Magnetic Resonance Imaging-Based Morphological Change of Paraspinal Muscles in Girls With Adolescent Idiopathic Scoliosis

Abstract

Study Design. A cross-sectional study. Objective. To investigate and compare any morphological differences in paraspinal muscles (PSM) between adolescent idiopathic scoliosis (AIS) patients (with severe or non-severe curves) and healthy controls. Summary of Background Data. Several studies have reported abnormalities in biochemical, electromyographic activity, and histological changes of PSM in AIS. However, these studies only had qualitative data and without comparison with controls. Changes of muscle mass and mean density at the lumbar region have been described for scoliotic spines. All these findings suggested that imbalance of PSM in AIS could be a contributing factor to the development of severe scoliotic curve. Methods. T2-weighted MR images with multi-planar reconstruction were acquired in 41 Chinese AIS girls with a primary right-sided thoracic curve and 23 age-matched controls. In AIS, measurements of PSM were taken on both concavity and convexity of scoliosis starting from two vertebrae above and two below the apex. Morphological assessments of the multifidus (MF) and erector spinae (ES) muscles on both sides were made including signal intensity (SI) and fat deposition using manual tracing and thresholding technique, respectively. Same parameters were measured in controls at matched vertebrae. One-way analysis of variance (ANOVA) and Pearson correlation tests were used for statistical analysis. Results. Abnormalities were found at concavity of muscles between AIS and controls. Significantly higher SI and fatty components was observed in AIS at MF muscles on concavity than controls (P-value <0.001). Additionally, SI at MF muscles was significantly correlated with Cobb angle. Conclusion. Increased SI and fatty components are asymmetrically present in PSM at apex in AIS. Our results showed higher intensity in PSM at concavity in AIS when compared with controls. There was a significant linear correlation between abnormal muscle signal and scoliotic curve. Above features are suggestive of altered muscle composition in concave PSM, possibly due to prolonged compression and reduced muscle activity of PSM caused by the spinal deformity. Level of Evidence: 4

Fiber Type-Specific Morphological and Cellular Changes of Paraspinal Muscles in Patients with Severe Adolescent Idiopathic Scoliosis

“…Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity with Cobb angle ≥10° [ 1 ]. As a common pediatric musculoskeletal disorder, it begins in early puberty and affects 1–4% of adolescents [ 2 ]. Scoliosis curve progresses in two-thirds of patients during puberty, and adults with large curves (>40°) are more likely to continue to deteriorate [ 3 ].…”

“…Paraspinal muscle (PSM) plays a significant role in stabilizing the spine, and it has been suggested as having a role in AIS [ 2 ]. In recent decades, there have been multiple reports of bilateral PSM asymmetry [ 2 , 5 – 11 ].…”

“…Paraspinal muscle (PSM) plays a significant role in stabilizing the spine, and it has been suggested as having a role in AIS [ 2 ]. In recent decades, there have been multiple reports of bilateral PSM asymmetry [ 2 , 5 – 11 ]. Abnormal hyperintense signal of PSM has been identified on the concave side by magnetic resonance imaging [ 2 , 11 ], which was consistent with the histologic finding of increased fibrosis and fatty infiltration on concavity [ 6 , 9 ].…”

“…In recent decades, there have been multiple reports of bilateral PSM asymmetry [ 2 , 5 – 11 ]. Abnormal hyperintense signal of PSM has been identified on the concave side by magnetic resonance imaging [ 2 , 11 ], which was consistent with the histologic finding of increased fibrosis and fatty infiltration on concavity [ 6 , 9 ]. Increased electrical activity of PSM was also found on the convex side [ 8 , 10 ].…”

“…In addition, it has been widely reported that the convex side has a higher numerical distribution of muscle fiber type I [ 8 , 12 , 13 ]. However, limited studies have determined the side of abnormality based on a strict control group and correlated the changes with curve severity [ 2 , 8 ], and the in-depth pathological changes of PSM in AIS remain incompletely known.…”