The fatty degeneration of the lumbar erector spinae muscles affects dynamic spinal compensation ability during gait in adult spinal deformity

Abstract

This study aimed to investigate whether fat infiltration in lumbar paravertebral muscles assessed by magnetic resonance imaging (MRI) could be related to dynamic sagittal spino-pelvic balance during gait in adult spinal deformity (ASD). This is a retrospective analysis of 28 patients with ASD. The fat infiltration rate of lumbar erector spinae muscles, multifidus muscles and psoas major muscles was measured by T2 weighted axial MRI at L1-2 and L4-5. Dynamic sagittal spinal and pelvic angles during gait were evaluated using 3D motion analysis. The correlation between fat infiltration rate of those muscles with variations in dynamic kinematic variables while walking and static radiological parameters was analyzed. Spinal kyphosis and pelvic anteversion significantly increased during gait. Fat infiltration rate of erector spinae muscles at L1-2 was positively correlated with thoracic kyphosis (r = 0.392, p = 0.039) and pelvic tilt (r = 0.415, p = 0.028). Increase of spinal kyphosis during walking was positively correlated with fat infiltration rate of erector spinae muscles both at L1-2 (r = 0.394, p = 0.038) and L4-5 (r = 0.428, p = 0.023). Qualitative evaluation of lumbar erector spinae muscles assessed by fat infiltration rate has the potential to reflect dynamic spino-pelvic balance during gait.

The relationship between spinal alignment and activity of paravertebral muscle during gait in patients with adult spinal deformity: a retrospective study

“…In previous studies, gait analysis has been performed on relatively short distance walking [ 10 , 11 , 17 – 19 ] or comparing the walking posture between the initiation and cessation of gait [ 9 , 12 , 14 , 15 ]. These studies reported that the spinal balance during gait was leaning forward, even in the healthy group [ 18 ]; however, the difference from the upright position was significantly larger in the ASD group [ 19 ].…”

“…In contrast to our hypothesis, no response to increased spinal alignment was evident in the muscle activity of the lumbar PVM. Lower lumbar muscle degeneration is more severe in ASD [ 12 , 24 ]. The activity of the lumbar PVM might have reflected its fatty infiltration due to severe degeneration, causing the per unit muscle volume measured by surface EMG to be less than the thoracic PVM and Quad.…”

“…Walking disrupts the compensatory mechanisms during standing posture and causes discrepancies in spinal alignment. Recent studies have reported the importance of paravertebral muscle assessment during this spinal alignment change [ 8 , 10 , 12 , 16 ]. As sagittal spinal unbalance occurs during walking, the trunk muscle group tries to respondto maintain spinal balance [ 5 , 7 ].…”

“…As sagittal spinal unbalance occurs during walking, the trunk muscle group tries to respondto maintain spinal balance [ 5 , 7 ]. However, most gait analyses investigated patients’ short walking with or without eliciting symptoms and measured muscle activity using the cross-sectional area of the paravertebral muscles from imaging studies as a surrogate [ 8 , 10 , 12 ]. To the best of our knowledge, few studies have investigated at which point during maximum walking distance the posture collapse, namely soon after walking starts, soon before the patient stops, or when it gradually worsens.…”

The relationship between clinical examination measures and ultrasound measures of fascia thickness surrounding trunk muscles or lumbar multifidus fatty infiltrations: An exploratory study

“…Again, only LuM MFI (not fibrosis) would explain the positive relationship with ECHO LuM , as an increased MFI in the posterior vertebral muscles (erector spinae + LuM) has been associated with pelvic retroversion (Elysee et al, 2021;Lee et al, 2022;Zhang et al, 2021). However, MFI in LuM was not enough to induce a change in pelvic inclination in 93 healthy controls (Menezes-Reis et al, 2018), which was later confirmed in a study showing a relationship with the erector spinae MFI but not LuM MFI in participants with spinal deformity (Miura et al, 2021). This could suggest that the participants of the present study may also have erector spinae MFI.…”