Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease

Stanuszek, Agnieszka; Jędrzejek, Adrian; Gancarczyk-Urlik, Eliza; Kołodziej, Izabela; Pisarska-Adamczyk, Magdalena; Milczarek, Olga; Trompeta, Jacek; Chrobak, Wojciech

doi:10.1007/s00402-021-03754-x

Cited by 25 publications

(23 citation statements)

References 30 publications

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“…On the same images that were used for CSA measurement, a semiquantitative measurement of fat infiltration of the paraspinal muscles was performed using a 3-grade system adapted from previous studies (Figure 3). 8,12,15 The grade of fat infiltration is defined as: Grade 0, normal (0%-10% fat within the muscle), Grade 1, mild (10%-50% fat within the muscle), and Grade 2, severe (>50% fat within the muscle). Fat infiltration grading was assessed on the right and left paraspinal muscles separately, with the final grade determined by the degree of fat infiltration of the bilateral paraspinal muscles.…”

Section: Csa and Fat Infiltration Measurementsmentioning

confidence: 99%

“…4 In addition, there is a growing number of publications highlighting high fat infiltration of paraspinal muscles as a poor prognostic factor for patient outcomes of spine surgery. [5][6][7][8] Epidural steroid injection (ESI) is one of the most commonly applied interventions used to manage low back or radicular pain. 9 A high prevalence of sarcopenia was consistently observed in elderly patients with chronic low back pain.…”

Section: Introductionmentioning

confidence: 99%

“…Fat deposition within the muscles, known as myosteatosis, significantly reduces muscle quality and strength, demonstrating a close association with morbidity and mortality in geriatric patients 4 . In addition, there is a growing number of publications highlighting high fat infiltration of paraspinal muscles as a poor prognostic factor for patient outcomes of spine surgery 5–8 …”

Section: Introductionmentioning

confidence: 99%

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Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients

et al. 2022

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Background: An assessment of paraspinal muscle degeneration based on magnetic resonance imaging has been used to investigate both sarcopenia and myosteatosis.The morphologic changes in cross-sectional area and fat infiltration of the paraspinal muscles can affect pain outcomes after epidural steroid injection.Methods: Patients ≥65 years of age who underwent fluoroscopy-guided lumbar epidural steroid injections were enrolled. Good analgesia was defined as ≥50% reduction in pain score at 4 weeks after injection. Cross-sectional area and grade of fat infiltration of the paraspinal muscles on magnetic resonance images at the level of L3-L4 disc were measured. Patient demographics, pain-related factors, clinical factors, and paraspinal muscle measurements were compared between good and poor analgesia groups. The factors associated with pain outcomes after injection were identified using multivariate analysis.Results: A total of 245 patients consisting of 149 and 96 patients in the good and poor analgesia groups, respectively, fully satisfied the study criteria for analysis.Patients of older age, opioid use, and high-grade foraminal stenosis were frequently observed in the poor analgesia group. The grade of fat infiltration of the paraspinal muscles was significantly higher in the poor analgesia group (Grade 2, 20.8% vs. 42.7%, p < 0.001), and this result was predominantly observed in female patients.However, there was no difference in the muscle cross-sectional area between the two groups (18.29 ± 3.16 vs. 18.59 ± 3.03 cm 2 /m 2 , p = 0.460). The percentage of patients with good analgesia decreased as the grade of fat infiltration increased (Grade 0 = 75.0%, Grade 1 = 65.8%, Grade 2 = 43.0%, p < 0.001). Multivariate logistic regression analysis revealed that preinjection opioid use [adjusted odds ratio (aOR) = 1.926, 95% confidence interval (CI) = 1.084-3.422, p = 0.025], moderate to severe foraminal stenosis (aOR = 2.859, 95% CI = 1.371-5.965, p = 0.005), and high-grade fat infiltration of the paraspinal muscles (aOR = 4.258, 95% CI = 1.805-10.043, p = 0.001) were significantly associated with poor analgesia after injection. Conclusion:High fat infiltration of the paraspinal muscles at the mid-lumbar region appeared to be an independent factor associated with poor analgesia after epidural steroid injection in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care. However, the cross-sectional area of the paraspinal muscles was not associated with pain relief after injection.

