Natural aging course of paraspinal muscle and back extensor strength in community-dwelling older adults (sarcopenia of spine, SarcoSpine): a prospective cohort study protocol

Lumbar Extensor Muscle Strength and Physical Performance in Community-Dwelling Older Adults: Findings From SarcoSpine Cohort

BACKGROUND

The lumbar extensor muscles (LEMs) play an important role in body posture and physical function in older adults. Because lumbar extensor strength decreases more rapidly than limb muscle strength with age, it should be evaluated to aid healthy aging. This study investigated the association between LEM strength and physical performance in community-dwelling older adults.

METHODS

This prospective observational cohort study of spinal sarcopenia (SarcoSpine) was conducted at a single center. One hundred and ten consecutive individuals who completed the baseline survey, including conventional sarcopenic indices, lumbar spine three-dimensional magnetic resonance imaging, isokinetic lumbar extensor strength, and physical performance tests (Short Physical Performance Battery, Berg Balance Scale, and Back Performance Scale [BPS]), were enrolled. A multivariate linear regression analysis was performed to determine the variables for evaluating their association with LEM strength.

RESULTS

Among the conventional sarcopenic indices, gait speed was significantly correlated with Short Physical Performance Battery results and Berg Balance Scale score in men and women. Handgrip strength was significantly correlated with the BPS score for both sexes. In the multivariable linear regression, age (β = -2.12, p < .01) and BPS score (β = -3.54, p = .01, R2 = .29) were independent indicators of LEM strength.

CONCLUSIONS

Our findings reveal the substantial association between LEM strength and BPS score in older women. The targeted intervention aimed at improving the LEMs strength would be needed to enhance physical performance in the aging population.

Efficacy of acupuncture for lumbar disc herniation: changes in paravertebral muscle and fat infiltration - a multicenter retrospective cohort study

Objective

This study seeks to elucidate the dynamic alterations in the multifidus, erector spinae, and psoas major muscles, along with their fatty infiltration, in patients diagnosed with lumbar disc herniation treated through acupuncture. Concurrently, the Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores are employed to evaluate modifications in lumbar and leg pain and the enhancement in lumbar functionality.

Methods

A retrospective multi-center cohort study enrolled 332 adult LDH patients. Participants were divided into acupuncture and rehabilitation therapy groups. The acupuncture cohort received targeted treatments at specific acupuncture points, while the rehabilitation group received traditional rehabilitative therapy. Magnetic Resonance Imaging (MRI) gauged muscle cross-sectional areas (Sm, Se, Sp) and their ratios to vertebral area (Sm/Sv, Se/Sv, Sp/Sv), and fatty infiltration areas (Sfm, Sfe, Sfp) and their ratios (Sfm/Sv, Sfe/Sv, Sfp/Sv). Pain and function were assessed using Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores pre-treatment, 2-weeks, and 3-months post-intervention.

Results

A total of 332 patients were enrolled for analysis. Post-treatment, the acupuncture group exhibited increased Sm, Se, Sp and their ratios and reduced fatty infiltration areas and their ratios (P<0.05) compared to rehabilitation. Both treatments decreased VAS scores and enhanced JOA scores at both intervals (P<0.05). Intriguingly, no significant disparities were observed between the acupuncture and rehabilitation groups concerning pain and JOA scores at the 2-week follow-up (p>0.05); however, 3 months post-treatment, the acupuncture group significantly outperformed the rehabilitation group in both pain and JOA scores (p<0.05).

Conclusion

This study demonstrates that acupuncture treatment is significantly more effective than traditional rehabilitation therapy in improving paraspinal muscle function, reducing muscle fat infiltration, and alleviating lumbar and leg pain in patients with lumbar disc herniation (LDH). Specifically, acupuncture significantly increases the cross-sectional areas (Sm, Se, Sp) of the paraspinal muscles and reduces muscle fat infiltration, showing superior long-term results in pain relief and functional improvement. Future research should further explore the long-term effects of acupuncture on the function and structure of paraspinal muscles, assess its potential in preventing the recurrence of LDH, and delve deeper into how acupuncture affects paraspinal muscles at the molecular level, to better understand its therapeutic mechanisms and enhance its clinical application.

