic resonance imaging (MRI) before surgery were reviewed. The cross-sectional area (CSA) and fatty infiltration ratio (FI%) of deep posterior cervical paraspinal muscles (multifidus [MF] and semispinalis cervicis [SCer]) were examined. We assessed the association of paraspinal muscle measurements with the clinical characteristics and clinical outcomes, such as Neck Disability Index (NDI) score. Moreover, we divided the patients into 2 groups according to the extent of the ossified lesion (segmental and localized [OPLL-SL] and continuous and mixed [OPLL-CM] groups) and compared these variables between the 2 groups. Results: 49 patients with cervical OPLL were enrolled in this study. The FI% of the paraspinal muscles was significantly associated with the number of vertebrae ( ρ = 0.283, p = 0.049) or maximum occupancy ratio of OPLL ( ρ = 0.397, p = 0.005). The comparative study results indicated that the NDI score was significantly worse (OPLL-SL, 22.9 ± 13.7 vs. OPLL-CM, 34.4 ± 13.7) and FI% of SCer higher (OPLL-SL, 9.1 ± 1.7% vs. OPLL-CM, 11.1 ± 3.7%) in the OPLL-CM group than those in the OPLL-SL group. Conclusions: Our results suggest that OPLL severity may be associated with fatty infiltration of deep posterior cervical paraspinal muscles, which could affect neck disability in patients with cervical OPLL.

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Statistical morphological analysis reveals characteristic paraspinal muscle asymmetry in unilateral lumbar disc herniation

Scientific Reports ◽

10.1038/s41598-021-95149-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yiming Xiao ◽

Maryse Fortin ◽

Joshua Ahn ◽

Hassan Rivaz ◽

Terry M. Peters ◽

...

Keyword(s):

Shape Analysis ◽

Disc Herniation ◽

Lumbar Disc ◽

Fatty Infiltration ◽

Erector Spinae ◽

Paraspinal Muscle ◽

Leg Pain ◽

Statistical Shape Analysis ◽

Muscle Morphology ◽

Statistical Shape

AbstractGrowing evidence suggests an association of lumbar paraspinal muscle morphology with low back pain (LBP) and lumbar pathologies. Unilateral spinal disorders provide unique models to study this association, with implications for diagnosis, prognosis, and management. Statistical shape analysis is a technique that can identify signature shape variations related to phenotypes but has never been employed in studying paraspinal muscle morphology. We present the first investigation using this technique to reveal disease-related paraspinal muscle asymmetry, using MRIs of patients with a single posterolateral disc herniation at the L5-S1 spinal level and unilateral leg pain. Statistical shape analysis was conducted to reveal disease- and phenotype-related morphological variations in the multifidus and erector spinae muscles at the level of herniation and the one below. With the analysis, shape variations associated with disc herniation were identified in the multifidus on the painful side at the level below the pathology while no pathology-related asymmetry in cross-sectional area (CSA) and fatty infiltration was found in either muscle. The results demonstrate higher sensitivity and spatial specificity for the technique than typical CSA and fatty infiltration measures. Statistical shape analysis holds promise in studying paraspinal muscle morphology to improve our understanding of LBP and various lumbar pathologies.

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Incidence and Risk Factors of Proximal Junctional Kyphosis in Elderly Patients Over 65 Years of Age with Degenerative Spinal Diseases

10.21203/rs.3.rs-241614/v1 ◽

2021 ◽

Author(s):

