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We observed that multifidus atrophy, rather than intervertebral disc swelling, associated strongly with lumbar flattening and increased stiffness. Because these changes have been previously linked with detrimental spine biomechanics and pain in terrestrial populations, when combined with evidence of pre-flight vertebral end plate insufficiency, they may elevate injury risk for astronauts upon return to gravity loading. Our results also have implications for deconditioned spines on Earth. We anticipate that our results will inform new astronaut countermeasures that target the multifidus muscles, and research on the role of muscular stability in relation to chronic low back pain and disc injury.

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Study Design-Cross-sectional cohort study of chronic low back pain (CLBP) patients and matched controls.Objective-To explore the interplay between vertebral endplate damage and adjacent paraspinal muscle (PSM) quality, and to test their association in a cohort of patients with chronic low back pain (CLBP) and matched controls. Summary of BackgroundData-Non-specific CLBP is challenging to diagnose, in part, due to uncertainty regarding the source of pain. Delineating interactions among potential CLBP mechanisms may enhance diagnosis and treatment customization.Methods-We collected advanced MRI imaging on 52 adult subjects, including 38 CLBP patients and 14 age-and sex-matched asymptomatic control subjects. Mean multifidus and erector spinae fat fraction (FF) was measured throughout the spine using an IDEAL MRI sequence. Presence of cartilage endplate (CEP) defects was determined at each disc level using UTE MRI. Logistic regression was used to test association of PSM FF, CEP defects, modic changes (MC), disc degeneration, and their interplay.Results-We observed that CEP defects were the strongest predictor of non-specific CLBP (OR: 14.1, p<0.01) even after adjusting for MC and disc degeneration (OR: 26.1, p=0.04). PSM quality did not independently distinguish patient and control groups, except for patients with high selfreported disability.At specifically L4L5, CEP damage was most prevalent and CEP damage was significantly associated with CLBP (OR: 3.7, 95%CI: 1.2-21.5, p=0.03). CEP damage at L4L5 was predictive