Associations between Paraspinal Muscle Morphology, Disc Degeneration, and Clinical Features in Patients with Lumbar Spinal Stenosis

Abstract

Objective: The purpose of this study was to examine the relationships between intervertebral disc degeneration in the lumbar spine, paraspinal muscle morphology, and clinical features in patients with lumbar spinal stenosis (LSS). Methods: A total of 52 patients with LSS participated in this study. Magnetic resonance imaging was used to assess intervertebral disc degeneration at L4/5 and to measure the standardized cross-sectional areas (SCSAs) of the multifidus and erector spinae muscles. The intensity of low back pain (LBP) and lower limb pain, the level of disability, and the quality of life (QoL) were evaluated using patient-reported outcome measures. The associations between the image findings and clinical features, including the disability score, the pain score for low back pain, and the QoL score, were calculated using Spearman’s rank correlation coefficient. Results: No associations were found between disc degeneration and clinical features. However, disc degeneration and the SCSA of the multifidus muscle ( r =−0.38, P <0.01) and of the erector spinae muscle ( r =−0.29, P=0.04) were significantly associated. Analysis of the associations between muscle morphology and clinical features found that the SCSA of the multifidus muscle was associated with LBP ( r =0.31, P=0.03). Conclusions: These results suggest that there is some correlation between atrophy of the multifidus and pain intensity. Consequently, focusing on the CSA of the multifidus muscle may help to clarify the causes of LBP in patients with LSS. However, because of the cross-sectional nature of this study, causal relationships could not be determined and further research is needed.

Spinal degeneration is associated with lumbar multifidus morphology in secondary care patients with low back or leg pain

“…Conversely, three conditions that did demonstrate a significant association with smaller % MCSA have no clear neuromechanical mechanism: multi-level, moderate to severe DD, moderate to severe Modic type 2 changes at any level, and endplate defects at any level. Associations noted between LMM morphology changes and DD, Modic changes, and endplate defects are consistent with the findings of several studies (particularly when focusing on muscle quality as opposed to overall volume) 13 , 14 , 18 , 19 , 24 , 35 , 38 , 39 , although a few studies have noted no consistent associations between these conditions and altered paraspinal muscles 20 , 32 , 40 , 41 . While we did find an initial association with LMM degradation and Modic type 1marrow changes consistent with Atci, et al’s 2020 study 13 , this association failed to remain significant after adjusting for covariates.…”

“…This relationship was particularly noted as disease severity increased, but it was also present in younger populations 11,12 . How some of these degenerative processes (e.g., those affecting spinal joints, vertebrae, or alignment) may relate to alterations in lumbar paraspinal muscle morphology has been investigated in numerous studies 10,[13][14][15][16][17][18][19][20][21][22][23][24][25] , but these have typically focussed on assessing specific types or focused combinations of pathology, provided generic pathology comparisons, or utilized smaller population samples. None have looked at the aggregate effect of numerous pathologies.…”

Associations Between Trunk Muscle/Fat Composition, Narrowing Lumbar Disc Space, and Low Back Pain in Middle-Aged Farmers: A Cross-Sectional Study

“…Different studies in the previous literature have used different ranges of interest for measuring muscle mass. Muscle mass areas found to be associated with LBP have included the multifidus [ 14 ], multifidus and erector spinae [ 13 , 32 ], paraspinal muscles (multifidus+erector spinae) [ 33 , 34 ], and paraspinal and psoas muscles [ 35 ]. These manual methods for demarcating the muscle mass area are time-consuming and rely on a technician with good anatomical knowledge.…”

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

“…Fatty infiltration of the paraspinal muscle has two components: intra-and extramyocellular lipid, both contributing to the fat component in chemical encoding-based water-fat MRI in our study [32,33]. In the last years, several studies assessed the association of paraspinal muscle fat composition in patients with spinal disorders, including lower back pain, osteoporosis, spinal stenosis, and radiculopathy [10,[34][35][36][37]. Significant associations of paraspinal muscle fatty degeneration with decreased bone mineral density (low bone mass/osteoporosis), measured by dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (qCT), have recently been described [36,37].…”