1
|
Tang M, Wang S, Wang Y, Zeng F, Chen M, Chang X, He M, Fang Q, Yin S. Nomogram Development and Validation for Predicting Postoperative Recurrent Lumbar Disc Herniation Based on Paraspinal Muscle Parameters. J Pain Res 2024; 17:2121-2131. [PMID: 38894861 PMCID: PMC11185253 DOI: 10.2147/jpr.s459846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose Previous studies highlight paraspinal muscles' significance in spinal stability. This study aims to assess paraspinal muscle predictiveness for postoperative recurrent lumbar disc herniation (PRLDH) after lumbar disc herniation patients undergo percutaneous endoscopic transforaminal discectomy (PETD). Patients and Methods Retrospectively collected data from 232 patients undergoing PETD treatment at our institution between January 2020 and January 2023, randomly allocated into training (60%) and validation (40%) groups. Utilizing Lasso regression and multivariable logistic regression, independent risk factors were identified in the training set to construct a Nomogram model. Internal validation employed Enhanced Bootstrap, with Area Under the ROC Curve (AUC) assessing accuracy. Calibration was evaluated through calibration curves and the Hosmer-Lemeshow goodness-of-fit test. Decision curve analysis (DCA) and clinical impact curve (CIC) were employed for clinical utility analysis. Results Diabetes, Modic changes, and ipsilesional multifidus muscle skeletal muscle index (SMI) were independent predictive factors for PRLDH following PETD (P<0.05). Developed Nomogram model based on selected predictors, uploaded to a web page. AUC for training: 0.921 (95% CI 0.872-0.970), validation: 0.900 (95% CI 0.828-0.972), respectively. The Hosmer-Lemeshow test yielded χ 2=5.638/6.259, P=0.688/0.618, and calibration curves exhibited good fit between observed and predicted values. DCA and CIC demonstrate clinical net benefit for both models at risk thresholds of 0.02-1.00 and 0.02-0.80. Conclusion The Nomogram predictive model developed based on paraspinal muscle parameters in this study demonstrates excellent predictive capability and aids in personalized risk assessment for PRLDH following PETD.
Collapse
Affiliation(s)
- Ming Tang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei City, Anhui Province, People’s Republic of China
| | - Siyuan Wang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei City, Anhui Province, People’s Republic of China
| | - Yiwen Wang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Fanyi Zeng
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Mianpeng Chen
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Xindong Chang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Mingfei He
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Qingqing Fang
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| | - Shiwu Yin
- Department of Interventional Vascular Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei City, Anhui Province, People’s Republic of China
| |
Collapse
|
2
|
Tang M, Zhang G, Zeng F, Chang X, Fang Q, He M, Yin S. Paraspinal muscle parameters' predictive value for new vertebral compression fractures post-vertebral augmentation: Nomogram development and validation. Front Med (Lausanne) 2024; 11:1379078. [PMID: 38813387 PMCID: PMC11133621 DOI: 10.3389/fmed.2024.1379078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Objective Prior research underscores the significance of paraspinal muscles in maintaining spinal stability. This study aims to investigate the predictive value of paraspinal muscle parameters for the occurrence of new vertebral compression fractures (NVCF) following percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). Methods Retrospectively collected data from October 2019 to February 2021 (internal validation, n = 235) and March 2021 to November 2021 (external validation, n = 105) for patients with OVCF treated with PVP/PKP at our institution. They were randomly divided into training (188 cases) and validation groups (47 cases) at an 8:2 ratio. Lasso regression and multivariable logistic regression identified independent risk factors in the training set, and a Nomogram model was developed. Accuracy was assessed using receiver operating characteristic curves (ROC), calibration was evaluated with calibration curves and the Hosmer-Lemeshow test, and clinical utility was analyzed using decision curve analysis (DCA) and clinical impact curve (CIC). Results Surgical approach, spinal computed tomography (CT) values, and multifidus skeletal muscle index (SMI) are independent predictors of postoperative NVCF in OVCF patients. A Nomogram model, based on the identified predictors, was developed and uploaded online. Internal validation results showed area under the curve (AUC) values of 0.801, 0.664, and 0.832 for the training set, validation set, and external validation, respectively. Hosmer-Lemeshow goodness-of-fit tests (χ2 = 7.311-14.474, p = 0.070-0.504) and calibration curves indicated good consistency between observed and predicted values. DCA and CIC demonstrated clinical net benefit within risk thresholds of 0.06-0.84, 0.12-0.23, and 0.01-0.27. At specificity 1.00-0.80, the partial AUC (0.106) exceeded that at sensitivity 1.00-0.80 (0.062). Conclusion Compared to the spinal CT value, the multifidus SMI has certain potential in predicting the occurrence of NVCF. Additionally, the Nomogram model of this study has a greater negative predictive value.