Precision MRI phenotyping of muscle volume and quality at a population scale

Introduction: Magnetic resonance imaging (MRI) enables direct measurements of muscle volume and quality, allowing for an in-depth understanding of their associations with anthropometric traits, and health conditions. However, it is unclear which muscle volume measurements: total muscle volume, regional measurements, measurements of muscle quality: intermuscular adipose tissue (IMAT) or proton density fat fraction (PDFF), are most informative and associate with relevant health conditions such as dynapenia and frailty. Methods: We have measured image-derived phenotypes (IDPs) including total and regional muscle volumes and measures of muscle quality, derived from the neck-to-knee Dixon images in 44,520 UK Biobank participants. We further segmented paraspinal muscle from 2D quantitative MRI to quantify muscle PDFF and iron concentration. We defined dynapenia based on grip strength below sex-specific cut-off points and frailty based on five criteria (weight loss, exhaustion, grip strength, low physical activity and slow walking pace). We used logistic regression to investigate the association between muscle volume and quality measurements and dynapenia and frailty. Results: Muscle volumes were significantly higher in male compared with female participants, even after correcting for height while, IMAT (corrected for muscle volume) and paraspinal muscle PDFF were significantly higher in female compared with male participants. From the overall cohort, 7.6% (N = 3,261) were identified with dynapenia, and 1.1% (N = 455) with frailty. Dynapenia and frailty were positively associated with age and negatively associated with physical activity levels. Additionally, reduced muscle volume and quality measurements were associated with both dynapenia and frailty. In dynapenia, muscle volume IDPs were most informative, particularly total muscle exhibiting odds ratios (OR) of 0.392, while for frailty, muscle quality was found to be most informative, in particular thigh IMAT volume indexed to height squared (OR = 1.396), both with p-values below the Bonferroni-corrected threshold (p < 8.8 × 10 - 5 ). Conclusion: Our fully automated method enables the quantification of muscle volumes and quality suitable for large population-based studies. For dynapenia, muscle volumes particularly those including greater body coverage such as total muscle are the most informative, whilst, for frailty, markers of muscle quality were the most informative IDPs. These results suggest that different measurements may have varying diagnostic values for different health conditions.

Quantitative multi-parameter assessment of age- and gender-related variation of back extensor muscles in healthy adults using Dixon MR imaging

OBJECTIVES

Investigate sex differences in age-related back extensor muscle degeneration using Dixon MRI and analyze the relationship between quantitative muscle parameters and back muscle strength in healthy adults.

METHODS

105 healthy subjects underwent lumbar Dixon MRI. Fat fraction (FF), cross-sectional area (CSA), functional CSA (FCSA), and relative FCSA (RFCSA) of multifidus muscle (MF) and erector spinae (ES) were quantified. Back extension muscle strength was measured using an external fixation dynamometer. ANOVA with post hoc Tukey correction was used for age group comparisons. Partial and Spearman's correlation analyzed relationships between age, muscle parameters, and muscle strength.

RESULTS

MF and ES FF significantly increased with age in both genders (r = 0.55-0.85; p < 0.001). Muscle FF increased prominently for females (40-49 years, MF and 50-59 years, ES) and males (60-73 years, MF and ES). In females, total ES FCSA and RFCSA (r =  - 0.42, - 0.37; p < 0.01) correlated with age. While in males, all MF and ES muscle size parameters, except total MF CSA, correlated with age (r =  - 0.30 to - 0.58; p < 0.05). Back extension muscle strength correlated with mean FF, total CSA, and total FCAS for MF and ES individually (p < 0.001). The combined MF + ES FCSA correlation coefficient (r = 0.63) was higher than FF (r =  - 0.51) and CSA (r = 0.59) (p < 0.001).

