Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients

Abstract

Study design A retrospective study. Objective To evaluate the different degeneration patterns of paraspinal muscles in degenerative lumbar diseases and their correlation with lumbar spine degeneration severity. Summary of background data The degeneration characteristics of different paraspinal muscles in degenerative lumbar diseases remain unclear. Methods 78 patients diagnosed with single-level degenerative lumbar spondylolisthesis (DLS) and 76 patients with degenerative lumbar kyphosis (DLK) were included as DLS and DLK groups. Paraspinal muscle parameters of psoas major (PS), erector spinae (ES) and multifidus muscle (MF) were measured, including fatty infiltration (FI) and relative cross-sectional area (rCSA), namely the ratio of the paraspinal muscle CSA to the CSA of the vertebrae of the same segment. Sagittal parameters including lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. The paraspinal muscle parameters and ES/MF rCSA ratio were compared between the two groups. Paraspinal muscles parameters including rCSA and FI were also compared between each segments from L1 to L5 in both DLS and DLK groups. In order to determine the influence of sagittal spinal alignment on paraspinal muscle parameters, correlation analysis was conducted between the MF, ES, PS rCSA and FI and the LL in DLS and DLK group. Result MF atrophy is more significant in DLS patients compared with DLK. Also, MF fatty infiltration in the lower lumbar spine of DLS patients was greater compared to DLK patients. DLK patients showed more significant atrophy of ES and heavier ES fatty infiltration. MF FI was significantly different between all adjacent segments in both DLS and DLK groups. In DLS group, ES FI was significantly different between L2/L3 to L3/L4 and L4/L5 to L5/S1, while in DLK group, the difference of ES FI between all adjacent segments was not significant, and ES FI was found negatively correlated with LL. Conclusions Paraspinal muscles show different degeneration patterns in degenerative lumbar diseases. MF degeneration is segmental in both DLS and DLK patients, while ES degenerated diffusely in DLK patients and correlated with the severity of kyphosis. MF degeneration is more significant in the DLS group, while ES degeneration is more significant in DLK patients. MF is the stabilizer of the lumbar spine segments, while the ES tends to maintain the spinal sagittal balance.

Biomechanical effects of iatrogenic muscle-ligaments complex damage on adjacent segments following posterior lumbar interbody fusion: A finite element analysis

“…Additionally, this phenomenon may be related to inserting the multifidus into the sacrum across multiple vertebral segments behind the lumbar spine alignment. 31 Furthermore, in the case of bending and torsion, we also found a similar situation: the model preserving the proximal MLC is relatively close to the normal physiological state. In extension, there is a situation beyond our conventional comprehension: Model C, which has more damaged posterior structures, shows more physiological ROM and maximum intradiscal stress.…”

“…3,4,28 Atrophy of damaged multifidus and fat infiltration after surgery occur, and clinical retrospective studies have shown that it may be related to ASD, especially the multifidus of adjacent segments. 7,[29][30][31] The multifidus is the core muscle group closest to the central axis of the spine; in addition to performing extension activities, its role is more reflected in strengthening the physiological lordosis sagittal alignment of the lumbar segment and acting as a dynamic stabilizer against flexion and torsion. 32,33 The PLC is an important part of the posterior column of the spine.…”

Paraspinal muscle gene expression across different aetiologies in individuals undergoing surgery for lumbar spine pathology

“…Many studies focus on the multifidus muscle in particular, given its role as a primary spine stabilizer [4]. The association between such degenerative changes in the multifidus muscle and poor patient outcomes highlights the clinical relevance in understanding the molecular drivers of these muscle changes [5][6][7]. Recent literature highlights the potential clinical impact of paraspinal muscle degeneration, as seen in studies concluding a higher risk of post-operative proximal junctional kyphosis, cage subsidence, and overall worse clinical outcomes in patients with lower paraspinal muscle volume and cross-sectional area [8,9].…”

The difference of paraspinal muscle between patients with lumbar spinal stenosis and normal middle-aged and elderly people, studying by propensity score matching

“…With the aging of the population, the incidence of lumbar degenerative diseases is gradually increasing. Recently, many studies focused on the degeneration of paraspinal muscle in lumbar degenerative diseases (1)(2)(3)(4)(5)(6), because paraspinal muscle plays an important role in maintaining stability. Ogon studied the degeneration of paraspinal muscles in 40 pairs of patients with chronic nonspecific low back pain and lumbar spinal stenosis (7).…”

“…Ogon studied the degeneration of paraspinal muscles in 40 pairs of patients with chronic nonspecific low back pain and lumbar spinal stenosis ( 7 ). Other studies also investigated the degeneration of paraspinal muscle in patients with low back pain ( 8 , 9 ) and lumbar degenerative kyphosis ( 3 , 10 ).…”