Junzhe Ding ◽

Chao Kong ◽

Weiguo Zhu ◽

Shibao Lu

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Fatty Infiltration ◽

The Elderly ◽

Erector Spinae ◽

Paraspinal Muscle ◽

Multifidus Muscle ◽

Cross Sectional ◽

Age At Surgery

Abstract Background. The mechanisms and risk factors for proximal junctional kyphosis of elderly patients may differ from those of non-elderly patients. The risk factors for PJK in the elderly population remain unclear. Methods. The present study enrolled elderly DSD patients over 65 years of age who underwent thoracolumbar fusion with no less than 3 levels fused. All patients underwent CT and MRI scans preoperatively, and full spine standing X-ray preoperatively, postoperatively and during follow-up with a minimum follow-up of 18 month. Paraspinal muscle cross-sectional area(CSA) and paraspinal muscle fatty infiltration(FI) of erector spinae(ES) and multifidus muscle(MF), LL, PI, PT, SS, PI-LL and vertebra CT HU value were measured. Radiological PJK was defined as a sagittal Cobb angle between the UIV and the two levels above the UIV (UIV+2) of 10° or greater and at least 10° greater than the preoperative measurement. Parameters were compared between PJK and Non-PJK patients.Result. A total of 259 patients were enrolled. The prevalence of PJK was 35.9%. Compared with Non-PJK group, PJK group had significantly older age at surgery, greater BMI, lower vertebra CT value and greater PI and a larger PI-LL mismatch. Both erector spinae(ES) and multifidus muscle(MF) relative cross-sectional area(rCSA) of PJK patients were significantly smaller, the ES and MF fatty infiltration(FI) were significantly greater than the Non-PJK patients. Older age at surgery, greater BMI, greater PI, smaller MF rCSA, greater ES and MF FI and smaller CT value were independent risk factors for PJK in elderly patient population.Conclusions. For elderly patients with DSD, PJK is a commonly seen complication. Higher age at surgery, larger BMI, significant paraspinal muscle degeneration and low bone mineral density are risk factors for PJK. Appropriate preoperative and postoperative measures are beneficial for reducing the risk of PJK in the elderly.

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Contribution of Lumbar Spine Pathology and Age to Paraspinal Muscle Size and Fatty Infiltration

Spine ◽

10.1097/brs.0000000000001848 ◽

2017 ◽

Vol 42 (8) ◽

pp. 616-623 ◽

Cited By ~ 45

Author(s):

Bahar Shahidi ◽

Callan L. Parra ◽

David B. Berry ◽

James C. Hubbard ◽

Sara Gombatto ◽

...

Keyword(s):

Lumbar Spine ◽

Fatty Infiltration ◽

Paraspinal Muscle ◽

Muscle Size ◽

Spine Pathology

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Assessing Fatty Infiltration of Paraspinal Muscles in Patients With Lumbar Spinal Stenosis: Goutallier Classification and Quantitative MRI Measurements

Frontiers in Neurology ◽

10.3389/fneur.2021.656487 ◽

2021 ◽

Vol 12 ◽

Author(s):

Filippo Mandelli ◽

Corina Nüesch ◽

Yuancheng Zhang ◽

Florian Halbeisen ◽

Stefan Schären ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Vertebral Body ◽