CONCLUSIONS

Age-related back extensor muscle degeneration varies by muscle type and sex. FCSA has the highest association with back muscle strength compared to FF and CSA.

CLINICAL RELEVANCE STATEMENT

The investigation of sex differences in age-related back extensor muscle degeneration utilizing Dixon imaging may hold significant implications for evaluating spine health and enabling earlier intervention. Muscles' FCSA could contribute to acquiring additional evidence for reflecting muscle function change.

KEY POINTS

• The multifidus muscle (MF) and erector spinae (ES) fat fraction (FF) increased with age at all lumbar disc levels in females and males. • Age-related changes in muscle morphological quantitative parameters of healthy adults were specific by muscle type and gender. • The muscle functional cross-sectional area (FCSA) measured by Dixon imaging may better monitor back extensor muscle strength changes than muscle FF and cross-sectional area (CSA).

Computed Tomography-Defined Sarcopenia in Outcomes of Patients with Unresectable Hepatocellular Carcinoma Undergoing Radioembolization: Assessment with Total Abdominal, Psoas, and Paraspinal Muscles

Introduction

Sarcopenia is an adverse prognostic factor in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Image-based sarcopenia assessment allows a standardized method to assess abdominal skeletal muscle. However, which is an index muscle for sarcopenia remains unclear. Therefore, we investigated whether sarcopenia defined according to different muscle groups with computed tomography (CT) scans can predict the prognosis of HCC after radioembolization.

Methods

In this retrospective study, we analyzed patients who underwent radioembolization for unresectable HCC between January 2010 and December 2019. Before treatment, the total abdominal muscle (TAM), psoas muscle (PM), and paraspinal muscle (PS) areas were evaluated using a single CT slice at the third lumbar vertebra. In previous studies, sarcopenia was determined using the TAM, PM, and PS after stratifying by sex. Finally, we investigated each muscle-defined sarcopenia to decide whether or not it can serve as a prognostic factor for overall survival (OS).

Results

We included 92 patients (74 men and 18 women). TAM, PM, and PS areas were significantly higher in the men than in the women (all p < 0.05). The patients with sarcopenia defined using PM, but not TAM and PS, exhibited significantly poorer OS than those without sarcopenia (median 15.3 vs. 23.8 months, p = 0.034, 0.821, and 0.341, respectively). After adjustment for clinical variables, such as body mass index, liver function, alpha-fetoprotein level, clinical staging, treatment response, and posttreatment curative therapy, PM-defined sarcopenia (hazard ratio: 1.899, 95% confidence interval: 1.087-3.315) remained an independent predictor for the poor OS.

Conclusion

CT-assessed sarcopenia defined using PM was an independent prognostic factor for the poorer prognosis of unresectable HCC after radioembolization.

Combined exercise and nutrition intervention for older women with spinal sarcopenia: an open-label single-arm trial

PURPOSE

Spinal sarcopenia is a multifactorial disorder associated with atrophy and fatty changes in paraspinal muscles. Interventional studies for spinal sarcopenia are limited. We aimed to evaluate the effectiveness of a combined exercise and nutrition intervention for the treatment of spinal sarcopenia.

METHODS

35 community-dwelling older women diagnosed with spinal sarcopenia in a previous cohort study were included. The 12-week combined intervention consisted of back extensor strengthening exercises and protein supplementation. The following outcomes were measured at baseline (week 0), after the intervention (week 12), and follow-up (week 24): conventional variables of sarcopenia (appendicular skeletal muscle mass, handgrip strength, 6-meter gait speed, and short physical performance battery); lumbar extensor muscle mass; lumbar extensor muscle volume and signal intensity; back extensor isokinetic strength; and back performance scale. We used the intention-to-treat analysis method, and repeated measures analysis of variance was used to analyze the data.

