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

Abstract

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.

From hyperglycemia to intervertebral disc damage: exploring diabetic-induced disc degeneration

“…In addition to abnormal mechanical overload, abnormal fat accumulation, changes in glucose and lipid metabolism and inflammation are important factors affecting IVD homeostasis and pro-inflammatory pathophysiology (49)(50)(51). High concentrations of pro-inflammatory cytokines, adipokines, sugars, and lipids, aggravate systemic low-grade inflammation, which consequently impairs the metabolism of articular chondrocytes and IVD cells.…”

Association of MRI findings with paraspinal muscles fat infiltration at lower lumbar levels in patients with chronic low back pain: a multicenter prospective study

“…Imaging parameters for evaluating paraspinal muscles mainly include muscle cross-sectional area (CSA) and the degree of fat infiltration [ 7 , 9 – 15 ]. In recent years, the proton density fat fraction (PDFF) can be obtained with high resolution and accuracy through available Iterative Decomposition of water and fat with Echo Asymmetry and Least Square Estimation (IDEAL-IQ) [ 16 ], which aids in accurately quantifying the fat content in the paraspinal muscles, especially the intramuscular fat [ 6 , 7 , 12 , 17 ]. This helps to further explore the relationship between lumbar spinal lesions and the paraspinal muscles in patients with CLBP.…”

“…However, the factors influencing the rise in paraspinal muscles fatty infiltration or muscle atrophy, as well as the relationship mechanism of paraspinal muscles between fatty infiltration and spinal diseases, are still subjects of ongoing research. This includes conditions such as IVDD [ 6 , 8 , 9 , 11 , 12 , 14 , 20 – 22 ], disc herniation [ 7 , 9 , 11 , 23 ], degenerative lumbar spondylolisthesis (DLS) [ 10 , 24 ], facet joint disease [ 11 , 15 ]and spinal stenosis [ 13 , 23 , 25 ]. There is currently still controversy over the relationship between different etiologies or disease durations and paraspinal muscles fat infiltration in CLBP patients.…”