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Guven AE, Chiapparelli E, Camino-Willhuber G, Zhu J, Schönnagel L, Amoroso K, Caffard T, Erduran A, Shue J, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Assessing paraspinal muscle atrophy with electrical impedance myography: Limitations and insights. J Orthop Res 2024; 42:2072-2079. [PMID: 38594874 DOI: 10.1002/jor.25848] [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: 10/11/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Paraspinal muscle atrophy is gaining attention in spine surgery due to its link to back pain, spinal degeneration and worse postoperative outcomes. Electrical impedance myography (EIM) is a noninvasive diagnostic tool for muscle quality assessment, primarily utilized for patients with neuromuscular diseases. However, EIM's accuracy for paraspinal muscle assessment remains understudied. In this study, we investigated the correlation between EIM readings and MRI-derived muscle parameters, as well as the influence of dermal and subcutaneous parameters on these readings. We retrospectively analyzed patients with lumbar spinal degeneration who underwent paraspinal EIM assessment between May 2023 to July 2023. Paraspinal muscle fatty infiltration (FI) and functional cross-sectional area (fCSA), as well as the subcutaneous thickness were assessed on MRI scans. Skin ultrasound imaging was assessed for dermal thickness and the echogenicities of the dermal and subcutaneous layers. All measurements were performed on the bilaterally. The correlation between EIM readings were compared with ultrasound and MRI parameters using Spearman's correlation analyses. A total of 20 patients (65.0% female) with a median age of 69.5 years (IQR, 61.3-73.8) were analyzed. The fCSA and FI did not significantly correlate with the EIM readings, regardless of frequency. All EIM readings across frequencies correlated with subcutaneous thickness, echogenicity, or dermal thickness. With the current methodology, paraspinal EIM is not a valid alternative to MRI assessment of muscle quality, as it is strongly influenced by the dermal and subcutaneous layers. Further studies are required for refining the methodology and confirming our results.
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Affiliation(s)
- Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York, USA
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
- Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Ada Erduran
- Department of Electrical Engineering, Technical University Berlin, Berlin, Germany
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
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Karri J, Cohen SP. Dilemmas with denervation: to do or not to do (that is the question). Pain 2024; 165:1904-1906. [PMID: 39159471 DOI: 10.1097/j.pain.0000000000003224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 08/21/2024]
Affiliation(s)
- Jay Karri
- Departments of Orthopedic Surgery and Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Steven P Cohen
- Departments of Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Departments of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Krkoska P, Kokosova V, Dostal M, Vlazna D, Kerkovsky M, Straka M, Gerstberger R, Matulova K, Ovesna P, Adamova B. Assessment of lumbar paraspinal muscle morphology using mDixon Quant magnetic resonance imaging (MRI): a cross-sectional study in healthy subjects. Quant Imaging Med Surg 2024; 14:6015-6035. [PMID: 39144006 PMCID: PMC11320528 DOI: 10.21037/qims-23-1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/13/2024] [Indexed: 08/16/2024]
Abstract
Background Lumbar paraspinal muscles (LPM) are a part of the deep spinal stabilisation system and play an important role in stabilising the lumbar spine and trunk. Inadequate function of these muscles is thought to be an essential aetiological factor in low back pain, and several neuromuscular diseases are characterised by dysfunction of LPM. The main aims of our study were to develop a methodology for LPM assessment using advanced magnetic resonance imaging (MRI) methods, including a manual segmentation process, to confirm the measurement reliability, to evaluate the LPM morphological parameters [fat fraction (FF), total muscle volume (TMV) and functional muscle volume (FMV)] in a healthy population, to study the influence of physiological factors on muscle morphology, and to build equations to predict LPM morphological parameters in a healthy population. Methods This prospective cross-sectional observational comparative single-centre study was conducted at the University Hospital in Brno, enrolling healthy volunteers from April 2021 to March 2023. MRI of the lumbar spine and LPM (erector spinae muscle and multifidus muscle) were performed using a 6-point Dixon gradient echo sequence. The segmentation of the LPM and the control muscle (psoas muscle) was done manually to obtain FF and TMV in a range from Th12/L1 to