Paravertebral Muscles Research Articles

Correlation of Sarcopenia with Coronary Artery Disease Severity and Pericoronary Adipose Tissue Attenuation: A Coronary CT Study

Objective: To investigate the association between sarcopenia, as appraised with CT-derived muscle metrics, and cardiovascular status, as assessed via coronary CT angiography (CCTA) using the Coronary Artery Disease-Reporting and Data System (CAD-RADS) and with pericoronary adipose tissue (pCAT) metrics. Methods: A retrospective observational study conducted on patients who underwent CCTA. The cross-sectional area (CSA) and attenuation values of the paravertebral muscles at the T8 level and the pectoralis major muscles at the T6 level were measured. The patient height was employed for the normalization of the skeletal muscle CSA. The pCAT attenuation around the coronary arteries was assessed, and the CAD severity was graded using the CAD-RADS reporting system. Regression analyses were performed to assess the impact of demographics, clinical factors, and CT variables on the CAD-RADS and pCAT. Results: A total of 220 patients were included (132 males, median age 65 years). Regression analyses showed the associations of CAD with age and sex (p < 0.001). Familiarity with CAD was related to the left anterior descending artery pCAT (p = 0.002) and circumflex artery pCAT (p = 0.018), whereas age was related to the left anterior descending artery pCAT (p = 0.032). Weak positive correlations were found between the lower muscle density and lower pCAT attenuation (ρ = 0.144–0.240, p < 0.039). Conclusions: This study demonstrated weak associations between the sarcopenia indicators and the cardiovascular risk, as assessed by the CAD severity and pCAT inflammation. However, these correlations were not strong predictors of CAD severity, as age and traditional cardiovascular risk factors overshadowed the impact of sarcopenia in the cardiovascular risk assessment.

Discussion of the Current Treatment Methods for Degenerative Lumbar Spondylolisthesis

Degenerative spondylolisthesis (DS) is caused by degeneration that causes the lumbar vertebral body of the diseased segment to be displaced relative to the lower vertebral body, which is usually forward, and is not accompanied by pedicle fracture or defect, also known as "pseudospondylolisthesis". DS is more common in the L4/L5 segment, followed by the L3/L4 and L5/S1 segments, and is mostly mild slippage of the first and second degrees [2-4]. At present, the pathogenesis of DS is not fully understood, and it may be related to age-related degeneration of supporting structures, such as intervertebral discs, facet joints, bones, ligaments, facet capsule, and paravertebral muscles. In addition, the decrease in estrogen in women is also associated with the development of DS [1]. Clinically, DS is characterized by recurrent symptoms such as low back and leg pain, numbness of the lower limbs, intermittent claudication, and in severe cases, colorectal symptoms may occur [4].

Chest Wall Hydatid Disease: Surgical management and risk Factors for Recurrence and Mortality

Background Hydatidosis of the thoracic wall differs from other hydatid localizations in its pathophysiology, diagnostic, and therapeutic management. It is a little-studied entity. The objectives of our work were to describe its surgical management and to analyze the factors that may influence recurrence and mortality. Methods A retrospective, descriptive, longitudinal, and multicenter study on four university hospital surgical centers of Tunis, from January 1995 to December 2022 including operated hydatid cysts of the thoracic wall. Overall survival (OS) and cumulative recurrence rates were calculated. Univariate and multivariable Cox regression analyses were performed to identify recurrence and mortality risk factors. Results Forty-nine patients were included. The mean age was 41 ± 17 years [8-76]. The main presenting sign was thoracic parietal swelling (n=22). Chest ultrasound and CT scan showed multivesicular formation in 17 and 33 cases, respectively. Muscle involvement was in the intercostal (n=4), paravertebral (n=13), and pectoralis major (n=3) muscles. Bone involvement was vertebral (n=11), costal (n=12), costo-vertebral (n=21) and sternal (n=2). A posterolateral thoracotomy was performed (n=20). Surgical excision at various levels of the chest wall with spinal stabilization (n=15) was performed. Sixty-three percent of the patients received antiparasitic medical treatment. Recurrence occurred in 37% of cases. Four patients died from hydatidosis-related complications. Factors could be independently associated with recurrence such as male gender, and vertebral involvement. The presence of a visceral hydatid cyst located at a distance from the parietal lesion at the time of diagnosis and the occurrence of postoperative infectious complications could increase mortality. Conclusions Chest wall hydatidosis represents a rare medical condition where surgery remains the preferred treatment modality. However, it carries a substantial burden of morbidity and mortality, influenced by various factors. Further large-scale studies are necessary to gain a deeper understanding of these factors and to optimize management strategies accordingly.

