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; Mündermann, Annegret; Netzer, Cordula

doi:10.1016/j.bas.2021.100100

Cited by 4 publications

(9 citation statements)

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“…Since it is known that proinflammatory mediators initiate and accelerate the process of IVDD [44], there may be a link between myosteatosis and IVDD. Numerous previous studies reported an association between paraspinal myosteatosis and IVDD [8,9,[45][46][47][48]. In line with these findings, we also report a significant positive association between paraspinal PDFF and IVDD.…”

Section: Discussionsupporting

confidence: 92%

Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study

et al. 2022

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Objective To assess the association of lumbar bone marrow adipose tissue fat fraction (BMAT-FF) and paraspinal muscle proton density fat fraction (PDFF) and their interplay with intervertebral disc degeneration (IVDD). Methods In this retrospective cross-sectional study based on a prospective population-based cohort, BMAT-FF and PDFF of asymptomatic individuals were calculated based on 3T-MRI dual-echo and multi-echo Dixon VIBE sequences. IVDD was assessed at motion segments L1 to L5 and dichotomized based on Pfirrmann grade ≥ 4 and/or presence of other severe degenerative changes or spinal abnormalities at least at one segment. Pearson’s correlation coefficients were calculated for BMAT-FF and PDFF. Univariable and multivariable logistic regression models for IVDD were calculated. Results Among 335 participants (mean age: 56.2 ± 9.0 years, 43.3% female), the average BMI was 27.7 ± 4.5 kg/m2 and the prevalence of IVDD was high (69.9%). BMAT-FF and PDFF were significantly correlated (r = 0.31–0.34; p < 0.001). The risk for IVDD increased with higher PDFF (OR = 1.45; CI 1.03, 2.04) and BMAT-FF (OR = 1.56; CI 1.16, 2.11). Pairwise combinations of PDFF and BMAT-FF quartiles revealed a lower risk for IVDD in individuals in the lowest BMAT-FF and PDFF quartile (OR = 0.21; CI 0.1, 0.48). Individuals in the highest BMAT-FF and PDFF quartile showed an increased risk for IVDD (OR = 5.12; CI 1.17, 22.34) Conclusion Lumbar BMAT-FF and paraspinal muscle PDFF are correlated and represent both independent and additive risk factors for IVDD. Quantitative MRI measurements of paraspinal myosteatosis and vertebral bone marrow fatty infiltration may serve as imaging biomarkers to assess the individual risk for IVDD. Key Points • Fat composition of the lumbar vertebral bone marrow is positively correlated with paraspinal skeletal muscle fat. • Higher fat-fractions of lumbar vertebral bone marrow and paraspinal muscle are both independent as well as additive risk factors for intervertebral disc degeneration. • Quantitative magnetic resonance imaging measurements of bone marrow and paraspinal muscle may serve as imaging biomarkers for intervertebral disc degeneration.

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Section: Discussionsupporting

confidence: 92%

Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study

et al. 2022

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“…In this study, obesity was associated with an increased risk of developing lumbar canal stenosis but was not associated with an increased risk of other spinal degenerative changes. Although such results need to be evaluated with caution because of the relatively limited sample size, they have not been affected by differences in the measured level, as in the previous studies, 5,25 where the qualitative or quantitative analysis of the muscle was restricted to only a single lumbar level. 24 FI seems to increase linearly with age for both sexes, with lumbar paravertebral values higher in women 23 and generally increasing from cranial to caudal, 26,27 with L4 and L5 being the most affected segments regardless of age.…”

Section: Discussionmentioning

confidence: 78%

“…2,3 Several authors have measured the muscles' CSA, density, or segmental fatty infiltration (FI) using computer tomography (CT) or magnetic resonance imaging (MRI). 2,3,[5][6][7] Measuring the CSA as a surrogate for muscle atrophy fails to capture internal architectural derangements, such as fat replacement. 5,7 Furthermore, a few authors have attempted a quantitative analysis of FI in the paraspinal muscle complex, mainly focusing on segmental analysis.…”

Section: Introductionmentioning

confidence: 99%

“…2,3,[5][6][7] Measuring the CSA as a surrogate for muscle atrophy fails to capture internal architectural derangements, such as fat replacement. 5,7 Furthermore, a few authors have attempted a quantitative analysis of FI in the paraspinal muscle complex, mainly focusing on segmental analysis. 7 We collected and analyzed clinical, structural, and spinopelvic parameters, such as intervertebral disc height, Modic changes, disc degeneration, stenosis degree, spondylolisthesis, lordosis, pelvic tilt (PT), and pelvic incidence (PI).…”

Section: Introductionmentioning

confidence: 99%

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The Correlation Between Paraspinal Muscular Morphology, Spinopelvic Parameters, and Back Pain: A Comparative Cohort Study