Collapse
Affiliation(s)
- Ming Tang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Guangdong Zhang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Fanyi Zeng
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xindong Chang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Qingqing Fang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Mingfei He
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Shiwu Yin
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
3
|
Yuan H, Dong L, Zhang O, Wang X, Chen Z, Li Y, He H, Lü G, Li J, Kuang L. A comparison of interferential current efficacy in elderly intervertebral disc degeneration patients with or without sarcopenia: a retrospective study. BMC Musculoskelet Disord 2024; 25:214. [PMID: 38481194 PMCID: PMC10935844 DOI: 10.1186/s12891-024-07337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Intervertebral disc degeneration and sarcopenia are both age-related diseases without effective treatments. Their comorbidities may worsen the prognosis, and further studies on interaction and therapy are needed. The purpose of the study was to investigate the prevalence of sarcopenia in intervertebral disc degeneration, and to compare the characteristics of intervertebral disc degeneration with and without sarcopenia and effects of interferential current. METHODS One hundred twenty disc degeneration patients were included from 2021 to 2022 in a single institute. Medical records, examination results and radiological reports were reviewed. Patients with sarcopenia were screened and grouped according to Asian Working Group for Sarcopenia 2019. VAS, ODI, SARC-F, SMI, gait speed (GS), grip strength, disc Pfirrmann grading, standard cross-sectional area (SCSA), degree of fatty infiltration (DFF), and nerve conduction velocity (NCV) were assessed before and after treatment. RESULTS The prevalence of sarcopenia in intervertebral disc degeneration was 28.3%. The difference of VAS, ODI, disc Pfirrmann grading, SCSA, DFF and NCV between two groups were significant before intervention (P < 0.05), SCSA and DFF were related to the degree of disc degeneration. The improvement of SMI, GS, grip strength, VAS, SARC-F and ODI in intervertebral disc degeneration with sarcopenia group was significant after intervention, as well as SMI, GS, grip strength, VAS and ODI in those without sarcopenia (P < 0.05). The improvement of grip strength, GS, ODI and SARC-F in intervertebral disc degeneration with sarcopenia group were greater than the one without sarcopenia (P < 0.05), whereas there was no significance in improvement degree of other indicators between the two groups (P > 0.05). CONCLUSION The prevalence of sarcopenia was high in intervertebral disc degeneration, and paravertebral muscles degeneration correlated with the degree of disc degeneration. Compared to those without sarcopenia, intervertebral disc degeneration patients with sarcopenia have more severe pain, poorer mobility and neurological function. Interferential current is effective in intervertebral disc degeneration patients and sarcopenia patients.
Collapse
Affiliation(s)
- Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Lini Dong
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Ou Zhang
- Medical Education and Microbiology, California University of Science and Medicine, 1501 Violet Street, Colton, CA, 92324, USA
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China
| | - Jing Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China.
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410001, P.R. China.
| |
Collapse
|
4
|
Hou X, Hu H, Kong C, Zhang S, Wang W, Lu S. Psoas muscle index and psoas muscle density are associated with functional status in patients with degenerative lumbar spinal stenosis. J Back Musculoskelet Rehabil 2024:BMR230138. [PMID: 38306020 DOI: 10.3233/bmr-230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND The factors affecting lumbar spinal function in patients with degenerative lumbar spinal stenosis (DLSS) are still unclear. OBJECTIVE This study explored psoas major muscle morphology in patients with DLSS and its association with their functional status. METHODS A retrospective study was conducted on 288 patients with DLSS and 260 control subjects. Psoas major muscle evaluation included three morphometric parameters at the L3/4 disc level: psoas major index (PMI), muscle attenuation, and psoas major morphological changes (MPM). The association between psoas major morphology and functional status was assessed using the Oswestry disability index (ODI). RESULTS Both female and male patients with DLSS had a higher PMI and lower muscle attenuation. PMI and muscle attenuation were inversely correlated with age in the DLSS group. After multivariable analyses, the PMI and psoas major muscle attenuation were positively correlated with patients' functional status. CONCLUSION The PMI and muscle attenuation were positively correlated with functional status in patients with DLSS. These findings have important implications for physiotherapy programs of postoperative rehabilitation and conservative management of DLSS.