Role of CT-based body composition parameters in the course of COVID-19.

A significant correlation is observed between the course of coronavirus disease 2019 (COVID-19) and body composition parameters including visceral fat quantification, muscle mass, and hepatic attenuation. The aim of the study was to investigate the correlation between the extent of lung involvement and various computed tomography (CT) parameters, as well as laboratory findings in COVID-19 patients. A retrospective analysis was conducted on 72 adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who underwent two consecutive thorax CT scans at least 2 weeks apart. The patients were divided into two groups, as progressive and nonprogressive, based on the presence of two consecutive CT scans. Skeletal muscle area (SMA), subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), liver-to-spleen (L/S) density ratio, and laboratory findings were compared between the groups. The correlation between the extent of lung involvement and CT parameters, as well as the laboratory findings were assessed. A total of 72 patients were included in the study, with 34 (47.2%) females and 38 (52.8%) males. Hemoglobin levels were significantly lower in the progressive group compared to the nonprogressive group. C-reactive protein (CRP) values were higher in the progressive group at follow-up. The nonprogressive group exhibited decreases in the SFA, VFA, and TFA, while liver density increased. The progressive group showed a decrease in the twelfth thoracic vertebra (T12) paravertebral muscle area and muscle index. In the comparison of the laboratory and radiological data in the course of COVID-19, white blood cell (WBC) and neutrophil counts increased, SMA T12, and the skeletal muscle index (SMI) decreased in the lung progressive group. Hemoglobin and CRP levels at admission may indicate disease progression. Future studies are warranted to increase the reliability with larger series.

Free-breathing qRF-MRF with pilot tone respiratory motion navigator for T1, T2, T2*, and off-resonance mapping of the human body at 3T.

Standard quantitative abdominal MRI techniques are time consuming, require breath-holds, and are susceptible to patient motion artifacts. Magnetic resonance fingerprinting (MRF) is naturally multi-parametric and quantifies multiple tissue properties, including T1 and T2. This work includes T2* and off-resonance mapping into a free-breathing MRF framework utilizing a pilot tone navigator. The new acquisition and reconstruction are compared to current clinical standards. Prospective. Ten volunteers. 3T scanner, Quadratic-RF MRF, Balanced SSFP, Inversion recovery spin-echo, LiverLab. MRI ROIs were evaluated in the liver, spleen, pancreas, kidney (cortex and medulla), and paravertebral muscle by two abdominal imaging investigators for ten healthy adult volunteers for clinical standard, breath-Hold (BH) qRF-MRF, and free-breathing qRF-MRF with pilot-tone (PT) acquisitions. Bland-Altman analysis as well as Student's T tests were used to evaluate and compare the respective ROI analyses. Quantitative values between breath-Hold (BH) and free-breathing qRF-MRF with pilot-tone (PT) results show good agreement with clinical standard T1 and T2 quantitative mapping, and Dixon q-VIBE (acquired using the Siemens LiverLAB). In this work, we show free-breathing abdominal MRF (T1, T2) with T2* results that are quantitatively comparable to current breath-hold MRF and clinical techniques.

Posterior Reduction and Temporary Fixation Through Intermuscular Approach for Odontoid Fracture.

Posterior reduction and temporary fixation (PRTF) through open approach can effectively avoid the loss of C1-C2 motion caused by posterior atlantoaxial fusion in the treatment of odontoid fracture. PRTF through intermuscular approach can preserve the integrity of the paravertebral muscle. However, its contribution to the preservation of C1-C2 rotation remains unassessed in the context of fresh odontoid fractures. The data of 31 patients with odontoid fractures who underwent PRTF through intermuscular approach were retrospectively reviewed. Operation time, intraoperative blood loss, the time of ambulation and surgery-related complications were recorded. After fracture healing, the instrumentation was removed. The Japanese Orthopedic Association score, Visual Analog Scale score for neck pain, and patient satisfaction were recorded. The range of motion in rotation of C1-C2 was calculated 1 month after removing the instrumentation. Fracture healing was observed in all patients, and the instrumentation was removed. After removing the instrumentation, the range of motion of C1-C2 in rotation was returned to 35.6° ± 4.8°. Patient satisfaction was improved (P < .05). There was no significant difference in Japanese Orthopedic Association scores and Visual Analog Scale score for neck pain between 2 values before and after removing the instrumentation (P > .05). No osteoarthritis was observed at the C1-C2 lateral mass joints. There were no perioperative complications. PRTF through intermuscular approach can be used as a salvage treatment of an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation. This minimally invasive technique can effectively preserve the rotational function of the atlantoaxial complex.