Giordan,

Drago,

Zanata

et al. 2023

Int J Spine Surg

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Background: The relationship between paraspinal muscle degeneration and low back pain (LBP), disability, and structural changes has been investigated in the literature, but it is still a matter of debate. We differentiated paraspinal muscle magnetic resonance imaging by quality and quantity, focusing on fatty infiltration (FI) and paraspinal muscles cross-sectional area (CSA) from T12 to S1 in patients with and without chronic LBP. We aimed to determine whether paraspinal muscle quantity (CSA) and quality (FI) are positively associated with LBP or degenerative/spinopelvic changes in the spine.Methods: Between 2018 and 2021, we prospectively enrolled 205 patients aged between 18 to 65 years, of whom 153 patients had chronic back pain (back pain group) and 52 patients did not have chronic back pain (no back pain group), and collected clinicodemographic, structural, and spinopelvic data. We correlated these data with paraspinal muscle FI and CSA from T12 to S1. Multivariate models were run to highlight associations between pain, disability, or degenerative and spinopelvic parameters.Results: Age was not associated with increased FI but consistently with decreased CSA values. After adjusting for age, sex, and body mass index, FI was associated with an increased risk of back pain (OR, 8.80; 95% CI, 1.9-39.79; P = 0.006) and high disability scores (OR, 3.41; 95% CI, 1.12-10.30; P = 0.030). Decreased CSA was associated with reduced disc height (P < 0.001), while FI and CSA did not associate with abnormal spinopelvic parameters.Conclusions: FI on paraspinal muscle highly correlates with back pain and disability but was not found in structural and degenerative changes in the lower back.Clinical Relevance: Findings from this study are clinically relevant for patient counseling and rehabilitation strategies.Level of Evidence: 2b.

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“…However, this might not be true in other cohorts. Mandelli et al 35 recently published a study demonstrating differences in paraspinal FMI between spinal levels in patients with LSCS. Therefore, the authors acknowledge that their assessment of muscle composition is limited.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Paraspinal Fatty Muscle Infiltration and Cumulative Lumbar Spine Degeneration on the Outcome of Patients with Lumbar Spinal Canal Stenosis: Analysis of the Lumbar Stenosis Outcome Study (LSOS) Data

Getzmann

Ashouri

Burgstaller

et al. 2022

Spine

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Study Design. Prospective. Objective. To investigate the influence of paraspinal fatty muscle infiltration (FMI) and cumulative lumbar spine degeneration as assessed by magnetic resonance imaging on long-term clinical outcome measures in patients with lumbar spinal canal stenosis (LSCS) of the Lumbar Stenosis Outcome Study (LSOS) cohort. Summary of Background Data. Past studies have tried to establish correlations of morphologic imaging findings in LSCS with clinical endpoints. However, the impact of FMI and overall lumbar spinal degeneration load has not been examined yet. Materials and Methods. Patients from the LSOS cohort with moderate to severe LSCS were included. Two radiologists assessed the degree of LSCS as well as cumulative degeneration of the lumbar spine. FMI was graded using the Goutallier scoring system. Spinal Stenosis Measure (SSM) was used to measure the severity level of symptoms and disability. European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) was used to measure health-related quality of life. Results. The nonsurgically treated group consisted of 116 patients (age 74.8±8.5 yr), whereas the surgically treated group included 300 patients (age 72.3±8.2 yr). Paraspinal FMI was significantly different between the groups (54.3% vs. 32.0% for Goutallier grade ≥2; P<0.001). Total degeneration score was comparable in both groups (9.5±2.0 vs. 9.3±2.0; P=0.418). FMI was associated with lower SSM function and lower EQ-5D-3L (all P<0.05), but not with SSM symptoms. Total degeneration of the lumbar spine was associated neither with SSM symptoms, nor with SSM function, nor with EQ-5D-3L (all P>0.05). Conclusions. FMI is associated with higher disability and worse health-related quality of life of LSCS patients in the LSOS cohort. There was no significant association between total cumulative lumbar spine degeneration and the outcome of either surgically or nonsurgically treated patients. Level of Evidence. 3.

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Assessing fatty infiltration of paraspinal muscles in patients with lumbar spinal stenosis: Goutallier classification and quantitative MRI measurements

Cited by 4 publications

References 0 publications

Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study

Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study

The Correlation Between Paraspinal Muscular Morphology, Spinopelvic Parameters, and Back Pain: A Comparative Cohort Study

The Effect of Paraspinal Fatty Muscle Infiltration and Cumulative Lumbar Spine Degeneration on the Outcome of Patients with Lumbar Spinal Canal Stenosis: Analysis of the Lumbar Stenosis Outcome Study (LSOS) Data

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