Abstract
Study designA retrospective study.ObjectiveTo evaluate the different degeneration patterns of paraspinal muscles in degenerative lumbar diseases and their correlation with lumbar spine degeneration severity.Summary of background dataThe degeneration characteristics of different paraspinal muscles in degenerative lumbar diseases remain unclear.Methods78 patients diagnosed with single-level degenerative lumbar spondylolisthesis (DLS) and 76 patients with degenerative lumbar kyphosis (DLK) were included as DLS and DLK groups. Paraspinal muscle parameters of psoas major (PS), erector spinae (ES) and multifidus muscle (MF) were measured, including fatty infiltration (FI) and relative cross-sectional area (rCSA), namely the ratio of the paraspinal muscle CSA to the CSA of the vertebrae of the same segment. Sagittal parameters including lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. The paraspinal muscle parameters and ES/MF rCSA ratio were compared between the two groups. Paraspinal muscles parameters including rCSA and FI were also compared between each segments from L1 to L5 in both DLS and DLK groups. In order to determine the influence of sagittal spinal alignment on paraspinal muscle parameters, correlation analysis was conducted between the MF, ES, PS rCSA and FI and the LL in DLS and DLK group.ResultMF atrophy is more significant in DLS patients compared with DLK. Also, MF fatty infiltration in the lower lumbar spine of DLS patients was greater compared to DLK patients. DLK patients showed more significant atrophy of ES and heavier ES fatty infiltration. MF FI was significantly different between all adjacent segments in both DLS and DLK groups. In DLS group, ES FI was significantly different between L2/L3 to L3/L4 and L4/L5 to L5/S1, while in DLK group, the difference of ES FI between all adjacent segments was not significant, and ES FI was found negatively correlated with LL.ConclusionsParaspinal muscles show different degeneration patterns in degenerative lumbar diseases. MF degeneration is segmental in both DLS and DLK patients, while ES degenerated diffusely in DLK patients and correlated with the severity of kyphosis. MF degeneration is more significant in the DLS group, while ES degeneration is more significant in DLK patients. MF is the stabilizer of the lumbar spine segments, while the ES tends to maintain the spinal sagittal balance.
Highlights
Materials and methodsThe degenerative change of paraspinal muscles has been proven to be associated with a various of lumbar disorders and diseases [1,2,3]
The present study showed MF atrophy is more significant in degenerative lumbar spondylolisthesis (DLS) patients compared with degenerative lumbar kyphosis (DLK), and DLS patients showed heavier MF fatty infiltration in the lower lumbar spine when compared to DLK patients
The results showed the MF relative cross-sectional area (rCSA) correlated with sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL) and thoracolumbar kyphosis (TLK), while the erector spinae (ES) rCSA correlated with pelvic incidence (PI) and sacral slope (SS), which indicated that MF and ES have different roles in maintaining the sagittal alignment of the spine, and there is no correlation between the psoas major (PS) and sagittal parameters [32]
Summary
Materials and methodsThe degenerative change of paraspinal muscles has been proven to be associated with a various of lumbar disorders and diseases [1,2,3]. The anatomical location of the MF and the ES are close, and even the boundary between the two is difficult to distinguish on imaging These two muscles are with different fascicles and innervation patterns [8]. Whether the degenerative changes of the paraspinal muscles are related to the severity of spinal degenerative diseases remains controversial It needs to be clear whether MF is the protagonist of a series of paraspinal muscles, and whether the different paraspinal muscles play the same role in degenerative lumbar diseases and exhibit consistent pattern of degeneration. We hypothesizes that (1) patients with DLS and those with DLK will differ in the extent and segmental distribution of degenerative changes in MF, ES and PS muscles; (2) the degree of paraspinal muscles degeneration is related to the severity of the spinal disorder
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