L5/S1. Intra-rater and inter-rater reliability were evaluated. Linear regression models were constructed to assess the effect of physiological factors on muscle FF, TMV and FMV. Results We enrolled 90 healthy volunteers (median age 38 years, 45 men). The creation of segmentation masks and the assessment of FF and TMV proved reliable (Dice coefficient 84% to 99%, intraclass correlation coefficient ≥0.97). The univariable models showed that FF of LPM was influenced the most by age (39.6% to 44.8% of variability, P<0.001); TMV and FMV by subject weight (34.9% to 67.6% of variability, P<0.001) and sex (24.7% to 64.1% of variability, P<0.001). Multivariable linear regression models for FF of LPM included age, body mass index and sex, with R-squared values ranging from 45.4% to 51.1%. Models for volumes of LPM included weight, age and sex, with R-squared values ranged from 37.4% to 76.8%. Equations were developed to calculate predicted FF, TMV and FMV for each muscle. Conclusions A reliable methodology has been developed to assess the morphological parameters (biomarkers) of the LPM. The morphological parameters of the LPM are significantly influenced by physiological factors. Equations were constructed to calculate the predicted FF, TMV and FMV of individual muscles in relation to anthropometric parameters, age, and sex. This study, which presented LPM assessment methodology and predicted values of LPM morphological parameters in a healthy population, could improve our understanding of diseases involving LPM (low back pain and some neuromuscular diseases).
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Affiliation(s)
- Peter Krkoska
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Viktoria Kokosova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Marek Dostal
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Daniela Vlazna
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Rehabilitation, University Hospital Brno, Brno, Czechia
| | - Milos Kerkovsky
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Matej Straka
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Radim Gerstberger
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | | | - Petra Ovesna
- Institute of Biostatistics and Analyses Ltd., Brno, Czechia
| | - Blanka Adamova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
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Köhli P, Schönnagel L, Hambrecht J, Zhu J, Chiapparelli E, Güven AE, Evangelisti G, Amoroso K, Duculan R, Michalski B, Shue J, Tsuchiya K, Burkhard MD, Sama AA, Girardi FP, Cammisa FP, Mancuso CA, Hughes AP. The relationship between paraspinal muscle atrophy and degenerative lumbar spondylolisthesis at the L4/5 level. Spine J 2024; 24:1396-1406. [PMID: 38570036 DOI: 10.1016/j.spinee.2024.03.016] [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: 01/16/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a prevalent spinal condition that can result in significant disability. DLS is thought to result from a combination of disc and facet joint degeneration, as well as various biological, biomechanical, and behavioral factors. One hypothesis is the progressive degeneration of segmental stabilizers, notably the paraspinal muscles, contributes to a vicious cycle of increasing slippage. PURPOSE To examine the correlation between paraspinal muscle status on MRI and severity of slippage in patients with symptomatic DLS. STUDY DESIGN/SETTING Retrospective cross-sectional study at an academic tertiary care center. PATIENT SAMPLE Patients who underwent surgery for DLS at the L4/5 level between 2016-2018 were included. Those with multilevel DLS or insufficient imaging were excluded. OUTCOME MEASURES The percentage of relative slippage (RS) at the L4/5 level evaluated on standing lateral radiographs. Muscle morphology measurements including functional cross-sectional area (fCSA), body height normalized functional cross-sectional area (HI) of Psoas, erector spinae (ES) and multifidus muscle (MF) and fatty infiltration (FI) of ES and MF were measured on axial MR. Disc degeneration and facet joint arthritis were classified according to Pfirrmann and Weishaupt, respectively. METHODS Descriptive and comparative statistics, univariable and multivariable linear regression models were utilized to examine the associations between RS and muscle parameters, adjusting for confounders sex, age, BMI, segmental degeneration, and back pain severity and symptom duration. RESULTS The study analyzed 138 out of 183 patients screened for eligibility. The median age of all patients was 69.5 years (IQR 62 to 73), average BMI was 29.1 (SD±5.1) and average preoperative ODI was 46.4 (SD±16.3). Patients with Meyerding-Grade 2 (M2, N=25) exhibited higher Pfirrmann scores, lower MFfCSA and MFHI, and lower BMI, but significantly more fatty infiltration in the MF and ES muscles compared to those with Meyerding Grade 1 (M1). Univariable linear regression showed that each cm2 