Lumbar localized fat distribution parameters are independent predictors of osteoporotic vertebral compression re-fractures (OVCRFs) following Percutaneous Kyphoplasty (PKP): a retrospective matched case-control study.

To investigate potential risk factors for osteoporotic vertebral compression re-fractures (OVCRFs) following percutaneous kyphoplasty (PKP). Patients who underwent PKP from January 2012 to January 2020 were included in this study within the same institution. Cases were defined as patients who experienced OVCRFs, while controls were matched based on corresponding clinical characteristics from those patients without OVCRFs. The lumbar localized fat distribution parameters, including the fat infiltration ratio (FIR) in muscles [multifidus (MF), erector spinae (ES), paravertebral muscles (PVM), and psoas major (PS)] and subcutaneous fat thickness (SFT), were compared between the two groups through radiological data. And other clinical data that may be relevant were also compared. Independent risk factors for OVCRFs after PKP were identified through a binary logistic regression analysis. A total of 1391 patients who underwent PKP were included in this study. 51 patients were categorized into the re-fracture group, and 102 patients were selected as matched controls from the remaining cohort. There were statistically significant differences between the two groups in metrics including MF-FIR, ES-FIR, PVM-FIR, PS-FIR, bone mineral density (BMD), body-mass index (BMI), SFT, hemoglobin (Hb), albumin (ALB), alkaline phosphatase (ALP), and triglycerides (TG) (P < 0.05). Binary logistic regression analysis demonstrated that PVM-FIR (P = 0.003), SFT (P < 0.001), BMD (P = 0.011), and ALP (P = 0.005) were independent predictors for the occurrence of OVCRFs. This study discovered that lumbar localized fat distribution parameters including PVM-FIR and SFT are independent predictors of OVCRFs. Additionally, BMD and ALP were found to be independent predictors of OVCRFs.

Investigating the association between osteopenia and bowel perforation through a multicenter radiologic analysis

Anecdotal evidence from preliminary observations has noted multiple instances where osteoporosis is present in elderly patients before the clinical detection of bowel disease, even in the absence of overt gastrointestinal symptoms. However, any potential association between these conditions remains to be further investigated. This computed tomography (CT) study investigates whether patients with gastrointestinal (GI) perforation have lower bone mineral density (BMD) than age and sex matched controls. BMD was measured by drawing 3D regions of interest in the bone marrow of the L1–L3 vertebral bodies on CT scans of each of 37 GI perforations and matched controls. Spectrometric calibration of Hounsfield units to the mineral scale was performed with density measurements in the paravertebral muscles (erector spinae) and subcutaneous adipose tissue. The mean BMD of patients with GI perforation (135.9 ± 24.3 mg/ml) was significantly lower than that of controls (96.9 ± 27.5 mg/ml, p < 0.05). The calculated T-and Z-scores of bone mineral density were also significantly different between the two groups (p < 0.05 for each) and were − 2.9 (± 0.90) and − 0.8 (± 0.91) in patients with GI perforation and − 1.6 (± 0.83) and 0 (± 0.96) in the control group, respectively. The results imply that patients with gastrointestinal (GI) perforation have lower bone mineral density (BMD) than age-and sex-matched controls, posing the question whether the screening and aggressive management of osteoporosis is high-risk populations for gastrointestinal perforation can prevent gastrointestinal complications in targeted populations.

Improving Osteoporosis Prediction Using Vertebral Bone Quality Score and Paravertebral Muscle Measurements From Lumbar MRI Scans.

