Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis

Wang, Gangliang; Karki, Saugat; Xu, Shaohua; Hu, Zhijun; Chen, Jian; Zhou, Zhong Kai; Fan, Shunwu

doi:10.3233/bmr-140515

Cited by 36 publications

(35 citation statements)

References 27 publications

(31 reference statements)

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“…Disc degeneration did have a correlation with MF muscle area values in our study, but it lost significance in the multivariate analysis. One study on PSMs in degenerative listhesis reported MF muscle atrophy and ES muscle hypertrophy, 35 paralleling the findings in our cohort with IS. Of interest in our study was the finding that while MF muscle atrophy was observed in the entire study cohort compared with controls, it was most pronounced in the patients exhibiting PSC.…”

Section: Lumbar Psm Morphometry and Its Correlationssupporting

confidence: 91%

“…

A lterAtions in lumbar paraspinal muscle (PSM) morphometry have been documented in low-back pain (LBP) 6,7,18,20 and degenerative listhesis, 35 with atrophy of the multifidus (MF) muscle frequently reported in these conditions. Paraspinal muscle morphometry has not been analyzed in isthmic spondylolisthesis (IS), a condition with strong physiotherapy connotations, especially in the lower grades.

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confidence: 99%

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

Thakar¹,

Sivaraju²,

Aryan³

et al. 2016

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OBJECTIVE 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. METHODS 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). RESULTS 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 < 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). CONCLUSIONS 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.

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Section: Lumbar Psm Morphometry and Its Correlationssupporting

confidence: 91%

“…

…”

mentioning

confidence: 99%

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

Thakar¹,

Sivaraju²,

Aryan³

et al. 2016

SPI

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“…A recent Chinese study [53] evaluated the MRIs of 149 middle-aged degenerative spondylolisthesis patients and the same total of age- and sex-matched controls. The multifidus muscle atrophy ratio of the patients tended to be significantly lower than those in the control group, whereas the signal intensity ratio of the paraspinal muscles and the erector spinae muscle atrophy ratio were significantly higher than in the control group.…”

Section: Resultsmentioning

confidence: 99%

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

Kalichman

Carmeli

Been

2017

BioMed Research International

185

179

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This narrative review investigated imaging parameters of the paraspinal muscles and their association with spinal degenerative features and low back pain (LBP) found in the literature. Three principal signs of muscle degeneration were detected on imaging: decreased muscle size, decreased radiographic density, and increased fat deposits. Men have a higher density of paraspinal muscles than women, younger individuals have a higher density than older ones, and lean individuals have a higher density than those with an increased body mass index. Fatty infiltration appears to be a late stage of muscular degeneration and can be measured noninvasively by an MRI scan. Fatty infiltration in the lumbar multifidus is common in adults and is strongly associated with LBP, especially in women, independent of body composition. Fatty infiltration develops in areas where most degenerative changes are found. MR spectroscopy studies have corroborated that the lumbar multifidus in LBP subjects has a significantly higher fat content than asymptomatic controls. There is a strong need for establishing uniform methods of evaluating normal parameters and degenerative changes of the paraspinal muscles. Additional imaging studies are needed to improve the understanding of the association and causal relationships between LBP, spinal degeneration, and changes in the paraspinal muscles.

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“…Wang and colleagues examined 149 patients with degenerative spondylolisthesis and similarly observed a greater degree of multifidus muscle atrophy compared with controls. 39 In contrast, however, the erector spinae muscles were significantly larger in patients with sagittal imbalance than in patients without deformity, possibly representing a compensatory mechanism to maintain sagittal stability.…”

Section: Discussionmentioning

confidence: 84%

“…Although anatomical studies have illustrated relatively safe corridors for lateral transpsoas approaches, these typical surgical strategies may be less valuable in patients with variable or asymmetrical paraspinal musculature, as has been associated with degenerative spinal diseases. [17][18][19]31,33,39 A variable psoas muscle anatomy is especially concerning because of the intrinsic relationship between the muscle belly and the lumbar plexus.…”

mentioning

confidence: 99%

Resolution of the more anteriorly positioned psoas muscle following correction of spinal sagittal alignment from spondylolisthesis: case report

Syed

Yaeger

Sandhu

2017

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Several studies have described the radiographic, histological, and morphological changes to the paraspinal muscle in patients with chronic low-back pain due to degenerative diseases of the spine. Gross anatomical illustrations have shown that the psoas muscle lies lateral to the L4–5 vertebrae and subsequently thins and dissociates from the vertebral body at L5–S1 in a ventrolateral course. A “rising psoas” may influence the location of the lumbar plexus and result in transient neurological injury on lateral approach to the spine. It is postulated that axial back pain may be exacerbated by anatomical changes of paraspinal musculature as a direct result of degenerative spine conditions. To their knowledge, the authors present the first reported case of a more anteriorly positioned psoas muscle and its resolution following correction of spondylolisthesis in a 62-year-old woman. This case highlights the dynamic nature of degenerative spinal disorders and illustrates that psoas muscle position can be affected by sagittal balance. Normal anatomical positioning can be restored following correction of spinal alignment.

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Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis

Abstract: Decreased anterior disc height and multifidus muscle atrophy are found in the LDS patients and thy could be the cause of LDS. The presence of erector spinae hypertrophy could be a compensatory mechanism to compensate for the instability.

Cited by 36 publications

References 27 publications

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

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

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

Resolution of the more anteriorly positioned psoas muscle following correction of spinal sagittal alignment from spondylolisthesis: case report

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