RESULTS

Of the total 35 potential participants, 26 older women participated in the study (mean age 72.5 ± 4.0 years old). After 12 weeks of combined exercise and nutrition intervention, there were no changes in the appendicular skeletal muscle mass, lumbar extensor muscle mass, volume, or signal intensity. Handgrip strength and back extensor isokinetic strength did not change significantly. Short physical performance battery significantly increased (P = 0.042) from 11.46 ± 0.86 to 11.77 ± 0.53 at week 12 and 11.82 ± 0.40 at week 24. The back performance scale sum score also significantly improved (P = 0.034) from 2.68 ± 1.81 to 1.95 ± 1.21 at week 12 and 2.09 ± 1.34 at week 24.

CONCLUSION

The combined exercise and nutrition intervention for community-dwelling older women with spinal sarcopenia could be feasible and helpful in improving the physical performance as well as back performance.

Deep learning for automatic segmentation of paraspinal muscle on computed tomography

BACKGROUND

Muscle quantification is an essential step in sarcopenia evaluation.

PURPOSE

To develop and evaluate an automated machine learning (ML) algorithm for segmenting the paraspinous muscles on either abdominal or lumbar (L) computed tomography (CT) scans.

MATERIAL AND METHODS

A novel deep neural network algorithm for automated segmentation of paraspinous muscle was developed, CT scans of 504 consecutive patients conducted between January 2019 and February 2020 were assembled. The muscle was manually segmented at L3 vertebra level by three radiologists as ground truth, divided into training and testing subgroups. Muscle cross-sectional area (CSA) was recorded. Dice similarity coefficients (DSCs) and CSA errors were calculated to evaluate system performance. The degree of muscle fat infiltration (MFI) recording by percentage value was the fat area within the region of interest divided by the muscle area. An analysis of the factors influencing the performance of the V-net-based segmentation system was also implemented.

RESULTS

The mean DSCs for paraspinous muscles were high for both the training (0.963, 0.970, 0.941, and 0.968, respectively) and testing (0.950, 0.960, 0.929, and 0.961, respectively) datasets, while the CSA errors were low for both training (1.9%, 1.6%, 3.1%, and 1.3%, respectively) and testing (3.4%, 3.0%, 4.6%, and 1.9%, respectively) datasets. MFI and muscle area index (MI) were major factors affecting DSCs of the posterior paraspinous and paraspinous muscle groups.

CONCLUSION

The ML algorithm for the measurement of paraspinous muscles was compared favorably to manual ground truth measurements.

The morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation

Objective

The objective of this study was to explore the morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation.

Methods

This study retrospectively analyzed young patients aged 18–40 years who were hospitalized for lumbar disc herniation in our hospital from June 2017 to June 2020. Data on sex, age, body mass index (BMI), subcutaneous fat tissue thickness (SFTT) at the L1-L2 level, duration of symptoms, degree of lumbar disc herniation, visual analog scale (VAS) for the lower back, Mo-fi-disc score, relative cross-sectional area (RCAS) of the paravertebral muscles (psoas major [PM], multifidus [MF], and erector spinae [ES]), and degree of fat infiltration (DFF) of the paravertebral muscles were collected. The VAS was used to evaluate the intensity of low back pain. Patients with VAS-back >4 points were defined as the low back pain group, and patients with ≤4 points were defined as the control group. The demographic characteristics, as well as the bilateral and ipsilateral paravertebral muscles, of the two groups were compared and analyzed.