Retrospective cohort. This study aims to use a novel method of combining vertebral bone quality score with paravertebral cross-sectional area measurements to improve the accuracy of predicting individuals with total hip T-scores <-2.5. Osteoporosis is a prevalent skeletal condition associated with decreased bone density and increased fracture risk. Dual-energy x-ray absorptiometry (DXA) is the conventional method for diagnosing osteoporosis, but it has limitations. Opportunistic osteoporosis screening techniques using lumbar magnetic resonance imaging (MRI), particularly the vertebral bone quality (VBQ) score, have shown promise. This study aims to improve the accuracy of predicting individuals with low total hip T-scores using a novel method that combines VBQ scores with paravertebral cross-sectional area (CSA) measurements. A retrospective cohort of 98 patients with DXA and lumbar MRI scans was analyzed. VBQ scores were calculated based on lumbar MRI images, and CSA measurements of paravertebral and psoas muscles were obtained. Threshold-based logistic regression was used to identify optimal thresholds for predicting total hip T-scores <-2.5. The combined model incorporating the VBQ score and paravertebral muscle percent achieved an accuracy of 96.9% for predicting total hip T-scores <-2.5, compared to 81.6% when using the VBQ score alone. Incorporating paravertebral muscle measurements significantly improved the accuracy of identifying osteoporotic individuals. The combination of VBQ score and paravertebral muscle measurements enhances the accuracy of predicting individuals with low total hip T-scores. Lumbar MRI scans provide valuable information beyond opportunistic osteoporosis screening, and the inclusion of paravertebral muscle measurements could aid in identifying at-risk individuals more accurately.

Use of two-point and six-point Dixon MRI for fat fraction analysis in the lumbar vertebral bodies and paraspinal muscles in healthy dogs: comparison with magnetic resonance spectroscopy.

Fatty degeneration of the vertebral bodies and paravertebral muscles is associated with the presence, severity, and prognosis of spinal disease such as intervertebral disc degeneration. Therefore, the fat fraction (FF) of the vertebral bodies and paraspinal muscles has been considered a potential biomarker for assessing the pathophysiology, progression, and treatment response of spinal disease. Magnetic resonance spectroscopy (MRS) is considered the reference standard for fat quantification; however, it has limitations of a long acquisition time and is technically demanding. Chemical shift-encoding water-fat imaging, called the Dixon method, has recently been applied for rapid fat quantification with high spatial resolution. However, the Dixon method has not been validated in veterinary medicine, and we hypothesized that the Dixon method would provide a comparable assessment of the FF to MRS but would be faster and easier to implement in dogs. In this prospective study, we assessed the FF of the lumbar vertebral bodies and paravertebral muscles from the first to sixth lumbar vertebrae using MRS, the two-point Dixon method (LAVA-FLEX), and the six-point Dixon method (IDEAL-IQ) and compared these techniques. The FFs of vertebral bodies and paravertebral muscles derived from LAVA-FLEX and IDEAL-IQ showed significant correlations and agreement with those obtained with MRS. In particular, the FFs obtained with IDEAL-IQ showed higher correlations and better agreement with those obtained with MRS than those derived by LAVA-FLEX. Both Dixon methods showed excellent intra- and interobserver reproducibility for FF analysis of the vertebral bodies and paraspinal muscles. However, the test-retest repeatability of vertebral body and paraspinal muscle FF analysis was low for all three sequences, especially for the paraspinal muscles. The results of this study showed that LAVA-FLEX and IDEAL-IQ have high reproducibility and that their findings were highly correlated with the FFs of the lumber vertebral bodies and paraspinal muscles determined by MRS in dogs. The FF analysis could be performed much more easily and quickly using LAVA-FLEX and IDEAL-IQ than using MRS. In conclusion, LAVA-FLEX and IDEAL-IQ can be used as routine procedures in spinal magnetic resonance imaging in dogs for FF analysis of the vertebral bodies and paraspinal muscles.

Comparison of different MRI-based unsupervised segmentation algorithms in predicting sarcopenia