Collapse
Affiliation(s)
- Xiaofei Hou
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hailiang Hu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sitao Zhang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Song Z, Chen W, Zhu G, Chen X, Zhou Z, Zhang P, Lin S, Wang X, Yu X, Ren H, Liang D, Cui J, Jiang X, Tang J. Psoas Major Swelling Grade Affects the Clinical Outcomes after OLIF: A Retrospective Study of 89 Patients. Orthop Surg 2023; 15:2274-2282. [PMID: 37403557 PMCID: PMC10475660 DOI: 10.1111/os.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTS Oblique lumbar interbody fusion (OLIF) has gained increasing popularity recently. However, complications resulting from intraoperative retraction of psoas major (PM) sometimes occur. The aim of this study is to evaluate the degree of PM swelling by developing a scoring system called the Psoas Major Swelling Grade (PMSG), and to investigate the correlation between the PMSG and clinical outcomes after OLIF. METHODS Patients who underwent L4-5 OLIF at our hospital from May 2019 to May 2021 were reviewed and all data were recorded. The extent of postoperative PM swelling was determined by calculating the percentage of change in the PM area before and after surgery on MRI and divided into three grades subsequently. Swelling within the range of 0% to 25% was defined as grade I, 25%-50% was grade II, and more than 50% was grade III. All patients were grouped into the new grade system and followed up for at least 1 year, during which the visual analog scale (VAS) and Oswestry disability index (ODI) scores were recorded. Categorical data were analyzed using chi-square and Fisher's exact tests, while continuous variables were assessed with one-way ANOVA and paired t-tests. RESULTS Eighty-nine consecutive patients were enrolled in this study, with a mean follow-up duration of 16.9 months. The proportion of female patients in the PMSG I, II, and III groups was 57.1%, 58.3%, and 84.1%, respectively (p = 0.024). Furthermore, the total complication rate was 43.2% in the PMSG III group, significantly higher than 9.5% and 20.8% in the PMSG I and II groups (p = 0.012). The incidence of thigh paraesthesia was also considerably higher in the PMSG III group at 34.1% (p = 0.015), compared to 9.5% and 8.3% in the PMSG I and II groups. Among the patients, 12.4% exhibited a teardrop-shaped PM, with the majority (90.9%) belonging to the PMSG III group (p = 0.012). Additionally, the PMSG III group demonstrated a higher estimated blood loss (p = 0.007) and significantly worse clinical scores at the 1-week follow-up assessment (p < 0.001). CONCLUSION PM swelling adversely affects the OLIF prognosis. Female patients with teardrop-shaped PM are more likely to develop swelling after OLIF. A higher PMSG is associated with a higher complication rate of thigh pain or numbness and worse short-term clinical outcomes.
Collapse
Affiliation(s)
- Zefeng Song
- First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Wanyan Chen
- First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Guangye Zhu
- First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Xingda Chen
- First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Zelin Zhou
- First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Peng Zhang
- First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Shaohao Lin
- First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Xiaowen Wang
- First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Xiang Yu
- Department of Spinal SurgeryThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Hui Ren
- Department of Spinal SurgeryThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - De Liang
- Department of Spinal SurgeryThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jianchao Cui
- Department of Spinal SurgeryThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xiaobing Jiang
- Department of Spinal SurgeryThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jingjing Tang
- Department of Spinal SurgeryThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| |
Collapse
|
6
|
Muellner M, Haffer H, Moser M, Amoroso K, Wang Z, Arzani A, Tan ET, Chiapparelli E, Dodo Y, Shue J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Changes of the posterior paraspinal and psoas muscle in patients with low back pain: a 3-year longitudinal study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3290-3299. [PMID: 37378708 DOI: 10.1007/s00586-023-07814-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time. METHODS Patients with LBP who had a repeat lumbar MRI with a minimum of 3-years apart at a tertiary referral center were analyzed. MRI-based quantitative assessments of the PPM and the psoas muscle were conducted for the baseline and follow-up MRI. The cross sectional area (CSA), the functional cross sectional area (fCSA) and the fat area (FAT) were calculated using a dedicated software program. The fatty infiltration (FI,%) of the regions of interest was calculated. Differences between the 1st and 2nd MRI were calculated for all assessed muscular parameters. RESULTS A total of 353 patients (54.4%female) with a median age of 60.1 years and BMI of 25.8 kg/m2 at baseline were analyzed. The mean time between the 1st and 2nd MRI was 3.6 years. The fCSAPPM declined in both sexes significantly from the 1st to the 2nd MRI, whereas the FATPPM increased. In line with this result, the FIPPM increased in both males (29.9%) and females (19.4%). Females had a higher FIPPM and FIPsoas than males in both MRIs. In females, no significant changes were found for the psoas muscle. The CSAPsoas and fCSAPsoas in males were significantly smaller in the 2nd MRI. With increasing age, a significant trend in a decrease in ∆FIPPM was observed for both sexes. CONCLUSION The study revealed significant quantitatively muscular changes in males and females, especially in the posterior paraspinal muscles in only three years' time.
