Association between fatty infiltration of paraspinal muscle, sagittal spinopelvic alignment and stenosis grade in patients with degenerative lumbar spinal stenosis

Zhang, Yuancheng; Mandelli, Filippo; Mündermann, Annegret; Kovács, Balazs; Schären, Stefan; Netzer, Cordula

doi:10.1016/j.xnsj.2021.100054

Cited by 11 publications

(12 citation statements)

References 36 publications

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“…41 While among symptomatic patients, spinopelvic malalignment, defined as an increased standing posterior pelvic tilt >20°or as a mismatch between PI and LL > 10°, was found to be associated with greater fatty infiltration of lumbar spine flexors and extensors. 42,43 In this study, we found that spinal stiffness (ΔLL < 20°) was associated with a higher degree of muscle fatty infiltration. This association was the strongest for the extensors (multifidus/erector spinae), but less present for the flexors (psoas).…”

Section: Discussionmentioning

confidence: 48%

What patient parameters influence lumbar stiffness in patients with hip pathology?

Verhaegen,

Alves Batista,

Foster

et al. 2023

Journal Orthopaedic Research

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Lumbar stiffness leads to greater hip dependence to achieve sagittal motion and increases instability after total hip arthroplasty (THA). We aimed to determine parameters that influence lumbar stiffness among patients with hip pathology. We hypothesized that modifiable (degenerative changes, spinal canal stenosis, facet orientation) and nonmodifiable factors (muscle condition) would be associated with lumbar spine stiffness. In this retrospective case‐cohort study from a tertiary referral center, consecutive patients presenting at a hip specialist clinic underwent standing and deep‐seated radiographic assessment to measure lumbar lordosis (∆LL) (stiffness: ∆LL < 20°), hip flexion (∆PFA: pelvic femoral angle), and degree of degenerative‐disc‐disease (DDD) (facet osteoarthritis, disc height, endplate proliferative changes). Of these, 65 patients were selected with previous lumbar spine magnetic resonance imaging, allowing to determine lumbar facet orientation, spinal canal stenosis (Schizas classification), and flexor‐ and extensor‐muscle atrophy (Goutallier classification). Mean ∆LL was 45° (range: 11°–72°) and four patients (6%) exhibited spine stiffness. Patients with multilevel DDD (n = 22) had less ∆LL than those with no/single level (n = 43) DDD (34° [range: 11°–53°] vs. 51° [21°–72°]; p < 0.001). Number of DDD levels correlated strongly with ∆LL (ρ = −0.642; p < 0.001). Spinal stiffness was only seen in patients with ≥4 DDD levels. There was no correlation between ∆LL and facet orientation (p > 0.05). ∆LL correlated strongly with extensor atrophy at L3–L4 (ρ = −0.473), L4–L5 (ρ = −0.520), and L5–S1 (ρ = −0.473) and poorly with flexors at L4–L5 (ρ = −0.134) and L5–S1 (ρ = −0.227). Lumbar stiffness is dependent on modifiable (muscle atrophy) and nonmodifiable (extend of DDD) factors. This can guide nonoperative management of hip pathology, emphasizing the relevance of core muscle rehabilitation to improve posture and stiffness. Identification ≥4 DDD levels should alert surgeons of increased THA instability risk. Level of evidence: level IV, cohort series.

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Section: Discussionmentioning

confidence: 48%

What patient parameters influence lumbar stiffness in patients with hip pathology?

Verhaegen,

Alves Batista,

Foster

et al. 2023

Journal Orthopaedic Research

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“…We did not measure cross-sectional area or volume of the paraspinal muscles, rather we used a semi-quantitative analysis which is routinely used in the paraspinal muscle studies. 70,71 Microarchitecture of the muscle is more important than the size of that. Fat tissue might occupy the muscle tissue without causing a decrease in muscle size.…”

Section: Discussionmentioning

confidence: 99%

“…The cohort was age‐, gender‐, and BMI‐matched all of which strengthened our findings. We did not measure cross‐sectional area or volume of the paraspinal muscles, rather we used a semi‐quantitative analysis which is routinely used in the paraspinal muscle studies 70,71 . Microarchitecture of the muscle is more important than the size of that.…”

Section: Discussionmentioning

confidence: 99%

Fatty infiltration of the erector spinae at the upper lumbar spine could be a landmark for low back pain

Ekşi,

Özcan‐Ekşi

2023

Pain Practice

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PurposeIntervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end‐plates, and fatty infiltration in their paraspinal muscles.MethodsConsecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age‐, gender‐ and BMI‐matched asymptomatic controls.ResultsLow back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels.ConclusionSevere IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration.