PurposeTo compare the performance of MRI-based Gaussian mixture model (GMM), K-means clustering, and Otsu unsupervised algorithms in predicting sarcopenia and to develop a combined model by integrating clinical indicators. MethodsRetrospective analysis was conducted on clinical and lumbar MRI data from 118 patients diagnosed with sarcopenia and 222 patients without the sarcopenia. All patients were randomly divided into training and validation groups in a 7:3 ratio. Regions of interest (ROI), specifically the paravertebral muscles at the L3/4 intervertebral disc level, were delineated on axial T2-weighted images (T2WI). The Gaussian mixture model (GMM), K-means clustering, and Otsu’s thresholding algorithms were employed to automatically segment muscle and adipose tissues at both the cohort and case levels. Subsequently, the mean signal intensity, volumes, and percentages of these tissues were calculated and compared. Logistic regression analyses were conducted to construct models and identify independent predictors of sarcopenia. An combined model was developed by combining the optimal magnetic resonance imaging (MRI) model and clinical predictors. The performance of the constructed model was assessed using receiver operating characteristic (ROC) curve analysis. ResultsAge, BMI, and serum albumin were identified as independent clinical predictors of sarcopenia. The cohort-level GMM demonstrated the best predictive performance both in the training group (AUC=0.840) and validation group (AUC=0.800), while the predictive performance of the other models was lower than that of the clinical model both in the training and validation groups. After combining the cohort-level GMM with the independent clinical predictors, the AUC of the training and validation groups increased to 0.871 and 0.867, respectively. ConclusionThe cohort-level GMM shows potential in predicting sarcopenia, and the incorporation of independent clinical predictors further increased the performance.

Evaluation and analysis of risk factors for adverse events of the fractured vertebra post-percutaneous kyphoplasty: a retrospective cohort study using multiple machine learning models

BackgroundAdverse events of the fractured vertebra (AEFV) post-percutaneous kyphoplasty (PKP) can lead to recurrent pain and neurological damage, which considerably affect the prognosis of patients and the quality of life. This study aimed to analyze the risk factors of AEFV and develop and select the optimal risk prediction model for AEFV to provide guidance for the prevention of this condition and enhancement of clinical outcomes.MethodsThis work included 383 patients with primary osteoporotic vertebral compression fracture (OVCF) who underwent PKP. The patients were grouped based on the occurrence of AEFV postsurgery, and data were collected. Group comparisons and correlation analysis were conducted to identify potential risk factors, which were then included in the five prediction models. The performance indicators served as basis for the selection of the best model.ResultsMultivariate logistic regression analysis revealed the following independent risk factors for AEFV: kissing spine (odds ratio (OR) = 8.47, 95% confidence interval (CI) 1.46–49.02), high paravertebral muscle fat infiltration grade (OR = 29.19, 95% CI 4.83–176.04), vertebral body computed tomography value (OR = 0.02, 95% CI 0.003–0.13, P < 0.001), and large Cobb change (OR = 5.31, 95% CI 1.77–15.77). The support vector machine (SVM) model exhibited the best performance in the prediction of the risk of AEFV.ConclusionFour independent risk factors were identified of AEFV, and five risk prediction models that can aid clinicians in the accurate identification of high-risk patients and prediction of the occurrence of AEFV were developed.

Characterization of SMA type II skeletal muscle from treated patients shows OXPHOS deficiency and denervation.

Spinal muscular atrophy (SMA) is a recessive developmental disorder caused by the genetic loss or mutation of the gene SMN1 (survival of motor neuron 1). SMA is characterized by neuromuscular symptoms and muscle weakness. Several years ago, SMA treatment underwent a radical transformation, with the approval of 3 different SMN-dependent disease-modifying therapies. This includes 2 SMN2 splicing therapies - risdiplam and nusinersen. One main challenge for type II SMA patients treated with these drugs is ongoing muscle fatigue, limited mobility, and other skeletal problems. To date, few molecular studies have been conducted on SMA patient-derived tissues after treatment, limiting our understanding of what targets remain unchanged after the spinal cord-targeted therapies are applied. Therefore, we collected paravertebral muscle from 8 type II patients undergoing spinal surgery for scoliosis and 7 controls. We used RNA-seq to characterize their transcriptional profiles and correlate these molecular changes with muscle histology. Despite the limited cohort size and heterogeneity, we observed a consistent loss of oxidative phosphorylation (OXPHOS) machinery of the mitochondria, a decrease in mitochondrial DNA copy number, and a correlation between signals of cellular stress, denervation, and increased fibrosis. This work provides new putative targets for combination therapies for type II SMA.

Magnetic resonance imaging findings in dogs with steroid-responsive meningitis-arteritis in the UK and their clinical significance: 53 cases (2013-2021).