Collapse
Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Zhaorui Wang
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Artine Arzani
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
| |
Collapse
|
7
|
Kang M, Kim SH, Jo M, Jung HE, Bae J, Kim HJ. Evaluation of Paraspinal Muscle Degeneration on Pain Relief after Percutaneous Epidural Adhesiolysis in Patients with Degenerative Lumbar Spinal Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1118. [PMID: 37374322 DOI: 10.3390/medicina59061118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The objective of this study was to assess whether the cross-sectional area or fatty infiltration of the paraspinal muscles impacts the treatment outcomes of epidural adhesiolysis. Materials and Methods: The analysis included a total of 183 patients with degenerative lumbar disease who underwent epidural adhesiolysis. Good analgesia was defined as a reduction in pain score of ≥30% at the 6-month follow up. We measured the cross-sectional area and fatty infiltration rate of the paraspinal muscles and divided the study population into age groups (≥65 years and <65 years). Variables were compared between the good and poor analgesia groups. Results: The results revealed that elderly patients experienced poorer analgesic outcomes as the rate of fatty infiltration in the paraspinal muscles increased (p = 0.029), predominantly in female patients. However, there was no correlation between the cross-sectional area and the analgesic outcome in patients younger than or older than 65 years (p = 0.397 and p = 0.349, respectively). Multivariable logistic regression analysis indicated that baseline pain scores < 7 (Odds Ratio (OR) = 4.039, 95% Confidence Interval (CI) = 1.594-10.233, p = 0.003), spondylolisthesis (OR = 4.074, 95% CI = 1.144-14.511, p = 0.030), and ≥ 50% fatty infiltration of the paraspinal muscles (OR = 6.576, 95% CI = 1.300-33.268, p = 0.023) were significantly associated with poor outcomes after adhesiolysis in elderly patients. Conclusions: Fatty degeneration of paraspinal muscles is correlated with inferior analgesic outcomes following epidural adhesiolysis in elderly patients, but not in young and middle-aged patients. The cross-sectional area of the paraspinal muscles is not associated with pain relief after the procedure.
Collapse
Affiliation(s)
- Misun Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minju Jo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyun Eom Jung
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jungbin Bae
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hee Jung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| |
Collapse
|
8
|
Muellner M, Chiapparelli E, Haffer H, Dodo Y, Salzmann SN, Adl Amini D, Moser M, Zhu J, Carrino JA, Tan ET, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The association between paraspinal muscle parameters and vertebral pedicle microstructure in patients undergoing lumbar fusion surgery. INTERNATIONAL ORTHOPAEDICS 2023; 47:1051-1060. [PMID: 36562815 PMCID: PMC10661537 DOI: 10.1007/s00264-022-05659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Lumbar fusion surgery has become a standard procedure in spine surgery and commonly includes the posterior placement of pedicle screws. Bone quality is a crucial factor that affects pedicle screw purchase. However, the relationship between paraspinal muscles and the bone quality of the pedicle is unknown. The aim of the study was to determine the relationship between paraspinal muscles and the ex vivo bony microstructure of the lumbar pedicle. METHODS Prospectively, collected data of patients undergoing posterior lumbar fusion for degenerative spinal conditions was analyzed. Pre-operative lumbar magnetic resonance imaging (MRI) scans were evaluated for a quantitative assessment of the cross-sectional area (CSA), functional cross-sectional area (fCSA), and the proportion of intramuscular fat (FI) for the psoas muscle and the posterior paraspinal muscles (PPM) at L4. Intra-operative bone biopsies of the lumbar pedicle were obtained and analyzed with microcomputed tomography (µCT) scans. The following cortical (Cort) and trabecular (Trab) bone parameters were assessed: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), connectivity density (CD), bone-specific surface (BS/BV), apparent density (AD), and tissue mineral density (TMD). RESULTS A total of 26 patients with a mean age of 59.1 years and a mean BMI of 29.8 kg/m2 were analyzed. fCSAPPM showed significant positive correlations with BV/TVTrab (ρ = 0.610; p < 0.001), CDTrab (ρ = 0.679; p < 0.001), Tb.NTrab (ρ = 0.522; p = 0.006), Tb.ThTrab (ρ = 0.415; p = 0.035), and ADTrab (ρ = 0.514; p = 0.007). Cortical bone parameters also demonstrated a significant positive correlation with fCSAPPM (BV/TVCort: ρ = 0.584; p = 0.002; ADCort: ρ = 0.519; p = 0.007). FIPsoas was negatively correlated with TMDCort (ρ = - 0.622; p < 0.001). CONCLUSION This study highlights the close interactions between the bone microstructure of the lumbar pedicle and the paraspinal muscle morphology. These findings give us further insights into the interaction between the lumbar pedicle microstructure and paraspinal muscles.
