Abstract
This study investigated feasibility of imaging lumbopelvic musculature and geometry in tandem using upright magnetic resonance imaging (MRI) in asymptomatic adults, and explored the effect of pelvic retroversion on lumbopelvic musculature and geometry. Six asymptomatic volunteers were imaged (0.5 T upright MRI) in 4 postures: standing, standing pelvic retroversion, standing 30° flexion, and supine. Measures included muscle morphometry [cross-sectional area (CSA), circularity, radius, and angle] of the gluteus and iliopsoas, and pelvic geometry [pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), L3–S1 lumbar lordosis (LL)] L3-coccyx. With four volunteers repeating postures, and three raters assessing repeatability, there was generally good repeatability [ICC(3,1) 0.80–0.97]. Retroversion had level dependent effects on muscle measures, for example gluteus CSA and circularity increased (up to 22%). Retroversion increased PT, decreased SS, and decreased L3–S1 LL, but did not affect PI. Gluteus CSA and circularity also had level-specific correlations with PT, SS, and L3–S1 LL. Overall, upright MRI of the lumbopelvic musculature is feasible with good reproducibility, and the morphometry of the involved muscles significantly changes with posture. This finding has the potential to be used for clinical consideration in designing and performing future studies with greater number of healthy subjects and patients.
Highlights
Up to 60% of aging adults are affected by some form of adult spinal deformity (ASD)[1]
Muscle activation was not controlled as volunteers were asked to assume and hold postures as naturally as possible. This pilot study demonstrates that lumbopelvic muscle morphometry and bony geometry can be measured synchronously in upright and retroverted postures in asymptomatic individuals
This study provides baseline values of parameters in a pilot group and illustrates feasibility and good repeatability of imaging both the lumbopelvic muscle morphometry and bony geometry in tandem
Summary
Up to 60% of aging adults are affected by some form of adult spinal deformity (ASD)[1]. Others include segmental lumbar hyperlordosis, segmental retrolisthesis, thoracic hypokyphosis, knee flexion, and cervical h yperlordosis[7,8,9,10] Such compensatory mechanisms require higher energy expenditure due to muscle activation to maintain these postures, which can lead to patient fatigue, discomfort, disability, and poor clinical outcomes[11]. Though spinal muscle dysfunction has been identified to play a critical role in sagittal balance disorder, the upright lumbopelvic muscle morphometry and the interactions with the bony pelvic geometry have not been previously studied. By increasing pelvic tilt, is typically an initial compensatory step, groundwork in studying both the lumbopelvic musculature and geometry synchronously in upright and retroverted postures first in asymptomatic individuals would support subsequent patient studies to inform future treatment and mitigation of ASD. Synchronous study has not previously been done, and it is key to determine repeatability of image segmentation of both lumbopelvic muscle morphometry and bony geometry in tandem before moving to a patient population
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