Fatty Infiltration ◽

Paraspinal Muscle ◽

Paraspinal Muscles ◽

Cross Sectional ◽

Goutallier Classification ◽

Lumbar Spinal ◽

Mri Measurements

Objective: Fatty infiltration of paraspinal muscle is associated with spinal disorders. It can be assessed qualitatively (i.e., Goutallier classification) and quantitatively using image processing software. The aims of this study were to compare paraspinal muscle fatty infiltration as assessed using the Goutallier classification vs. quantitative magnetic resonance images (MRI) measurements and to investigate the association between anthropometric parameters and paraspinal muscle morphology and fatty infiltration in patients with symptomatic lumbar spinal stenosis (LSS).Methods: Patients affected by symptomatic LSS scheduled for surgery with available MRI of the lumbar spine were included in this retrospective cross-sectional study. Fatty infiltration at each lumbar level was rated qualitatively according to the Goutallier classification and quantified based on the cross-sectional area (CSA) of the paraspinal muscle, of its lean fraction (LeanCSA), and the ratio between LeanCSA and CSA and the CSA relative to the CSA of vertebral body (RCSA). Considering the muscle as a single unit, overall fatty infiltration according to Goutallier, overall CSA, LeanCSA, LeanCSA/CSA, and RCSA were computed as averages (aGoutallier, aCSA, aLeanCSA, aLeanCSA/aCSA, and aRCSA). Associations among parameters were assessed using Spearman's respective Pearson's correlation coefficients.Results: Eighteen patients, with a mean age of 71.3 years, were included. aGoutallier correlated strongly with aLeanCSA and aLeanCSA/aCSA (R = −0.673 and R = −0.754, both P < 0.001). There was a very strong correlation between values of the left and right sides for CSA (R = 0.956, P < 0.001), LeanCSA (R = 0.900, P < 0.001), and LeanCSA/CSA (R = 0.827, P < 0.001) at all levels. Among all anthropometric measurements, paraspinal muscle CSA correlated the most with height (left: R = 0.737, P < 0.001; right: R = 0.700, P < 0.001), while there was a moderate correlation between vertebral body CSA and paraspinal muscle CSA (left: R = 0.448, P < 0.001; right: R = 0.454, P < 0.001). Paraspinal muscle CSA correlated moderately with body mass index (BMI; left: R = 0.423, P < 0.001; right: R = 0.436, P < 0.001), and there was no significant correlation between aLeanCSA or aLeanCSA/CSA and BMI.Conclusions: The Goutallier classification is a reliable yet efficient tool for assessing fatty infiltration of paraspinal muscles in patients with symptomatic LSS. We suggest taking body height as a reference for normalization in future studies assessing paraspinal muscle atrophy and fatty infiltration.

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The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04943-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Geng-Xiong Lin ◽

Yan-Ming Ma ◽

Yong-Chun Xiao ◽

Dian Xiang ◽

Jian-Xian Luo ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Internal Fixation ◽

Fatty Infiltration ◽

Operation Time ◽

Low Back ◽

Paraspinal Muscles ◽

Cross Sectional ◽

Vas Score ◽

Adjacent Segments

Abstract Background The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases. Methods This study retrospectively collected 52 patients who underwent lumbar surgery with the K-rod group or PLIF. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative exercise time were compared in the two groups. The visual analog scale (VAS) score and the oswestry dysfunction index (ODI) were employed to evaluate the clinical outcomes. The functional cross-sectional area (FCSA) of the paraspinal muscles and paraspinal muscles fat infiltration were measured to assess on the paraspinal muscles. Results As compared with the PLIF group, the operation time, the postoperative time in the field, and the average postoperative hospital stay in the K-rod internal fixation group were significantly shortened. At the last follow-up, both the groups showed significant improvement in the VAS score and ODI. The FCSA atrophy of the upper and lower adjacent segments (UAS and LAS) of the K-rod internal group was significantly less than that of the PLIF group. The extent of increase in the fatty infiltration of the paraspinal muscles in the K-rod group was significantly lesser than that in the PLIF group. The postoperative low back pain of the two groups of patients was significantly positively correlated with the FCSA atrophy. Conclusions As compared to PLIF, the posterior lumbar unilateral K-rod dynamic internal fixation showed significantly lesser paraspinal muscle atrophy and fatty infiltration, which were significantly positively correlated with postoperative low back pain.

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The Effect of Posterior Lumbar Dynamic Fixation and Intervertebral Fusion on Paraspinal Muscles

10.21203/rs.3.rs-800229/v1 ◽

2021 ◽

Author(s):

Geng-Xiong Lin ◽

Yan-Ming Ma ◽

Rong-Sheng Wang ◽

Dian Xiang ◽

Jian-xian Luo ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Internal Fixation ◽