Collapse
Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Division of Orthopaedics, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jiaqi Zhu
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
| |
Collapse
|
9
|
A clinical nomogram for predicting the residual low back pain after percutaneous endoscopic surgery for lumbar disc herniation. INTERNATIONAL ORTHOPAEDICS 2023; 47:819-830. [PMID: 36542140 DOI: 10.1007/s00264-022-05658-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Current findings suggest that minimally percutaneous endoscopic lumbar discectomy (PELD) is a practical therapeutic approach for lumbar disc herniation (LDH). However, some patients still end up with residual low back pain, even after surgery. Our study aims to construct and validate a nomogram to predict residual low back pain after PELD. METHODS The medical records of 355 LDH patients admitted to the author's hospital were retrospectively analyzed between January 2019 and December 2021. The patients were randomly divided into two groups with a ratio of 7:3, namely a modelling group and a validation group. The univariable logistics and multivariable regression methods were used to screen the independent risk factors. A nomogram was then drawn using independent risk factors selected from the univariable and multivariable regression analyses. The concordance index (C-index), the receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis were used to evaluate the nomogram's performance. Finally, the accuracy of the nomogram was verified by a validation cohort. RESULTS 36.6% (130/355) of patients showed low back pain after percutaneous endoscopic lumbar discectomy, while 63.4% (225/355) showed no symptoms. Multivariable logistical regression analysis showed that Modic change (p < 0.05, OR = 1.813), fatty infiltration of the paravertebral muscle (p < 0.05, OR = 2.935), and edema of lumbodorsal fascia (p = 0.049, OR = 1.611) were significant risk factors for post-operative residual back pain. Moreover, the C-index of the predictive nomogram was 0.743 (0.681-0.805), the area under the receiver operating characteristic curve (AUC) value was 0.739, and the DCA results exhibit a net benefit between 0.16 and 0.66. The above internal validation methods demonstrate the nomogram's good predictive capability. CONCLUSION Each variable in the model had a quantitatively corresponding risk score, which can be used in predicting residual low back pain after PELD.
Collapse
|
10
|
Cui M, Zhang Q, Chen X, Wu H. Analysis of CT imaging changes of psoas major muscles in patients with lumbar disc herniation mainly based on low back pain and lower limb pain. Front Surg 2023; 9:1022903. [PMID: 36756659 PMCID: PMC9899798 DOI: 10.3389/fsurg.2022.1022903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023] Open
Abstract
Background The study aimed to compare the area changes of CT (computed tomograghy) imaging of psoas major muscle (PM) in patients with lumbar disc herniation (LDH) mainly based on low back pain (LBP) and lower limb pain (LLP), and to analyze the correlation among them. Methods We retrospectively analyzed the lumbar CT imaging data of 120 patients with LDH and 60 healthy control people in our hospital from July 2017 to August 2019. They were divided into LBP group (60 cases), LLP group (60 cases) and healthy controls group (60 cases). According to the pain duration and pain degree, LBP group and LLP group were divided into three subgroups respectively. The maximum cross-sectional area (CSA) of PM and the CSA of L5 vertebral body were calculated by Image J software, and the ratio of them was the maximum CSA index of PM. The maximum CSA indices of PM among three groups and three subgroups were compared, respectively. Results The baseline data among the three groups weren't significantly different (P > 0.05), yet the maximum CSA index of PM did (P < 0.05). In the LBP group, the maximum CSA indices of PM among the three subgroups (short, medium and long) according to the pain duration were significantly different (P < 0.05), and those among the three subgroups (light, medium and heavy) according to pain degree did (P < 0.05). In the LLP group, the maximum CSA indices of PM among the three subgroups (short, medium and long) were compared, but there was not statistical difference among the three subgroups (P > 0.05). No statistical difference in terms of the maximum CSA indices of PM among the three subgroups (light, medium and heavy) was observed (P > 0.05). Conclusion The atrophy and thinning of PM may be related to LDH. The correlation between the atrophy of PM and LBP was greater than that of LLP. The atrophy of PM in LDH patients with LBP increased with the prolongation of pain duration and aggravation of pain degree.