Result

A total of 129 patients were included in this study (52 patients in the LBP group and 77 patients in the control group). There were no significant differences in sex, BMI, or Pfirrmann grade of lumbar disc herniation between the two groups (P > 0.05). The age of the LBP group (33.58 ± 2.98 years) was greater than that of the control group (24.13 ± 2.15 years) (P = 0.002), and the SFTT at the L1-L2 level (13.5 ± 7.14 mm) was higher than that of the control group (7.75 ± 6.31 mm) (P < 0.05). Moreover, the duration of symptoms (9.15 ± 0.31 months) was longer than that of the control group (3.72 ± 0.48 months) (P < 0.05), and the Mo-fi-disc score (8.41 ± 3.16) was higher than that of the control group (5.53 ± 2.85) (P < 0.05). At L3/4 and L5/S1, there was no significant difference in the RCSA and DFF of the bilateral and ipsilateral paraspinal muscles between the LBP group and the control group. At L4/5, there was no significant difference in the RCSA and DFF of the paraspinal muscles on either side in the LBP group (P > 0.05). In the control group, the RCSA of the MF muscle on the diseased side was smaller than that on the normal side (P < 0.05), and the DFF of the MF muscle on the diseased side was larger than that on the normal side (P < 0.05). In addition, there was no significant difference in the ES and PM muscles on both sides (P > 0.05). At L4/5, the RCSA of the MF muscle on the normal side was significantly smaller in the LBP group than in the control group (P < 0.05), and the DFF of the MF muscle on the normal side was significantly larger in the LBP group than in the control group (P < 0.05). There was no significant difference in the ES and PM muscles on the same side between the two groups (P > 0.05).

Conclusion

In young patients with unilateral neurological symptoms of lumbar disc herniation, symmetrical atrophy of the bilateral MF muscle is more prone to causing low back pain. Older age, higher SFTT at the L1-L2 levels, longer symptom duration, higher Mo-fi-di score, and greater muscle atrophy on the normal side of the MF increased the incidence of low back pain in young patients with unilateral lumbar disc herniation.

Age- and sex-dependent differences in the morphology and composition of paraspinal muscles between subjects with and without lumbar degenerative diseases

BACKGROUND

The quality of the paraspinal muscles has been recommended as a surrogate marker for the evaluation of the severity of the lumbar degenerative diseases (LDD). The purpose of this study is to determine the age- and sex-dependent differences in the morphology and composition of the paraspinal muscles between LDD and asymptomatic subjects.

METHODS

We analyzed data from 370 patients and 327 asymptomatic volunteers aged between 18-85 years. The measurement of the cross-sectional area (CSA) of the erector spinae, multifidus, and psoas at the L4/5-disc level was performed by the magnetic resonance imaging (MRI). The fatty infiltration ratio (FI %) of the multifidus and erector spinae was calculated.

RESULTS

FI % of the lumbar paraspinal muscles were significantly and positively correlated with the severity of LDD instead of the CSA. Males had greater CSA than females, and females showed higher FI % than males in the paraspinal muscles. With the increase of age, the CSA of the lumbar paraspinal muscles gradually decreased, and the psoas showed the most significant decreasing trend. However, the FI % gradually increased in both LDD and asymptomatic groups with aging.

CONCLUSION

Age- and sex-dependent differences were found in the morphology and composition of the paraspinal muscles between subjects with and without LDD. Further long-term follow up investigations and basic studies will continue to confirm the natural history of the paraspinal muscles with aging and their association with LDD.

Natural aging course of lumbar extensor muscle mass and strength in community-dwelling older women: a 1-year prospective observational study

BACKGROUND

Although the loss of skeletal limb muscle mass and muscle strength in the elderly have been demonstrated, the aging process of the back muscles to maintain core stability is not well known. This 1-year prospective observational study aimed to investigate the natural aging course of the lumbar extensor muscles (LEMs) compared with the extremity muscles and determine whether muscle strength or mass decreases more in community-dwelling older women.

METHODS

Twenty-four older urban-dwelling women aged 70 years or older were initially enrolled. Their demographic variables, conventional and spinal sarcopenia indices, and functional outcome parameters were evaluated. We also measured back extensor strength, radiological parameters for spinal sagittal balance on whole-spine radiography, and volumetric parameters of the LEM on computed tomography.

RESULTS

After the exclusion of 6 subjects, 18 older women were finally analyzed. All variables related to extremity muscle mass, muscle strength, physical performance, and LEM volume declined over the study period, but the changes were insignificant. However, back extensor strength decreased significantly (median, first, and third quartile: 35.20 [30.80, 44.00] N to 31.40 [29.25, 37.90] N, P = 0.026). Among spinal sagittal balance-related parameters, lumbar lordosis (44.25 [39.30, 47.35]° to 43.15 [31.43, 45.75]°, P = 0.043) and sagittal vertical axis (33.85 [3.57, 58.75] mm to 45.15 [25.35, 58.68] mm, P = 0.004) showed significant changes during the study.