decrease in MFfCSA was associated with a 0.9%-point increase in RS (95% CI -1.4 to - 0.4, p<.001), and each cm2/m2 decrease in MFHI was associated with an increase in slippage by 2.2%-points (95% CI -3.7 to -0.7, p=.004). Each 1%-point rise in ESFI and MFFI corresponded to 0.17%- (95% CI 0.05-0.3, p=.01) and 0.20%-point (95% CI 0.1-0.3 p<.001) increases in relative slippage, respectively. Notably, after adjusting for confounders, each cm2 increase in PsoasfCSA and cm2/m2 in PsoasHI was associated with an increase in relative slippage by 0.3% (95% CI 0.1-0.6, p=.004) and 1.1%-points (95% CI 0.4-1.7, p=.001). While MFfCSA tended to be negatively associated with slippage, this did not reach statistical significance (p=.105). However, each 1%-point increase in MFFI and ESFI corresponded to increases of 0.15% points (95% CI 0.05-0.24, p=.002) and 0.14% points (95% CI 0.01-0.27, p=.03) in relative slippage, respectively. CONCLUSION This study found a significant association between paraspinal muscle status and severity of slippage in DLS. Whereas higher degeneration of the ES and MF correlate with a higher degree of slippage, the opposite was found for the psoas. These findings suggest that progressive muscular imbalance between posterior and anterior paraspinal muscles could contribute to the progression of slippage in DLS.
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Affiliation(s)
- Paul Köhli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Charitéplatz 1, Berlin 10117, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Charitéplatz 1, Berlin 10117, Germany
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Charitéplatz 1, Berlin 10117, Germany
| | - Jan Hambrecht
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Department of Trauma Surgery, University Hospital Zurich, Ramistrasse 100, Zurich 8091, Switzerland
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71th Street, New York, NY 10021, USA
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Ali E Güven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Gisberto Evangelisti
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Instituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, BO, 40136, Italy
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | | | - Bernhard Michalski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Charitéplatz 1, Berlin 10117, Germany
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Koki Tsuchiya
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Marco D Burkhard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA.
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Balling H, Holzapfel BM, Böcker W, Simon D, Reidler P, Arnholdt J. Musculoskeletal Dimension and Brightness Reference Values in Lumbar Magnetic Resonance Imaging-A Radio-Anatomic Investigation in 80 Healthy Adult Individuals. J Clin Med 2024; 13:4496. [PMID: 39124762 PMCID: PMC11313155 DOI: 10.3390/jcm13154496] [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: 05/18/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Magnetic resonance imaging (MRI) is the preferred diagnostic means to visualize spinal pathologies, and offers the possibility of precise structural tissue analysis. However, knowledge about MRI-based measurements of physiological cross-sectional musculoskeletal dimensions and associated tissue-specific average structural brightness in the lumbar spine of healthy young women and men is scarce. The current study was planned to investigate characteristic intersexual differences and to provide MRI-related musculoskeletal baseline values before the onset of biological aging. Methods: At a single medical center, lumbar MRI scans of 40 women and 40 men aged 20-40 years who presented with moderate nonspecific low back pain were retrospectively evaluated for sex-specific differences in cross-sectional sizes of the fifth lumbar vertebrae, psoas and posterior paravertebral muscles, and respective sex- and age-dependent average brightness alterations on T2-weighted axial sections in the L5-level. Results: In women (mean age 33.5 years ± 5.0 (standard deviation)), the investigated musculoskeletal cross-sectional area sizes were significantly smaller (p < 0.001) compared to those in men (mean age 33.0 years ± 5.7). Respective average musculoskeletal brightness values were higher in women compared to those in men, and most pronounced in posterior paravertebral muscles (p < 0.001). By correlating brightness results to those of subcutaneous fat tissue, all intersexual differences, including those between fifth lumbar vertebrae and psoas muscles, turned out to be statistically significant. This phenomenon was least pronounced in psoas muscles. Conclusions: Lumbar musculoskeletal parameters showed significantly larger dimensions of investigated anatomical structures in men compared to those in women aged 20-40 years, and an earlier onset and faster progress of bone loss and muscle degradation in women.