Collapse
Affiliation(s)
- Mingchao Cui
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China,Department of Orthopedics, The Second Hospital of Tangshan, Tangshan, China
| | - Qianru Zhang
- Department of Cardiology,Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xipeng Chen
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China,Correspondence: Han Wu
| |
Collapse
|
11
|
Caprariu R, Oprea M, Popa I, Andrei D, Birsasteanu F, Poenaru VD. Cohort study on the relationship between morphologic parameters of paravertebral muscles, BMI and lumbar lordosis on the severity of lumbar stenosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03435-4. [PMID: 36534368 DOI: 10.1007/s00590-022-03435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION There is a growing body of literature separately linking lumbar spinal stenosis (LSS) with various factors such as paravertebral muscle (PVM) impaired function/morphology, lordosis or BMI. However, their interplay is yet to be known. The present study aims to investigate the relationship between PVM morphology, BMI and lumbar lordosis in a population with a surgical indication for LSS. MATERIALS AND METHODS A cross-sectional retrospective study was conducted on a group of 122 patients diagnosed with LSS in a hospital setting and scheduled for spine surgery. Epidemiological data and body mass index (BMI) were gathered. The cross-sectional area of the psoas muscle (rCSA) at the L4-L5 disc level on preoperative axial T2 MRI was measured. Fat infiltration of the anterior (APVM) and posterior paravertebral muscles (PPVM) was evaluated according to Goutallier classification while the severity of lumbar stenosis was staged according to Schizas criteria. Lumbar lordosis was measured on sagittal MRI using Cobb's angle method. The presence of the "rising psoas" sign was also noted. Statistical analysis of the data was performed using Pearson and Spearman correlations. RESULTS Statistical analysis revealed a moderate correlation between the severity of LSS and BMI (p = 0.001), and fatty infiltration of paravertebral muscles (p = 0.000, p = 0.000). Adjusting for age, gender, and BMI resulted in a low correlation (p = 0.003, p = 0.045), rCSA correlated negatively with age, gender, and lordosis. BMI had a low positive correlation with lumbar lordosis (p = 0.006), severity (p = 0.001), number of levels (p = 0.005) and PPVM (p = 0.031). CONCLUSIONS This study highlighted the relationship between PVM morphology and the severity of radiological signs in patients with LSS undergoing spine surgery and found a correlation independent of age, gender, and BMI. BMI was also shown to correlate with the severity after controlling for age and gender. rCSA has limited use in evaluating the severity of LSS.
Collapse
Affiliation(s)
- Radu Caprariu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Manuel Oprea
- Department of Traumatology and Orthopedics, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Iulian Popa
- Department of Traumatology and Orthopedics, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
| | - Diana Andrei
- Department of Balneology, Medical Rehabilitation and Rheumatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Florin Birsasteanu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - V Dan Poenaru
- Department of Traumatology and Orthopedics, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| |
Collapse
|
12
|
Gökşen A, Kocaman H, Merve Arman G, Lütfi Selçuk M. Comprehensive analysis of muscles wasting in disc herniation. J Biomech 2022; 145:111391. [PMID: 36435096 DOI: 10.1016/j.jbiomech.2022.111391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/30/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Neuromuscular reeducation of the muscles that stabilize the spine is the basis of conservative treatment of disc herniation. Therefore, it is important to investigate how these muscles are affected by disc herniation. The aim of this study was to investigate the effect of disc herniation, herniation severity, patient age, and biomechanics on the lumbar stabilizer muscles. A total of 330 individuals, including 261 patients with disc herniations and 69 without disc herniation participated in this study. The cross-sectional areas (CSAs) of the lumbar stabilizer muscles and the lumbar lordosis angle were evaluated by magnetic resonance imaging (MRI), according to the severity of the disc herniation and the patient's age. In the patients with disc herniation, the CSAs of the quadratus lumborum (QL) and the multifidus (MF) muscles were decreased. The psoas major (PM) muscle CSA was higher in the patients with sequestered discs than in those with protruded and extruded discs. A negative relationship between the sagittal curve and the PM muscle CSA was found. In addition, MF muscle CSA was found to decrease at age 45 years and over. Although disc herniation negatively affects muscle CSAs, no linear relationship was found between the severity of the herniation and the muscle CSA. In addition, the PM muscle was found to be a strong compensatory muscle in disc herniation.
Collapse
Affiliation(s)
- Ayşenur Gökşen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tarsus University, Mersin, Turkey.
| | - Hikmet Kocaman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Gökçe Merve Arman
- Department of Radiology, Karamanoglu Mehmetbey University Karaman Education and Research Hospital, Karaman, Turkey
| | - Muhammet Lütfi Selçuk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karamanoglu Mehmetbey University, Karaman, Turkey
| |
Collapse
|
13
|
Evaluation of Sagittal Spinopelvic Alignment on Analgesic Efficacy of Lumbar Epidural Steroid Injection in Geriatric Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101383. [PMID: 36295544 PMCID: PMC9606979 DOI: 10.3390/medicina58101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/08/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate the impact of sagittal imbalance based on pelvic incidence−lumbar lordosis (PI-LL) mismatch on the analgesic efficacy of epidural steroid injection in geriatric patients. Materials and Methods: Patients aged 65 years or older who received lumbar epidural steroid injections under fluoroscopy were enrolled. The cutoff of PI-LL mismatch >20° was used as an indicator of a marked sagittal imbalance. The cross-sectional area of the psoas and paraspinal muscles, as well as the paraspinal fat infiltration grade were measured. A 50% or more decrease in pain score at four weeks after injection was considered as good analgesia. Variables were compared between PI-LL ≤ 20° and >20° groups and multivariate analysis was used to identify factors related to pain relief after injection. Results: A total of 237 patients consisting of 150 and 87 patients in the PI-LL ≤ 20° and >20° groups, respectively, were finally analyzed. Female patients, patients with lumbar surgery history, and the smaller cross-sectional area of the psoas muscles were predominantly observed in patients with sagittal imbalance. There was no difference in analgesic outcome after injection according to the PI-LL mismatch (good analgesia 60.0 vs. 60.9%, p = 0.889). Multivariate analysis showed that pre-injection opioid use, moderate to severe foraminal stenosis, and high-graded paraspinal fat infiltration were significantly associated with poor analgesia after injection. Conclusions: There was no significant correlation between sagittal spinopelvic alignment and pain relief after lumbar epidural steroid injection for geriatric patients.