CONCLUSIONS

When the natural aging course of LEM in women aged 70 years or older was observed for 1 year, muscle mass decreased less than back extensor strength and spinal sagittal balance. Measurements of back extensor strength and spinal sagittal balance are necessary for the clinical evaluation of spinal aging.

Thoracolumbar Slope Is Useful Parameter for Evaluating HealthRelated Quality of Life and Sagittal Imbalance Aggravation in Adult Spinal Deformity: A Prospective Observational Cohort Study

Objective

The purpose of the present study was to evaluate the natural course of primary degenerative sagittal imbalance (PDSI), its aggravating factors, and health-related quality of life (HRQoL) associated with various spinal alignment parameters (SAPs) in patients with PDSI who have not undergone surgery.

Methods

One hundred three participants volunteered to participate. The SAPs, including T1 pelvic angle (T1PA), thoracolumbar tilt, and thoracolumbar slope (TLS), were measured on whole-spine standing radiographs. The back and lumbar muscle volumes were measured. To determine HRQoL at baseline and at 2-year follow-up, face-to-face questionnaires were administered, which included visual analogue scale of the back and leg, physical component summary/mental component summary of 36-item Short Form Health Survey, Oswestry Disability Index (ODI), and Mini-Mental State Examination.

Results

Overall HRQoL measures had improved after 2 years of follow-up compared to baseline. PDSI aggravation was observed in 18 participants (26.1%). TLS, sagittal vertical axis (SVA), and T1PA were strongly correlated with each other. TLS, SVA, and T1PA were correlated with ODI score. Among them, TLS was most highly correlated with ODI score. TLS greater than -3.5° was a predicting factor for PDSI aggravation (p=0.034; 95% confidence interval, 1.173–63.61; odds ratio, 8.636).

Conclusion

The present study implied that PDSI does not necessarily worsen with aging. TLS is an appropriate parameter for assessing the clinical situation in patients with PDSI. Furthermore, a TLS greater than -3.5° predicts PDSI aggravation; thus, TLS may be a useful parameter for predicting prognosis in PDSI.

Novel lateral whole-body dual-energy X-ray absorptiometry of lumbar paraspinal muscle mass: results from the SarcoSpine study

BACKGROUND

Here, we aimed to propose novel lateral whole-body dual-energy X-ray absorptiometry (lateral DXA) as a simple tool for measuring spinal muscle mass and investigate the feasibility of lateral DXA to measure lumbar paraspinal muscle (LPM) mass compared with lumbosacral spine three-dimensional magnetic resonance imaging (3D MRI).

METHODS

Twenty consecutive participants were enrolled from a prospective observational cohort (SarcoSpine study). Lateral DXA was scanned with each participant in the lateral decubitus position. The region of interest was defined to analyse the LPM mass. LPM total volume, LPM cross-sectional area at the L3 mid-vertebra and L4/5 mid-disc levels and each signal intensity were measured by 3D MRI. Isokinetic and isometric back extensor muscle strengths as well as back extensor endurance were examined. The correlation between lateral DXA-based mass (weight) and 3D MRI-based LPM volume was analysed.

RESULTS

The mean age of the 20 participants (15 women, 5 men) was 72.2 ± 4.9 years. LPM mass by lateral DXA was positively correlated with LPM volume by 3D MRI (β = 0.333, r = 0.692, p < 0.001) and negatively correlated with signal intensity of the total LPM (β = -0.263, r = -0.530, p = 0.016). LPM mass was also correlated with appendicular limb muscle mass, handgrip strength and gait speed as well as back extensor endurance (r = 0.620, p = 0.004).

CONCLUSIONS

Our data suggest that LPM mass assessed by lateral DXA was positively correlated with LPM volume by 3D MRI in older adults. Lateral DXA may be a potential substitute for the cross-sectional area measurement of LPM mass. Further studies are required to validate this lateral DXA technique.