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Affiliation(s)
- Horst Balling
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377 Munich, Germany (J.A.)
- Center for Spine Surgery, Neckar-Odenwald-Kliniken gGmbH Buchen, Dr.-Konrad-Adenauer-Str. 37, 74722 Buchen, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377 Munich, Germany (J.A.)
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377 Munich, Germany (J.A.)
| | - Dominic Simon
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377 Munich, Germany (J.A.)
| | - Paul Reidler
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Joerg Arnholdt
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377 Munich, Germany (J.A.)
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Snodgrass SJ, Weber KA, Wesselink EO, Stanwell P, Elliott JM. Reduced Cervical Muscle Fat Infiltrate Is Associated with Self-Reported Recovery from Chronic Idiopathic Neck Pain Over Six Months: A Magnetic Resonance Imaging Longitudinal Cohort Study. J Clin Med 2024; 13:4485. [PMID: 39124753 PMCID: PMC11312969 DOI: 10.3390/jcm13154485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background: It is unclear why neck pain persists or resolves, making assessment and management decisions challenging. Muscle composition, particularly muscle fat infiltrate (MFI), is related to neck pain, but it is unknown whether MFI changes with recovery following targeted interventions. Methods: We compared muscle composition quantified from fat-water magnetic resonance images from the C3 to T1 vertebrae in individuals with and without chronic idiopathic neck pain at two times 6 months apart. Those with neck pain received six weeks of intervention (physiotherapy or chiropractic) after their baseline MRI; at 6 months, they were classified as recovered (≥3 on the 11-point Global Rating of Change scale) or not recovered. Results: At 6 months, both asymptomatic and recovered individuals had decreased MFI compared to baseline (asymptomatic estimated marginal mean difference -1.6% 95%; CI -1.9, -1.4; recovered -1.6; -1.8, -1.4; p < 0.001) whereas those classified as not recovered had increased MFI compared to baseline (0.4; 0.1, 0.7; p = 0.014), independent of age, sex and body mass index. Conclusions: It appears MFI decreases with recovery from neck pain but increases when neck pain persists. The relationship between cervical MFI and neck pain suggests MFI may inform diagnosis, theragnosis and prognosis in individuals with neck pain. Future development of a clinical test for MFI may assist in identifying patients who will benefit from targeted muscle intervention, improving outcomes.
