Paraspinal muscles density: a marker for degenerative lumbar spinal stenosis?

Janan Abbas,Kamal Hamoud,Viviane Slon,Israel Hershkovitz,Nathan Peled,Hila May

doi:10.1186/s12891-016-1282-6

Abstract

BackgroundThe condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain. It is generally agreed that these muscles play an important role in the stability and functional movements of the lumbar vertebral column. Although spinal instability has been shown to play an essential role in degenerative lumbar spinal stenosis (DLSS), the role of paraspinal muscles remains elusive. The main purpose of this study was to shed light on the relationship between the condition of paraspinal muscles and symptomatic DLSS.MethodsTwo sample populations were studied. The first included 165 individuals with DLSS (age range: 40–88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40–99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2 circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS.ResultsIndividuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS.ConclusionsOur results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.

Highlights

The condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain
The present study is, to the best of our knowledge, among the largest to examine the relationship between paraspinal muscles density and cross-sectional area (CSA) and symptomatic degenerative lumbar spinal stenosis (DLSS)
The results of our study show that both males and females in our stenotic group manifested significantly greater density of the paraspinal muscles and higher CSA at the L3 level compared to the control group

Summary

Introduction

The condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain. It is generally agreed that these muscles play an important role in the stability and functional movements of the lumbar vertebral column. Spinal instability has been shown to play an essential role in degenerative lumbar spinal stenosis (DLSS), the role of paraspinal muscles remains elusive. The paraspinal muscles play an important role in the stability and functional movements of the lumbar vertebral column [14, 15]. Spinal instability has been shown to play an essential role in DLSS [22], the role of paraspinal muscles remains elusive

Objectives

Methods

Results

Discussion

Conclusion