Computed tomography-based sarcopenia in patients receiving peritoneal dialysis: Correlation with lean soft tissue and survival

BACKGROUND/PURPOSE

We evaluated whether the results of the computed tomography (CT)-based sarcopenia assessment were correlated with edema-free lean soft tissue (LST) and were associated with the prognosis of patients receiving peritoneal dialysis (PD).

METHODS

We conducted a prospective cohort study and enrolled patients aged >20 years who started to undergo PD between February 2009 and February 2012. All patients underwent LST evaluation and non-contrast abdominal CT for assessing the total skeletal muscle (TSM) and psoas muscle (PM) indices at the level of the third lumbar vertebra. We analyzed the correlation between LST and CT assessment of muscle mass. Then we determined optimal sex-specific cutoff values for TSM-defined and PM-defined sarcopenia to predict mortality, aided by the maximally selected rank statistics.

RESULTS

A total of 158 patients were enrolled, of whom 41 (25.9%) and 65 (41.1%) had sarcopenia based on the TSM and PM indices, respectively. LST was significantly strong correlated with TSM and PM indices (r = 0.517, p < 0.001 and r = 0.688, p < 0.001, respectively). In univariate and multivariate analyses after adjusting clinical and PD-related parameters, only patients with PM-defined sarcopenia had poorer survival than did those without (hazard ratio [HR]: 2.386, 95% confidence interval [CI]: 1.315-4.330), but patients with TSM-defined sarcopenia did not show a poorer survival (HR: 1.608, 95% CI: 0.860-3.006).

CONCLUSION

Sarcopenia assessment based on CT was strongly correlated with LST and PM-defined sarcopenia indicated poor prognosis in patients receiving long-term PD.

Combined exercise and nutrition intervention for spinal sarcopenia: A pilot study protocol

INTRODUCTION

Spinal sarcopenia is a multifactorial disorder associated with the atrophy of and fatty changes to the paraspinal muscles. We previously developed the concept of spinal sarcopenia in community-dwelling older adults and investigated the association between conventional sarcopenic indices and spinal sarcopenia. However, interventional studies of spinal sarcopenia are lacking. This pilot study will aim to evaluate the effectiveness of a combined exercise and nutrition intervention for treating spinal sarcopenia.

METHODS AND ANALYSIS

This open-label single-arm prospective study will include 35 community-dwelling older women who were diagnosed with spinal sarcopenia in our previous cohort study. The 12-week combined intervention will consist of back extensor strengthening exercise and nutritional supplementation. The primary outcome of this study will be isometric back extensor strength after the 12-week intervention. All functional and radiographic outcomes will be measured at 0, 12, and 24 weeks post-intervention. The data will be analyzed using the intention-to-treat principle.

Computed tomography-based skeletal muscle and adipose tissue attenuation: Variations by age, sex, and muscle

OBJECTIVE

This study aimed to investigate how skeletal muscle attenuation and adipose tissue (AT) attenuation of the quadriceps, hamstrings, paraspinal muscle groups and the psoas muscle vary according to the targeted muscles, sex, and age.

DESIGN

Population-based cross-sectional study.

SETTING

Community-dwelling old population in Reykjavik, Iceland.

SUBJECTS

A total of 5331 older adults (42.8% women), aged 66-96 years from the Age, Gene/Environment Susceptibility (AGES)- Reykjavik Study, who participated in the baseline visit (between 2002 and 2006) and had valid thigh and abdominal computed tomography (CT) scans were studied.

METHODS

Muscle attenuation and AT attenuation of the quadriceps, hamstrings, paraspinal muscle groups and the psoas muscle were determined using CT. Linear mixed model analysis of variance was performed for each sex, with skeletal muscle or AT attenuation as the dependent variable.