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Affiliation(s)
- Suzanne J. Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callaghan 2308, Australia
- Centre for Active Living and Learning, Hunter Medical Research Institute, New Lambton Heights 2305, Australia
| | - Kenneth A. Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | | | - Peter Stanwell
- Discipline of Medical Radiation Science (Diagnostic Radiography), The University of Newcastle, Callaghan 2308, Australia;
| | - James M. Elliott
- The Kolling Institute, Northern Sydney (Arabanoo) Precinct, St Leonards 2065, Australia;
- Sydney School of Health Sciences, The University of Sydney, Camperdown 2050, Australia
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王 伟, 李 危. [Radiographic parameters and influencing factors of paraspinal muscle degeneration in healthy people]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:880-888. [PMID: 39013828 PMCID: PMC11252678 DOI: 10.7507/1002-1892.202402060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/25/2024] [Indexed: 07/18/2024]
Abstract
Objective To measure the paraspinal muscle parameters, explore the characteristics of paraspinal muscles, and investigate the influence factors of paraspinal muscle degeneration in healthy people. Methods Eighty-two healthy Chinese people were prospectively recruited between February 2020 and November 2020, including 36 males and 46 females. The age ranged from 21 to 75 years, with a mean of 48.0 years. The height ranged from 150 to 183 cm, with a mean of 165.6 cm. The body mass ranged from 43 to 100 kg, with a mean of 65.4 kg. The body mass index (BMI) ranged from 16.7 to 32.4 kg/m 2, with a mean of 23.7 kg/m 2. Parameters of the paraspinal muscles (multifidus muscle, erector spinae muscle, and psoas major muscle) at L 3, L 4, and L 5 levels were measured by MRI, including the relative total cross-sectional area (rtCSA), relative fatty cross-sectional area (rfCSA), relative signal intensity (rSI), and fatty infiltration (FI). The differences of paraspinal muscle parameters at different genders and different measurement levels were compared; Pearson or Spearman correlation analysis was used to explore the relationship between paraspinal muscle parameters and age, height, body mass, BMI. Results From L 3 to L 5 level, the rtCSA and rfCSA of multifidus muscle and psoas major muscle as well as the rfCSA of erector spinae muscle increased, while rtCSA of erector spinae muscle decreased. The FI and rSI of paraspinal muscles increased gradually. The parameters of paraspinal muscles at L 4 and L 5 levels were significantly different from those at L 3 levels ( P<0.05). There were significant differences in rtCSA and rfCSA of multifidus muscle, rtCSA, FI, and rSI of erector spinae muscle as well as rtCSA, rfCSA, and FI of psoas major muscle between L 4 and L 5 levels ( P<0.05). Compared with males, the rfCSA and FI of multifidus muscle, FI of erector spinae muscle, and FI of psoas major muscle were significantly higher in females, while the rtCSA of psoas major muscle was significantly lower ( P<0.05). Age was significantly negatively correlated with rtCSA of paraspinal muscles ( P<0.05), but significantly positively correlated with FI of paraspinal muscles, rfCSA and rSI of multifidus and erector spinae muscles ( P<0.05). Height was significantly negatively correlated with rfCSA and FI of paraspinal muscles ( P<0.05). Conclusion The degree of paraspinal muscle degeneration increases gradually along the spine axis from head to tail. Paraspinal muscle degeneration is related to age, height, and gender. The relationship between the body mass, BMI and paraspinal muscle degeneration needs further study.
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Affiliation(s)
- 伟 王
- 天津市天津医院骨科(天津 300211)Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, P. R. China
| | - 危石 李
- 天津市天津医院骨科(天津 300211)Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, P. R. China
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Somasundaram A, Wu M, Reik A, Rupp S, Han J, Naebauer S, Junker D, Patzelt L, Wiechert M, Zhao Y, Rueckert D, Hauner H, Holzapfel C, Karampinos DC. Evaluating Sex-specific Differences in Abdominal Fat Volume and Proton Density Fat Fraction at MRI Using Automated nnU-Net-based Segmentation. Radiol Artif Intell 2024; 6:e230471. [PMID: 38809148 PMCID: PMC11294970 DOI: 10.1148/ryai.230471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/19/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024]
Abstract