To describe the MRI findings in a UK referral population of dogs with steroid-responsive meningitis-arteritis and to determine if they were associated with any specific clinical features or outcomes. We performed a multi-centre retrospective case series of dogs diagnosed with steroid-responsive meningitis-arteritis in the UK that underwent MRI. Blinded consensus review of the MRI studies was performed and the findings described. The presence or absence of specific MRI abnormalities were analysed for significant associations with presenting signs, results of investigations or case outcomes. Fifty-three dogs were included. The most common MRI findings were paravertebral muscle changes (30/53; 56.6%), meningeal contrast enhancement (13/41; 31.7%) and spinal cord parenchymal T2-W hyperintensity (15/53; 28.3%). Haemorrhage was observed in five of 53 (9.4%) cases - three intradural-extramedullary, one intramedullary and one extradural. Following binary logistic regressions, T2-W spinal cord parenchymal hyperintensity had a significant positive association with paresis/paralysis (odds ratio 14.86, 95% confidence interval 1.42 to 154.99) as did haemorrhage (odds ratio 16.12, confidence interval 2.05 to 126.73). Fifty-two (98.1%) dogs survived to discharge. Relapse occurred in nine of 29 (31.0%) dogs with sufficient follow-up, and no MRI finding had a significant relationship with its occurrence. Magnetic resonance imaging findings for steroid-responsive meningitis-arteritis can be severe and extensive, as can the clinical presentation. The presence of paresis/paralysis should raise concern for haemorrhage, though most dogs still have a good prognosis.

MRI-based assessment paraspinal extensor muscle fatty infiltration in acute cervical spinal cord injury patients - a retrospective study

BackgroundThe effect of fat infiltration in the paraspinal muscles on cervical degenerative disease has been confirmed by multiple studies. However, little is known about fat infiltration in the paraspinal extensors in patients with acute cervical spinal cord injury (SCI). This study aimed to investigate the difference in paraspinal extensor fatty infiltration between patients with acute cervical SCI and healthy controls, and to further explore the protective role of the paravertebral extensor muscles in patients with cervical SCI.MethodsA total of 50 patients with acute cervical SCI admitted to the emergency department from January 2019 to November 2023 were retrospectively analyzed, including 26 males and 24 females, with an average age of 59.60 ± 10.81 years. A control group of 50 healthy middle-aged and elderly individuals was also included, comprising 28 males and 22 females, with an average age of 55.00 ± 8.21 years. Cervical spine magnetic resonance imaging (MRI) was used to measure the cross-sectional areas of the superficial and deep cervical extensor muscles, the corresponding vertebral body cross-sectional areas, and the fat area within the superficial and deep extensor muscle groups using Image J software. Differences between the two groups were compared, and the cervical SCI patients were further analyzed based on the severity of the spinal cord injury and gender differences.ResultsThe deep fatty infiltration ratio (DFIR) and superficial fatty infiltration ratio (SFIR) at C4-C7 in the cervical SCI group were significantly higher than those in the control group (P < 0.001). The cross-sectional area of the functional deep extensor area (FDEA) relative to the vertebral body area (VBA) and the cross-sectional area of the functional superficial extensor area (FSEA) relative to the VBA at the C5 and C6 levels in the cervical SCI group were significantly lower than those in the control group (P < 0.001, P < 0.001, P = 0.034, P = 0.004 respectively). Among the cervical SCI patients, the cross-sectional areas of the deep extensor area (DEA) and the superficial extensor area (SEA) in males were significantly higher than those in females (P < 0.001). At the C6 and C7 levels, the FDEA/VBA and FSEA/VBA ratios in the male group were higher than those in the female group (P = 0.009, P = 0.022, P = 0.019, P = 0.005, respectively).ConclusionPatients with acute cervical SCI exhibit significantly higher fatty infiltration and a greater degree of paravertebral extensor muscle degeneration compared to healthy controls. This finding underscores the importance of the paravertebral extensor muscles in the context of cervical SCI and may guide future therapeutic strategies.

