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

Mandelli, Filippo; Nüesch, Corina; Zhang, Yuancheng; Halbeisen, Florian S.; Schären, Stefan; Netzer, Cordula

doi:10.3389/fneur.2021.656487

Cited by 29 publications

(27 citation statements)

References 48 publications

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“…However, another study found no association between E-selectin levels and pain or pain-related function in an older adult cohort with disc degeneration [ 9 ]. Our study highlights that pain levels in acute and subacute LBP patients may be associated with heightened levels of E-selectin, thus adding evidence to an area of research that needs clarification [ 37 – 40 ].…”

Section: Discussionmentioning

confidence: 83%

The association of biomarkers with pain and function in acute and subacute low back pain: a secondary analysis of an RCT

Enrico

Schneider

Haas

et al. 2022

BMC Musculoskelet Disord

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Background Low back pain (LBP) is a common musculoskeletal condition and a major cause of disability worldwide. Previous studies have found associations of biomarkers with pain and pain-related disability in LBP patients. This study aimed to explore the association between serum biomarkers and pain and disability in patients with acute or subacute axial LBP. Methods This study was ancillary to a parent randomized controlled trial. Enrolled participants were randomized into three intervention groups: one of two types of spinal manipulation or medical care. In the parent study, 107 adults who experienced a new episode of LBP within 3 months prior to enrollment were recruited. For this study, 90 of these 107 participants consented to have blood samples obtained, which were drawn immediately before the beginning of treatment. Seven biomarkers were chosen based on previous literature and analyzed. Clinical outcomes were pain and Oswestry Disability Index (ODI) evaluated at baseline and 4 weeks. Spearman’s |r| was used to study the association of initial levels of each biomarker with pain and ODI scores at baseline and with changes in outcome scores from baseline to 4 weeks (end of treatment) within each intervention group. Results At baseline, 4 of 7 biomarkers had an association with pain that was |r| ≥ .20: neuropeptide Y (NPY) (r = 0.23, p = .028), E-Selectin (r = 0.22, p = .043), vitamin D ((r = − 0.32, p = .002), and c-reactive protein (CRP) (r = 0.37, p = .001). No baseline biomarker had an association with disability that was |r| ≥ 0.20. For the correlations of baseline biomarkers with 4-week change in outcomes, vitamin D showed a correlation with change in disability and/or pain (|r| ≥ 0.20, p > .05) in manipulation-related groups, while CRP, NPY, and E-selectin along with TNFα, Substance P and RANTES showed at least one correlation with change in pain or disability (|r| ≥ 0.20, p > .05) in at least one of the treatment groups. Conclusions In 90 LBP patients, the analyzed biomarkers, especially vitamin D, represent a small set of potential candidates for further research aimed at individualizing patient care. Overall, the associations investigated in the current study are an initial step in identifying the direct mechanisms of LBP and predicting outcomes of manipulation-related treatments or medical care. Trial registration ClinicalTrials.gov Identifier: NCT01211613, Date of Registration: September 29, 2010, https://clinicaltrials.gov/ct2/show/NCT01211613?term=schneider&cond=Low+Back+Pain&cntry=US&state=US%3APA&draw=2&rank=1

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Section: Discussionmentioning

confidence: 83%

The association of biomarkers with pain and function in acute and subacute low back pain: a secondary analysis of an RCT

Enrico

Schneider

Haas

et al. 2022

BMC Musculoskelet Disord

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“…( 28 ) Wu and colleagues reported that visual dual‐energy CT assessment using the Goutallier classification could distinguish severe from normal and moderate fat infiltration of lumbar paravertebral muscles in subjects with low back pain. ( 13 ) Several prior studies have reported that the Goutallier classification correlated strongly with quantitative measurements ( 29,30 ) and that the Goutallier classification and quantitative measures had comparable diagnostic efficiency without a statistically significant difference. ( 28,31 ) Despite the widespread use and diagnostic value of the Goutallier classification system, there is currently no study comparing its effectiveness in predicting the risk of hip refracture to that of quantitative muscle parameters.…”

Section: Discussionmentioning

confidence: 95%

Associations of Quantitative and Qualitative Muscle Parameters With Second Hip Fracture Risk in Older Women: A Prospective Cohort Study