RESULTS

Muscle attenuation decreased, and AT attenuation increased with age in both sexes, and these differences were specific for each muscle, although not in all age groups. Age-related differences in muscle and AT attenuation varied with specific muscle. In general, for both sexes, skeletal muscle attenuation of the hamstrings declined more than average with age. Men and women displayed a different pattern in the age differences in AT attenuation for each muscle.

CONCLUSIONS

Our data support the hypotheses that skeletal muscle attenuation decreases, and AT attenuation increases with aging. In addition, our data add new evidence, supporting that age-related differences in skeletal muscle and AT attenuation vary between muscles.

A new easily accessible and practical method for dynapenia screening: blink rate

BACKGROUND

The methods used in the diagnosis and screening of sarcopenia are not available everywhere. There is a need for more practical tests that can be used especially in the first step.

AIMS

We aimed to investigate the usability of blink rate as an alternative test for dynapenia screening.

METHODS

A total of 355 patients ≥ 65 years of age (254 (71.50%) female and 101 (28.50%) male) who were admitted to geriatric outpatient clinic were included in this prospective cross-sectional study.

RESULTS

Blink rate was positively correlated with grip strength and negatively correlated with SARC-F. Also, it was found that the blink rate was associated with dynapenia independent of other factors. The optimal cut-off value of 15 s blink rate to predict dynapenia was measured as ≤ 40.5, with 70.3% sensitivity and 43.3% specificity.

CONCLUSION

Our study indicated the relationship between blink rate with dynapenia and grip strength. Especially in patients with limited mobilization and where it is not possible to reach the hand dynamometer to measure grip strength, the blink rate can be used as an alternative test to detect dynapenia.

Age-related degeneration of lumbar muscle morphology in healthy younger versus older men

AIM

The aim of this study was to evaluate age-related changes in lumbar paravertebral muscle (LPM) morphology in healthy younger and older adult men.

METHODS

T2-weighted axial MRI of the lumbar spine were obtained for 12 healthy older (67.3 ± 6.0 years) and younger (24.7 ± 3.1 years) men. Normalised muscle volume (NMV) and muscle fat infiltrate (MFI) were determined bilaterally for the psoas (PS), quadratus lumborum (QL), erector spinae (ES) and multifidus (MF). MANOVA was used to compare NMV and MFI between age groups. Follow-up ANOVA compared NMV and MFI for each muscle between age groups, with physical activity (PA) as a covariate. Stepwise regression was used to explore the association between muscle morphology.

RESULTS

NMV of the ES and QL were significantly lower in the older group (OG) (p = 0.040 and p < 0.001, respectively). MFI across all muscles was significantly greater in the OG (p < 0.001). PA did not moderate the relationship between aging and muscle degeneration. Non-dominant handgrip strength was associated with NMV (p = 0.003).

CONCLUSIONS

Age-related atrophy is muscle specific in the lumbar spine; changes in lumbar musculature is independent of PA, handgrip strength may reflect morphological changes in the postural muscles with age. This study supports establishing effective targeted exercise interventions in the lumbar musculature.

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

Spinal sarcopenia is a complex and multifactorial disorder associated with a loss of strength, increased frailty, and increased risks of fractures and falls. In addition, spinal sarcopenia has been associated with lumbar spine disorders and osteoporosis, which renders making decisions on treatment modalities difficult. Patients with spinal sarcopenia typically exhibit lower cumulative survival, a higher risk of in-hospital complications, prolonged hospital stays, higher postoperative costs, and higher rates of blood transfusion after thoracolumbar spine surgery. Several studies have focused on the relationships between spinal sarcopenia, appendicular muscle mass, and bone-related problems-such as osteoporotic fractures and low bone mineral density-and malnutrition and vitamin D deficiency. Although several techniques are available for measuring sarcopenia, each of them has its advantages and shortcomings. For treating spinal sarcopenia, nutrition, physical therapy, and medication have been proven to be effective; regenerative therapeutic options seem to be promising owing to their repair and regeneration potential. Therefore, in this narrative review, we summarize the characteristics, detection methodologies, and treatment options for spinal sarcopenia, as well as its role in spinal disorders.