Fatty Infiltration ◽

Operation Time ◽

Low Back ◽

Paraspinal Muscles ◽

Cross Sectional ◽

Vas Score ◽

Adjacent Segments

Abstract Background: The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases. Methods: This study retrospectively collected 52 patients who underwent lumbar surgery with the K-rod group or PLIF. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative exercise time were compared in the two groups. The visual analog scale (VAS) score and the oswestry dysfunction index (ODI) were employed to evaluate the clinical outcomes. The functional cross-sectional area (FCSA) of the paraspinal muscles and paraspinal muscles fat infiltration were measured to assess on the paraspinal muscles. Results: As compared with the PLIF group, the operation time, the postoperative time in the field, and the average postoperative hospital stay in the K-rod internal fixation group were significantly shortened. At the last follow-up, both the groups showed significant improvement in the VAS score and ODI. The FCSA atrophy of the upper and lower adjacent segments (UAS and LAS) of the K-rod internal group was significantly less than that of the PLIF group. The extent of increase in the fatty infiltration of the paraspinal muscles in the K-rod group was significantly lesser than that in the PLIF group. The postoperative low back pain of the two groups of patients was significantly positively correlated with the FCSA atrophy.Conclusions: As compared to PLIF, the posterior lumbar unilateral K-rod dynamic internal fixation showed significantly lesser paraspinal muscle atrophy and fatty infiltration, which were significantly positively correlated with postoperative low back pain.

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Fatty infiltration of paraspinal muscles is associated with bone mineral density of the lumbar spine

Archives of Osteoporosis ◽

10.1007/s11657-019-0639-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Yinxia Zhao ◽

Mingqian Huang ◽

Mario Serrano Sosa ◽

Renee Cattell ◽

Wei Fan ◽

...

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

Bone Mineral ◽

Fatty Infiltration ◽

Paraspinal Muscles ◽

Mineral Density

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Patients With Becker Muscular Dystrophy Have Severe Paraspinal Muscle Involvement

Frontiers in Neurology ◽

10.3389/fneur.2021.613483 ◽

2021 ◽

Vol 12 ◽

Author(s):

Aisha M. Sheikh ◽

Karen Rudolf ◽

Josefine de Stricker Borch ◽

Tahmina Khawajazada ◽

Nanna Witting ◽

...

Keyword(s):

Muscular Dystrophy ◽

Becker Muscular Dystrophy ◽

Erector Spinae ◽

Paraspinal Muscle ◽

Paraspinal Muscles ◽

Muscle Mri ◽

Cross Sectional ◽

Muscle Involvement ◽

Fat Replacement ◽

Fat Fraction

Introduction: Paraspinal muscles are important for gross motor functions. Impairment of these muscles can lead to poor postural control and ambulation difficulty. Little knowledge exists about the involvement of paraspinal muscles in Becker muscular dystrophy.Objective: In this cross-sectional study, we investigated the involvement of paraspinal muscles with quantitative trunk strength measure and quantitative muscle MRI.Methods and Materials: Eighteen patients with Becker muscular dystrophy underwent trunk, hip, and thigh strength assessment using a Biodex dynamometer and an MRI Dixon scan. Fourteen age- and body mass index-matched healthy men were included for comparison.Results: Muscle fat fraction (FF) of the paraspinal muscles (multifidus and erector spinae) was higher in participants with Becker muscular dystrophy vs. healthy controls at all three examined spinal levels (C6, Th12, and L4/L5) (p < 0.05). There was a strong and inverse correlation between paraspinal muscle FF and trunk extension strength (ρ = −0.829, p < 0.001), gluteus maximus FF and hip extension strength (ρ = −0.701, p = 0.005), FF of the knee extensor muscles (quadriceps and sartorius) and knee extension strength (ρ = −0.842, p < 0.001), and FF of the knee flexor muscles (hamstring muscles) and knee flexion strength (ρ = −0.864, p < 0.001). Fat fraction of the paraspinal muscles also correlated with muscle FF of the thigh muscles and lower leg muscles.Conclusion: In conclusion, patients with Becker muscular dystrophy demonstrate severe paraspinal muscular involvement indicated by low back extension strength and high levels of fat replacement, which parallel involvement of lower limb muscles. Assessment of paraspinal muscle strength and fat replacement may serve as a possible biomarker for both the clinical management and further study of the disease.

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