Zhang,

Ge,

Liu

et al. 2023

JBMR Plus

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Older women with a first hip fracture exhibit heightened susceptibility and incidence of second fracture and potentially severe consequences. This prospective study was to compare the predictive power of qualitative and quantitative muscle parameters for a second hip fracture in older women with a first hip fracture. A total of 206 subjects were recruited from the longitudinal Chinese Second Hip Fracture Evaluation study. Hip computed tomography (CT) scans were obtained immediately after the first fracture. Muscle fat infiltration was assessed according to the Goutallier classification qualitatively. Quantitative parameters included cross‐sectional area and density of gluteus maximus (G.MaxM) and gluteus medius and minimus (G.Med/MinM) muscles. CT X‐ray absorptiometry was used to measure the areal bone mineral density (aBMD) of the contralateral femur. Cox proportional hazards models were used to compute hazard ratios (HR) of second hip fracture risk. The mean age of subjects was 74.9 (±9.5) years at baseline. After 4.5 years, 35 had a second hip fracture, 153 without a second hip fracture, and 18 died. Except for the combined G.MinM Goutallier grade 3 and 4 groups before adjustment for covariates (HR = 5.83; 95% confidence interval [CI] 1.49–22.83), there were no significant HRs for qualitative classification to predict a second hip fracture. Among quantitative metrics, after adjustment for covariates, G.Med/MinM density was significant in the original (HR = 1.44; CI 1.02–2.04) and competing risk analyses (HR = 1.46; CI 1.02–2.07). After additional adjustment for femoral neck (FN) aBMD, G.Med/MinM density remained borderline significant for predicting a second hip fracture in competing risk analysis (HR = 1.43; CI 0.99–2.06; p = 0.057). Our study revealed that Goutallier classification was less effective than quantitative muscle metrics for predicting hip second fracture in this elderly female cohort. After adjustment for FN aBMD, G.Med/MinM density is a borderline independent predictor of second hip fracture risk. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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“…Several studies have examined the relationship between fatty infiltration of the paraspinal muscles and symptoms of degenerative diseases of the lumbar spine [ 6 , 15 , 23 , 44 , 45 ], but not all studies have considered the role of the PM muscle in this relationship [ 6 , 15 , 45 ]. To estimate the degree of fatty imbalance between the PM and the paraspinal muscles, we calculated the MFI by dividing the signal intensity of the PM with that of the MF and ES.…”

Section: Discussionmentioning

confidence: 99%

A novel MRI index for paraspinal muscle fatty infiltration: reliability and relation to pain and disability in lumbar spinal stenosis: results from a multicentre study

et al. 2022

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Background Fatty infiltration of the paraspinal muscles may play a role in pain and disability in lumbar spinal stenosis. We assessed the reliability and association with clinical symptoms of a method for assessing fatty infiltration, a simplified muscle fat index (MFI). Methods Preoperative axial T2-weighted magnetic resonance imaging (MRI) scans of 243 patients aged 66.6 ± 8.5 years (mean ± standard deviation), 119 females (49%), with symptomatic lumbar spinal stenosis were assessed. Fatty infiltration was assessed using both the MFI and the Goutallier classification system (GCS). The MFI was calculated as the signal intensity of the psoas muscle divided by that of the multifidus and erector spinae. Observer reliability was assessed in 102 consecutive patients for three independent investigators by intraclass correlation coefficient (ICC) and 95% limits of agreement (LoA) for continuous variables and Gwet’s agreement coefficient (AC1) for categorical variables. Associations with patient-reported pain and disability were assessed using univariate and multivariate regression analyses. Results Interobserver reliability was good for the MFI (ICC 0.79) and fair for the GCS (AC1 0.33). Intraobserver reliability was good or excellent for the MFI (ICC range 0.86–0.91) and moderate to almost perfect for the GCS (AC1 range 0.55–0.92). Mean interobserver differences of MFI measurements ranged from -0.09 to -0.04 (LoA -0.32 to 0.18). Adjusted for potential confounders, none of the disability or pain parameters was significantly associated with MFI or GCS. Conclusion The proposed MFI demonstrated high observer reliability but was not associated with preoperative pain or disability.

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

Cited by 29 publications

References 48 publications

The association of biomarkers with pain and function in acute and subacute low back pain: a secondary analysis of an RCT

The association of biomarkers with pain and function in acute and subacute low back pain: a secondary analysis of an RCT

Associations of Quantitative and Qualitative Muscle Parameters With Second Hip Fracture Risk in Older Women: A Prospective Cohort Study

A novel MRI index for paraspinal muscle fatty infiltration: reliability and relation to pain and disability in lumbar spinal stenosis: results from a multicentre study

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