Abstract
Sarcopenia is characterized by a decline in systemic muscle mass and physical performance. Disc degeneration also causes back muscle atrophy. Therefore, we aimed to evaluate the influence of systemic muscle mass decline on back muscle atrophy and fatty infiltration compared to disc degeneration. We included 127 patients (65.54 ± 14.93 years) with back pain who underwent lumbar spine magnetic resonance imaging (MRI). Axial T2-weighted MRI data of the L4–5 and L5-S1 levels were used to measure the cross-sectional area (CSA) of the psoas and spinal muscles. The psoas index (cm2/m2) was used as a surrogate for systemic muscle mass. The Pfirrmann grading system was used to evaluate intervertebral disc degeneration. The functional area of the back muscles was calculated by subtracting the fat infiltration area from the CSA; the functional CSA ratio was calculated by dividing the functional CSA by the CSA. Image-processing software (ImageJ; National Institutes of Health, Bethesda, MD, USA) was used for analysis. Psoas index and aging significantly affected CSA and the ratio of functional CSA of the back muscles and multifidi. Disc degeneration did not significantly affect the back muscles beyond aging in patients with back pain. Males showed substantially higher CSA of the back muscles and multifidi than females; however, sex did not affect the functional CSA ratio of these muscles. Systemic muscle mass decline showed a more powerful influence on back muscle atrophy and fatty infiltration than disc degeneration. Therefore, proper evaluation of sarcopenia is needed for patients with chronic back pain and back muscle degeneration.
Highlights
Core stability is the principal factor in spinal stability and skeletal muscle activation
Disc degeneration was positively correlated with multifidus atrophy or fatty infiltration [2]
In our study, the psoas index and aging significantly influenced the cross-sectional area (CSA) and ratio of functional CSA of the back muscles and multifidi, and disc degeneration did not significantly affect the back muscles beyond aging in patients with back pain. These results showed that disc degeneration and generalized muscle atrophy significantly affected back muscle atrophy and fatty infiltration
Summary
Core stability is the principal factor in spinal stability and skeletal muscle activation. The muscles involved in core stability are activated before those of the extremities. These muscles support the activities of the extremities [1]. Patients with back pain show paraspinal muscle atrophy [4,5]. Activation patterns in the back and extremity muscles change in back pain patients [1]. Based on this notion, researchers have regarded back muscles as a key factor in chronic back pain. Core muscle strength training has been the focus of exercise treatment for patients with back pain. Sarcopenia is defined as low skeletal muscle mass and reduced muscle strength and physical performance in old age [6]
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