Lumbar paraspinal muscle morphometry and its correlations with demographic and radiological factors in adult isthmic spondylolisthesis: a retrospective review of 120 surgically managed cases

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The objective of this study was to assess the cross-sectional areas (CSAs) of lumbar paraspinal muscles in adults with isthmic spondylolisthesis (IS), to compare them with those in the normative population, and to evaluate their correlations with demographic factors and MRI changes in various spinal elements.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors conducted a retrospective study of patients who had undergone posterior lumbar interbody fusion for IS, and 2 of the authors acting as independent observers calculated the CSAs of various lumbar paraspinal muscles (psoas, erector spinae [ES], multifidus [MF]) on preoperative axial T2-weighted MR images from the L-3 to L-5 vertebral levels and computed the CSAs as ratios with respect to the corresponding vertebral body areas. These values were then compared with those in an age- and sex-matched normative population and were analyzed with respect to age, sex, duration of symptoms, grade of listhesis, and various MRI changes at the level of the listhesis (pedicle signal change, disc degeneration, and facetal arthropathy).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Compared with values in normative controls, the mean CSA value for the ES muscle was significantly higher in the study cohort of 120 patients (p = 0.002), whereas that for the MF muscle was significantly lower (p = 0.009), and more so in the patients with PSC (p = 0.002). Magnetic resonance imaging signal change in the pedicle was seen in half of the patients, all of whom demonstrated a Type 2 change. Of the variables tested in a multivariate analysis, age independently predicted lower area values for all 3 muscles (p ≤ 0.001), whereas female sex predicted a lower mean psoas area value (p &lt; 0.001). None of the other variables significantly predicted any of the muscle area values. A decrease in the mean MF muscle area value alone was associated with a significantly increased likelihood of a PSC (p = 0.039).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Compared with normative controls, patients with IS suffer selective atrophy of their MF muscle, whereas their ES muscle undergoes a compensatory hypertrophy. Advancing age has a detrimental effect on the areas of the lumbar PSMs, whereas female sex predisposes to a decreased psoas muscle area. Multifidus muscle atrophy correlates with PSC, indicating the role of this deep stabilizer in the biomechanical stability of spondylolisthetic spines. This may be of clinical significance in targeted physiotherapy programs during the conservative management of IS.</jats:p></jats:sec>

The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain

“…Most demonstrated a decrease in the CT-evaluated muscle density [5, 10, 37, 38] and the CSA of the multifidus and erector spinae [39–41]. On the other hand, US studies [19, 42] showed no association between the size of the multifidus and age.…”

“…Another MRI study from India [41] assessed the CSA of the lumbar paraspinal muscles in 120 adults with isthmic spondylolisthesis. Compared with normal controls, the mean CSA value for the erector spinae was significantly higher in the study cohort ( p = 0.002), whereas the CSA for the multifidus muscle was significantly lower ( p = 0.009).…”

Clinical Significance of Paraspinal Muscle Parameters as a prognostic factor for survival in Gastric Cancer Patients who underwent Curative Surgical Resection

“…In studies by Dohzono and Deng, it was suggested that paraspinal muscle was composed of multifidus and erector spinae [19,20]. In other studies, multifidus and erector spinae combined with either psoas muscle [27], quadratus lumborum [17], or psoas muscle/quadratus lumborum [15,25,26] were defined as paraspinal muscles.…”

The Implications of Paraspinal Muscle Atrophy in Low Back Pain, Thoracolumbar Pathology, and Clinical Outcomes After Spine Surgery: A Review of the Literature

“…While PMA has been associated with ipsilateral LBP and radiculopathy, a study by Ploumis et al 30 found no correlation with duration and the severity of pain as measured by ODI and VAS. Interestingly, a study of 120 patients with surgically managed isthmic spondylolisthesis in which an association was found between the pathology and multifidus atrophy did not illustrate a similar association between multifidus atrophy and disc degeneration or facet arthropathy, 26 nor did it note significant reductions in psoas cross-sectional area to vertebral body area ratios (0.61 + 0.19, 0.63 + 0.20, P ¼ .427) in isthmic spondylolisthesis versus controls. In fact, the erector spinae cross-sectional area to vertebral body area ratio was increased (0.99 + 0.26, 0.89 + 0.24, P ¼ .002) in the isthmic spondylolisthesis group, suggesting compensatory hypertrophy.…”

“…25 Decreased multifidus cross-sectional area relative to vertebral body area was noted in a group of 120 individuals with isthmic spondylolisthesis when compared with normal controls (0.42 + 0.09, 0.46 + 0.14, P ¼.009). 26 The remaining studies implicating paraspinal muscle atrophy in thoracolumbar pathology development address Individuals with greater preoperative paraspinal muscle fat infiltration did not have significantly different failure rates than those with less degeneration after surgical decompression for symptomatic lumbar spinal stenosis.…”