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Section: Csa and Fat Infiltration Measurementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients

et al. 2022

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“…Також кращі результати за шкалою ВАШ та Освестрі отримані у хворих із меншим вмістом жиру в паравертеб-ральних м'язах і великому поперековому через 1 і 6 міс. після мікродискектомії [66]. У пацієнтів після усунення стенозу в поперековому відділі хребта менший вміст жиру в паравертебральних м'язах перед операцією також був пов'язаний із кращим післяопераційним функціональним результатом за шкалою Освестрі [67,68].…”

Section: больовий синдромunclassified

Relationship between structural changes in paravertebral muscles and the development of spine degenerative diseases

Radchenko¹,

Ashukina²,

Maltseva³

et al. 2021

OTP

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Based on the systematic approach to the diagnosis of spinal pathology, there are no fundamental differences in the etiology of spine degenerative disease, facet joints arthritis, and other diseases. These diseases are considered multifactorial: age (aging), systemic regulatory factors (hormones, peptides, cytokines), genetic predisposition, inadequate physical activity, unfavorable environmental factors, and others lead to pathological changes in the structure of the spinal motor segment components. Recently, much attention has been paid to the paravertebral muscles changes, in which over time, as a result of injuries or degenerative processes, inevitably lead to dysfunction, which can lead to the occurrence of chronic lumbar pain. Objective. To assess the relationship between structural changes in paravertebral muscles and the development of degenerative diseases of the spine on the basis of scientific literature review. It was found that degenerative changes in paravertebral muscles, as components of spinal motor segments, develop with aging. In particular, muscle fibers are replaced by fat tissue, which is more pronounced in women compared to men. A direct correlation between chronic lumbar pain and paravertebral muscle atrophy has been reported. Systemic factors, in particular low levels of vitamin D, also can cause the development of degenerative changes in paravertebral muscles, especially in women. Obesity provokes systemic inflammation, increases fatty infiltration of skeletal muscles and increases sensitivity to pain. Reduced levels of physical activity lead to weakness and atrophy of the paravertebral muscles, which can cause degeneration of the intervertebral disc. At the same time, exercise prior to spinal surgery for degenerative diseases improves functional outcomes and reduces pain. Conversely, damage to the paravertebral muscles increase the load on the adjacent to spinal fusion segments. In general, the role of paravertebral muscles in the development of degenerative spinal diseases has not been definitively studied.

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“…Fatty degeneration is also present in lumbar spine segments with different modic changes, ranging from type I to III, due to disc degeneration [2]. In summary, degeneration of the lumbar paravertebral musculature seems to influence the outcomes of patients with degenerative spinal degeneration [3][4][5]. As described in more detail below, we questioned whether an automated method could reliably detect fatty infiltration in the paravertebral musculature.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the paraspinal muscle morphology of the lumbar spine using a convolutional neural network (CNN)

et al. 2021

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Purpose This single-center study aimed to develop a convolutional neural network to segment multiple consecutive axial magnetic resonance imaging (MRI) slices of the lumbar spinal muscles of patients with lower back pain and automatically classify fatty muscle degeneration. Methods We developed a fully connected deep convolutional neural network (CNN) with a pre-trained U-Net model trained on a dataset of 3,650 axial T2-weighted MRI images from 100 patients with lower back pain. We included all qualities of MRI; the exclusion criteria were fractures, tumors, infection, or spine implants. The training was performed using k-fold cross-validation (k = 10), and performance was evaluated using the dice similarity coefficient (DSC) and cross-sectional area error (CSA error). For clinical correlation, we used a simplified Goutallier classification (SGC) system with three classes. Results The mean DSC was high for overall muscle (0.91) and muscle tissue segmentation (0.83) but showed deficiencies in fatty tissue segmentation (0.51). The CSA error was small for the overall muscle area of 8.42%, and fatty tissue segmentation showed a high mean CSA error of 40.74%. The SGC classification was correctly predicted in 75% of the patients. Conclusion Our fully connected CNN segmented overall muscle and muscle tissue with high precision and recall, as well as good DSC values. The mean predicted SGC values of all available patient axial slices showed promising results. With an overall Error of 25%, further development is needed for clinical implementation. Larger datasets and training of other model architectures are required to segment fatty tissue more accurately.

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Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease

Cited by 25 publications

References 30 publications

Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients

Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients

Relationship between structural changes in paravertebral muscles and the development of spine degenerative diseases

Analysis of the paraspinal muscle morphology of the lumbar spine using a convolutional neural network (CNN)

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