Paraspinal Muscle Degeneration: A Potential Risk Factor for New Vertebral Compression Fractures After Percutaneous Kyphoplasty

Abstract

Background The paraspinal muscle is essential for maintaining normal spine function and structure, which degeneration is closely related to various spinal diseases. The main objective of this study was to identify the potential role of paraspinal muscle degeneration in the occurrence of new vertebral compression fractures (NVCF) and develop a clinically applicable nomogram for prospective NVCF risk prediction. Methods A total of 202 patients with single-level osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous kyphoplasty treatment between January 2016 and March 2019 were included in this study. Demographic, clinical, radiological, and treatment data were collected and analyzed. The paraspinal muscle cross-sectional area (CSA) and fat signal fraction (FSF) were measured to quantify the extent of muscle degeneration. Multivariate binary logistic regression analysis was performed to select risk factors to build a nomogram that predicted the occurrence of NVCF. The concordance index (C-index) and calibration curve were used to evaluate the discriminative capacity and predictive accuracy of the nomogram. Results NVCF occurred in 54 of 202 patients (26.7%). The erector spinae FSF (OR = 1.064; P = 0.001), psoas major FSF (OR = 1.326; P < 0.001), and the difference index of the muscle CSA between multifidus and psoas major (OR = 1.048; P < 0.001) were independent risk factors for the occurrence of NVCF. The nomogram performance was good after evaluation using the calibration curves and C-index (95% confidence interval, 0.854–0.943). Conclusion Paraspinal muscle degeneration is a potential risk factor for NVCF occurrence. A nomogram was designed to precisely predict the risk of NVCF. This predictive nomogram may help clinicians to make better clinical decisions and provide more accurate functional exercise protocol for OVCF patients.

Prediction of Subsequent Vertebral Fracture After Acute Osteoporotic Fractures from Clinical and Paraspinal Muscle Features

“…Hence, we speculate that vertebral attachment to a dysfunctional MFM is less effective against perturbations and thus more susceptible to subsequent vertebral fracture. Consistent with this, previous research reported that incomplete MFM function was associated with bone nonunion after lumbar interbody fusion [ 22 ], new compression fracture after vertebroplasty [ 28 ], and OVCF [ 32 ]. We also found that, although the rFCSA and FI of the MFM at the L3/4 and L4/5 IVD levels were associated with fracture, only rFCSA of the MFM at the L4/5 IVD level was an independent risk factor, even for OVCF at other levels, indicating that this factor best reflects overall MFM function and its influence on subsequent vertebral fracture.…”

“…An important finding of our study was that rFCSA of the MFM at the L4/5 IVD level was an independent risk factor for subsequent vertebral fracture. Among the paraspinal muscles, the MFM is the strongest stabilizer of the lumbar spine [ 28 ]. The effect of the bilateral MFM accounts for more than two-thirds of the spine stiffness.…”

Exploring the interplay between paraspinal muscular status and bone health in osteoporosis and fracture risk: a comprehensive literature review on computed tomography (CT) and magnetic resonance imaging (MRI) studies

“…Si et al ( 59 ) conduced a similar study on patients after percutaneous kyphoplasty and observed that multifidus, psoas, and erector spinae muscles fatty infiltration was correlated with the occurrence of new OVCF after undergoing the procedure. They also observed that the CSA difference index between multifidus muscle and psoas muscle represented a risk factor for the recurrence of OVCF.…”

Development and Validation of a Nomogram for New Vertebral Compression Fractures in Postmenopausal Female Patients Undergoing Percutaneous Kyphoplasty Surgery

“…Furthermore, Kanis et al [27] identi ed a history of prior fractures as one of the most in uential factors contributing to the occurrence of new fractures in postmenopausal women. Additionally, high-risk factors for NVCF include paraspinal muscle degeneration, bone cement leakage into the intervertebral disc, the initial fracture occurring at the thoracolumbar junction, the natural progression of osteoporosis, and the volume of bone cement injected [28][29][30] .…”