Collapse
|
14
|
Wang XW, Sun YJ, Chen X, Zhang WZ. Interleukin-4-induced FABP4 promotes lipogenesis in human skeletal muscle cells by activating the PPAR γ signaling pathway. Cell Biochem Biophys 2022; 80:355-366. [PMID: 35122221 DOI: 10.1007/s12013-022-01063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
Abstract
Chronic low back pain (CLBP) is a common symptom of lumbar degenerative disease. Degeneration of the lumbar paravertebral muscles causes a loss of muscle mass and strength, which is a vital factor causing CLBP and often accompanied by lipid infiltration. Tandem mass spectrometry (TMT) was used to identify differentially expressed proteins in lipid-infiltrated and normal muscles. The results show that fatty acid binding protein 4 (FABP4) participated in the peroxisome proliferator-activated receptor-γ (PPAR γ) signaling pathway as an up-regulated protein, which is related to lipogenesis in diverse cells. In addition, chronic inflammation is believed to be involved in lumbar muscle degeneration and lipogenesis, with interleukin-4 (IL-4) considered as the predominant contributor. In present study, we investigate the effect of FABP4 on lipogenesis in human skeletal muscle cells (HSMCs) stimulated by Interleukin-4 (IL-4) and explore the mechanistic basis. We found expression level of FABP4 in lipid-infiltrated muscles was significantly higher than that in normal muscles. Lipogenesis in HSMCs could be increased by IL-4 treatment, as well as by FABP4 overexpression. FABP4 inhibition suppressed IL-4-mediated lipogenesis in HSMCs, whereas the PPAR γ inhibitor alleviated lipogenesis in both IL-4-treated and FABP4-overexpressed HSMCs. Collectively, the results indicate that FABP4 induces lipogenesis in HSMCs stimulated with IL-4 via activating the PPAR γ signaling pathway. Our study offers a detailed perspective on the pathogenesis of muscle lipid infiltration and provides a potential target for the clinical treatment strategy of muscle lipid infiltration and CLBP.
Collapse
Affiliation(s)
- Xin-Wen Wang
- Spine Center, Department of Orthopedics, Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, China
| | - Yong-Jin Sun
- Spine Center, Department of Orthopedics, Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, China
| | - Xiao Chen
- Spine Center, Department of Orthopedics, Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, China
| | - Wen-Zhi Zhang
- Spine Center, Department of Orthopedics, Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, China.
| |
Collapse
|
15
|
Wang W, Guo Y, Li W, Chen Z. The difference of paraspinal muscle between patients with lumbar spinal stenosis and normal middle-aged and elderly people, studying by propensity score matching. Front Endocrinol (Lausanne) 2022; 13:1080033. [PMID: 36482999 PMCID: PMC9722946 DOI: 10.3389/fendo.2022.1080033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to elaborate the characteristics of paraspinal muscles in lower lumbar, to compare the differences of paraspinal muscle between patients with lumbar spinal stenosis and normal people and to explore the influencing factors of paraspinal muscle degeneration in patients with lumbar spinal stenosis. METHOD The 39 pairs of patients and normal people were selected by propensity score matching. The differences of multifidus muscle and erection spine muscle parameters between the two groups were compared by independent-samples t-test and the relationship between age, paraspinal muscle degeneration and other factors in patients with lumbar spinal stenosis was analyzed by Pearson or Spearman correlation analysis. RESULT The general conditions of the two groups (patients with lumbar spinal stenosis and normal people) were well matched. There were significant differences in the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle at L3 level. The fatty infiltration and relative signal intensity of multifidus muscle at L4 level and the relative signal intensity of multifidus muscle at L5 level were also significantly different. For male, the relative fatty cross sectional area, the fatty infiltration and relative signal intensity of multifidus muscle in patients were higher than those in healthy peers. For female, the relative signal intensity of multifidus muscle in patients was higher, too. In patients group, age was significantly correlated with the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle and erector spinae muscle. Weight and BMI were significantly correlated with the relative total cross-sectional area of erector spinae muscle. The fatty infiltration increased more significantly with age in patients than that in normal people. CONCLUSION The change rules of paraspinal muscles in patients with lumbar spinal stenosis are similar to those in normal people. The degeneration of paraspinal muscle in patients with lumbar spinal stenosis was more severe than that in normal people, mostly in multifidus muscle. The paraspinal muscle degeneration was related to age in patients, and the effect of age on atrophy of paraspinal muscle was greater than that of normal people.