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“…Why was pelvis flexion ROM also involved in the present regression model? Again, only LuM MFI (not fibrosis) would explain the positive relationship with ECHO LuM , as an increased MFI in the posterior vertebral muscles (erector spinae + LuM) has been associated with pelvic retroversion (Elysee et al, 2021; Lee et al, 2022; Zhang et al, 2021). However, MFI in LuM was not enough to induce a change in pelvic inclination in 93 healthy controls (Menezes‐Reis et al, 2018), which was later confirmed in a study showing a relationship with the erector spinae MFI but not LuM MFI in participants with spinal deformity (Miura et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

The relationship between clinical examination measures and ultrasound measures of fascia thickness surrounding trunk muscles or lumbar multifidus fatty infiltrations: An exploratory study

et al. 2022

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Patients with chronic low back pain (CLBP) exhibit remodelling of the lumbar soft tissues such as muscle fatty infiltrations (MFI) and fibrosis of the lumbar multifidus (LuM) muscles, thickness changes of the thoracolumbar fascia (TLF) and perimuscular connective tissues (PMCT) surrounding the abdominal lateral wall muscles. Rehabilitative ultrasound imaging (RUSI) parameters such as thickness and echogenicity are sensitive to this remodelling. This experimental laboratory study aimed to explore whether these RUSI parameters (LuM echogenicity and fascia thicknesses), hereafter called dependent variables (DV) were linked to independent variables (IV) such as (1) other RUSI parameters (trunk muscle thickness and activation) and (2) physical and psychological measures. RUSI measures, as well as a clinical examination comprising physical tests and psychological questionnaires, were collected from 70 participants with LBP. The following RUSI dependent variables (RUSI‐DV), measures of passive tissues were performed bilaterally: (1) LuM echogenicity (MFI/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1); (2) TLF posterior layer thickness, and (3) PMCT thickness of the fasciae between subcutaneous tissue thickness (STT) and external oblique (PMCTSTT/EO), between external and internal oblique (PMCTEO/IO), between IO and transversus abdominis (PMCTIO/TrA) and between TrA and intra‐abdominal content (PMCTTrA/IA). RUSI measures of trunk muscle's function (thickness and activation), also called measures of active muscle tissues, were considered as independent variables (RUSI‐IV), along with physical tests related to lumbar stability (n = 6), motor control deficits (n = 7), trunk muscle endurance (n = 4), physical performance (n = 4), lumbar posture (n = 2), and range of motion (ROM) tests (n = 6). Psychosocial measures included pain catastrophizing, fear‐avoidance beliefs, psychological distress, illness perceptions and concepts related to adherence to a home‐based exercise programme (physical activity level, self‐efficacy, social support, outcome expectations). Six multivariate regression models (forward stepwise selection) were generated, using RUSI‐DV measures as dependent variables and RUSI‐IV/physical/psychosocial measures as independent variables (predictors). The six multivariate models included three to five predictors, explaining 63% of total LuM echogenicity variance, between 41% and 46% of trunk superficial fasciae variance (TLF, PMCTSTT/EO) and between 28% and 37% of deeper abdominal wall fasciae variance (PMCTEO/IO, PMCTIO/TrA and PMCTTrA/IA). These variables were from RUSI‐IV (LuM thickness at rest, activation of IO and TrA), body composition (percent fat) and clinical physical examination (lumbar and pelvis flexion ROM, aberrant movements, passive and active straight‐leg raise, loaded‐reach test) from the biological domain, as well as from the lifestyle (physical activity level during sports), psychological (psychological distress—cognitive subscale, fear‐avoidance beliefs during physical ac...

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Association between fatty infiltration of paraspinal muscle, sagittal spinopelvic alignment and stenosis grade in patients with degenerative lumbar spinal stenosis

Cited by 11 publications

References 36 publications

What patient parameters influence lumbar stiffness in patients with hip pathology?

What patient parameters influence lumbar stiffness in patients with hip pathology?

Fatty infiltration of the erector spinae at the upper lumbar spine could be a landmark for low back pain

The relationship between clinical examination measures and ultrasound measures of fascia thickness surrounding trunk muscles or lumbar multifidus fatty infiltrations: An exploratory study

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