Evaluation of Paravertebral Muscle Structure Asymmetry in Idiopathic Scoliosis Using Imaging Techniques

ObjectiveThis study aimed to assess variances in paravertebral muscle structure in individuals with idiopathic scoliosis（IS） through imaging techniques. MethodsA cohort of 112 patients diagnosed with IS and treated at our institution between January and December 2023 were included in the analysis. During the same period, 37 patients with secondary scoliosis（SS）were included as controls. Imaging data were used to measure the Cobb angle of the apical vertebrae in scoliosis patients, along with the area and fat infiltration of the paravertebral muscles on both sides. Finally, the cross-sectional area of the paravertebral muscles and the degree of fat infiltration were comparatively evaluated. ResultsIn patients with IS, the paravertebral muscles on the concave side of the main curve were significantly larger than those on the convex side (P < 0.05). The concave/convex muscle area ratio in IS patients showed a positive correlation with the Cobb angle and scoliosis duration (both P < 0.05). There was no significant difference in the muscle area ratio between patients with IS and those with SS (P > 0.05). In IS, the paravertebral muscles on the concave side of the main curve exhibited more fat infiltration than those on the convex side, with this fat infiltration positively correlating with body mass index (BMI), Cobb angle, age, and scoliosis duration. Similarly, the degree of fat infiltration in the paravertebral muscles on the concave side of SS was greater than that observed on the convex side. Furthermore, the degree of fat infiltration in the paravertebral muscles associated with SS was more pronounced compared to that seen in IS (P < 0.05). ConclusionIn IS patients, the paravertebral muscles on the concave side are more prominent and exhibit more fat infiltration compared to those on the convex side. This fat infiltration positively correlates with the Cobb angle, scoliosis duration, BMI, and age, possibly indicating scoliosis progression.

The predictive value of albumin to alkaline phosphatase ratio for vertebral refractures in postmenopausal women.

To investigate the clinical value of serum albumin to alkaline phosphatase ratio (AAPR) in predicting the risk of osteoporotic vertebral refractures group (OVRFs) after percutaneous vertebral augmentation (PVA) in postmenopausal women. This is a retrospective case-control study including a series of postmenopausal women patients with osteoporotic vertebral fracture (OVF) and underwent PVA. Patients were divided into OVRFs and non-OVRFs. COX model was used to evaluate the correlation between preoperative AAPR and OVRFs after PVA. The receiver operating characteristic (ROC) curve and Kaplan-Meier method were used to analyze the predictive value of AAPR for the incidence of OVRFs. A total of 305 patients were included in the final study, and the incidence of postoperative OVRFs was 28.9%. Multivariate COX analysis showed that advanced age (HRs = 1.062, p = 0.002), low BMI (HRs = 0.923, p = 0.036), low AAPR (HRs = 0.019, p = 0.001), previous fall history (HRs = 3.503, p = 0.001), denosumab treatment (HRs = 0.409, p = 0.007), low L3 BMD (HRs = 0.977, p = 0.001) and low L3 paravertebral muscle density (PMD)value (HRs = 0.929, p = 0.001)) were closely related to the incidence of OVRFs. The area under the curve (AUC) of AAPR for predicting OVRFs was 0.740 (p < 0.001), and the optimal diagnostic cut-off value was 0.49. Kaplan-Meier curve analysis showed that low AAPR group (< 0.49) was significantly associated with lower OVRFs-free survival (p = 0.001; log-rank test). AAPR is an independent risk factor for OVRFs after PVA in postmenopausal women, and it can be used as an effective index to predict OVRFs.

Risk factors of domino osteoporotic vertebral fractures is severe paraspinal muscle fatty degeneration

BACKGROUND CONTEXTDomino osteoporotic vertebral fractures (OVFs) involve multiple OVFs occurring simultaneously or sequentially, before healing of the initial OVFs. However, the risk factors and long-term clinical outcomes of domino OVFs are unclear. PURPOSETo identify the risk factors associated with domino OVFs and to assess their impact on patients’ quality of life (QOL). STUDY DESIGN/SETTINGMulticenter prospective observational cohort study. PATIENT SAMPLEPatients (n = 190) treated conservatively for acute OVFs in 8 hospitals with 12-month follow-up. OUTCOME MEASURESClinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Multivariate analyses were performed to identify risk factors for domino OVFs. METHODSAll patients underwent magnetic resonance imaging (MRI) at 3 months to detect subsequent domino OVFs. Domino OVF group included initial domino OVFs (multiple acute OVFs at baseline) and subsequent domino OVFs at 3 months. Paraspinal muscle assessment was performed using the lumbar indentation value and Goutallier classification. Patient characteristics, bone quality, paravertebral muscle degeneration, nutritional status, radiographic parameters, and QOL scores were compared between the nondomino and domino OVF groups. RESULTSWe evaluated 50 (26.3%) patients with domino OVFs (34 with initial domino OVFs; 20 with subsequent domino OVFs). Walking ability was poorer in the domino than in the nondomino OVF group, from baseline to the 12 months follow-up. Groups with 3 or more adjacent domino OVFs showed worse VAS and ODI scores. Multivariate logistic regression analysis revealed that severe fatty degeneration of the paraspinal muscle was an independent risk factor for domino OVFs. CONCLUSIONSSevere paraspinal muscle fatty degeneration is an independent risk factor for domino OVFs. Our study showed that the quality, rather than the quantity, of paraspinal muscles had an impact on domino OVFs. Early assessment of fatty degeneration in the paraspinal muscles is essential for predicting the development of domino OVFs.