Collapse
Affiliation(s)
- Wei Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Yang Guo
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- *Correspondence: Weishi Li,
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| |
Collapse
|
16
|
Sun JM, Hsieh CT, Chen YH, Huang KC, Ko PC. Preliminary report on value of Wallis interspinous device for back pain following microdiscectomy: A prospective cohort study. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_98_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
17
|
Analysis of the paraspinal muscle morphology of the lumbar spine using a convolutional neural network (CNN). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:774-782. [PMID: 34894288 DOI: 10.1007/s00586-021-07073-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE This single-center study aimed to develop a convolutional neural network to segment multiple consecutive axial magnetic resonance imaging (MRI) slices of the lumbar spinal muscles of patients with lower back pain and automatically classify fatty muscle degeneration. METHODS We developed a fully connected deep convolutional neural network (CNN) with a pre-trained U-Net model trained on a dataset of 3,650 axial T2-weighted MRI images from 100 patients with lower back pain. We included all qualities of MRI; the exclusion criteria were fractures, tumors, infection, or spine implants. The training was performed using k-fold cross-validation (k = 10), and performance was evaluated using the dice similarity coefficient (DSC) and cross-sectional area error (CSA error). For clinical correlation, we used a simplified Goutallier classification (SGC) system with three classes. RESULTS The mean DSC was high for overall muscle (0.91) and muscle tissue segmentation (0.83) but showed deficiencies in fatty tissue segmentation (0.51). The CSA error was small for the overall muscle area of 8.42%, and fatty tissue segmentation showed a high mean CSA error of 40.74%. The SGC classification was correctly predicted in 75% of the patients. CONCLUSION Our fully connected CNN segmented overall muscle and muscle tissue with high precision and recall, as well as good DSC values. The mean predicted SGC values of all available patient axial slices showed promising results. With an overall Error of 25%, further development is needed for clinical implementation. Larger datasets and training of other model architectures are required to segment fatty tissue more accurately.
Collapse
|
18
|
Yang JE, Zhao KH, Qu Y, Zou YC. Increased serum CXCL10 levels are associated with clinical severity and radiographic progression in patients with lumbar disc degeneration. Clin Chim Acta 2021; 525:15-22. [PMID: 34902344 DOI: 10.1016/j.cca.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/16/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lumbar intervertebral degenerative disc disease (IDD) is a multifaceted progressive condition that commonly occurs in conjunction with lumbar disc herniation (LDH). CXCL10 mRNA appears to be increased in both IDD and LHD. OBJECTIVE This study was performed to identify the relationship between serum CXCL10 levels and disease severity in patients with IDD. METHODS 136 IDD patients with low back pain, 127 asymptomatic volunteers and 120 healthy controls were enrolled. Serum CXCL10 protein concentrations were detected using commercial human CXCL10 ELISA Kits. Serum CXCL10 mRNA were examined using qRT-PCR. Clinical severity was assessed using the visual analog scale (VAS) and Oswestry Disability Index(ODI) scores. Radiographic severity was defined using the MRI-based Pfirrmann classification of disc degeneration. Receiver operating characteristic (ROC) curve analysis was used in estimating the correlation between CXCL10 and Pfirrmann grade. The cross-sectional area (CSA) of the lumbar multifidus muscle (LMM) and psoas major (PM) were calculated, and fat infiltration was evaluated by Ropponen-Kjaer criteria. RESULTS Serum CXCL10 concentrations were markedly raised in IDD patients with low back pain in contrast to asymptomatic individuals and healthy controls. Serum CXCL10 levels were positively associated with Pfirrmann grade. ROC curve analysis indicated that serum CXCL10 correlated well with Pfirrmann grade. In addition, serum CXCL10 concentrations were significantly higher in IDD patients with LMM and PM degeneration compared with IDD patients without degeneration. Increased CXCL10 levels positively correlated with VAS and ODI scores, as well as decreased CSA and fat filtration of the LMM and PM. CONCLUSION Increased serum CXCL10 levels correspond to clinical severity and radiographic progression in IDD patients.
Collapse
Affiliation(s)
- Jia-En Yang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu 610041, Sichuan, China; Department of Rehabilitation Medicine, Affiliated Foshan Gaoming Hospital of Guangdong Medical University, Foshan 528000, Guangdong, China
| | - Ke-Hong Zhao
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Yu-Cong Zou
- Department of Rehabilitation,The third Affiliated Hospital,Southern Medical University ,Guangzhou 510630, GuangDong, China.
| |
Collapse
|