Trans-spinal magnetic stimulation combined with kinesiotherapy as a new method for enhancing functional recovery in patients with spinal cord injury due to neuromyelitis optica: a case report

BackgroundExperimental studies have shown that repetitive trans-spinal magnetic stimulation (TsMS) decreases demyelination and enables recovery after spinal cord injury (SCI). However, the usefulness of TsMS in humans with SCI remains unclear. Therefore, the main objective of this study is to evaluate the effects of TsMS combined with kinesiotherapy on SCI symptoms. We describe a protocol treatment with TsMS and kinesiotherapy in a patient with SCI due to neuromyelitis optica (NMO)-associated transverse myelitis.Case presentationA 23-year-old white male with NMO spectrum disorders started symptoms in 2014 and included lumbar pain evolving into a mild loss of strength and sensitivity in both lower limbs. Five months later, the symptoms improved spontaneously, and there were no sensorimotor deficits. Two years later, in 2016, the symptoms recurred with a total loss of strength and sensitivity in both lower limbs. Initially, physiotherapy was provided in 15 sessions with goals of motor-sensory recovery and improving balance and functional mobility. Subsequently, TsMS (10 Hz, 600 pulses, 20-seconds inter-trains interval, at 90% of resting motor threshold of the paravertebral muscle) was applied at the 10th thoracic vertebral spinous process before physiotherapy in 12 sessions. Outcomes were assessed at three time points: prior to physiotherapy alone (T-1), before the first session of TsMS combined with kinesiotherapy (T0), and after 12 sessions of TsMS combined with kinesiotherapy (T1). The patient showed a 25% improvement in walking independence, a 125% improvement in balance, and an 18.8% improvement in functional mobility. The Patient Global Impression of Change Scale assessed the patient’s global impression of change as ‘much improved’.ConclusionTsMS combined with kinesiotherapy may safely and effectively improve balance, walking independence, and functional mobility of patients with SCI due to NMO-associated transverse myelitis.

Effect of Paravertebral Muscle Degeneration on Lumbar and Pelvic Sagittal Alignment in Patients With Degenerative Scoliosis.

Retrospective study. To explore the relationship between lumbar spine muscle mass and lumbar pelvic sagittal parameters in patients with degenerative scoliosis. This study included ADS patients who were treated in our hospital from 2019 to 2023. The spinal parameters were evaluated through X-rays, and the relative muscle volume (RMV) and fat infiltration (FI) were measured through three-dimensional reconstruction. Patients were categorized into 3 groups based on SRS-Schwab sagittal balance correction (0, +, ++), and into 3 groups based on GAP score (proportioned, moderately dis-proportioned, severely dis-proportioned). Finally, patients were classified into low-quality and high-quality groups based on the FI of Paraspinal muscles (PSM). The study included a total of 63 patients. Significant statistical differences were observed in the FI and RMV of MF, ES and PS among patients classified by SRS-Schwab PT classification. Additionally, significant statistical differences were found in the RMV of MF and PS among patients classified by SRS-Schwab PI-LL classification and GAP score. Furthermore, a significant correlation was found between the FI and RMV of PSM and lumbopelvic sagittal parameters. The ordinal regression model analysis revealed that FI of ES significantly impacted PT imbalance, while RMV of MF significantly impacted PI-LL imbalance. Moreover, significant differences were noted in PT and PI between the low-quality and high-quality multifidus groups. As sagittal imbalance worsens, PSM degeneration also intensifies, primarily characterized by an increase in FI and a decrease in RMV. Notably, PT and PI-LL are positively correlated with RMV and negatively correlated with FI.