Sex-specific abdominal organ volume and proton density fat fraction (PDFF) in people with obesity during a weight loss intervention was assessed with automated multiorgan segmentation of quantitative water-fat MRI. An nnU-Net architecture was employed for automatic segmentation of abdominal organs, including visceral and subcutaneous adipose tissue, liver, and psoas and erector spinae muscle, based on quantitative chemical shift-encoded MRI and using ground truth labels generated from participants of the Lifestyle Intervention (LION) study. Each organ's volume and fat content were examined in 127 participants (73 female and 54 male participants; body mass index, 30-39.9 kg/m2) and in 81 (54 female and 32 male participants) of these participants after an 8-week formula-based low-calorie diet. Dice scores ranging from 0.91 to 0.97 were achieved for the automatic segmentation. PDFF was found to be lower in visceral adipose tissue compared with subcutaneous adipose tissue in both male and female participants. Before intervention, female participants exhibited higher PDFF in subcutaneous adipose tissue (90.6% vs 89.7%; P < .001) and lower PDFF in liver (8.6% vs 13.3%; P < .001) and visceral adipose tissue (76.4% vs 81.3%; P < .001) compared with male participants. This relation persisted after intervention. As a response to caloric restriction, male participants lost significantly more visceral adipose tissue volume (1.76 L vs 0.91 L; P < .001) and showed a higher decrease in subcutaneous adipose tissue PDFF (2.7% vs 1.5%; P < .001) than female participants. Automated body composition analysis on quantitative water-fat MRI data provides new insights for understanding sex-specific metabolic response to caloric restriction and weight loss in people with obesity. Keywords: Obesity, Chemical Shift-encoded MRI, Abdominal Fat Volume, Proton Density Fat Fraction, nnU-Net ClinicalTrials.gov registration no. NCT04023942 Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
| | | | - Anna Reik
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Selina Rupp
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Jessie Han
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Stella Naebauer
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Daniela Junker
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Lisa Patzelt
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Meike Wiechert
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Yu Zhao
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Daniel Rueckert
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Hans Hauner
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Christina Holzapfel
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
| | - Dimitrios C. Karampinos
- From the Department of Diagnostic and Interventional Radiology,
Klinikum rechts der Isar (A.S., M. Wu, S.R., J.H., S.N., D.J., L.P., D.C.K.),
Institute of Nutritional Medicine, School of Medicine (A.R., M. Wiechert, H.H.,
C.H.), TUM School of Computation, Information, and Technology (Y.Z., D.R.), TUM
School of Medicine and Health (D.R.), and Else Kröner Fresenius Center
for Nutritional Medicine, School of Medicine (H.H.), Technical University of
Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Computing,
Imperial College London, London, UK (D.R.); Department of Nutritional, Food and
Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (C.H.);
and Munich Institute of Biomedical Engineering and Munich Data Science
Institute, Technical University of Munich, Garching, Germany (D.C.K.)
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9
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Wesselink EO, Pool-Goudzwaard A, De Leener B, Law CSW, Fenyo MB, Ello GM, Coppieters MW, Elliott JM, Mackey S, Weber KA. Investigating the associations between lumbar paraspinal muscle health and age, BMI, sex, physical activity, and back pain using an automated computer-vision model: a UK Biobank study. Spine J 2024; 24:1253-1266. [PMID: 38417587 DOI: 10.1016/j.spinee.2024.02.013] [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: 10/12/2023] [Revised: 02/06/2024] [Accepted: 02/18/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND CONTEXT The role of lumbar paraspinal muscle health in back pain (BP) is not straightforward. Challenges in this field have included the lack of tools and large, heterogenous datasets to interrogate the association between muscle health and BP. Computer-vision models have been transformative in this space, enabling the automated quantification of muscle health and the processing of large datasets. PURPOSE To investigate the associations between lumbar paraspinal muscle health and age, sex, BMI, physical activity, and BP in a large, heterogenous dataset using an automated computer-vision model. DESIGN Cross-sectional study. PATIENT SAMPLE Participants from the UK Biobank with abdominal Dixon fat-water MRI (N=9,564) were included (41.8% women, mean [SD] age: 63.5 [7.6] years, BMI: 26.4 [4.1] kg/m2) of whom 6,953 reported no pain, 930 acute BP, and 1,681 chronic BP. OUTCOME MEASURES Intramuscular fat (IMF) and average cross-sectional area (aCSA) were automatically derived using a computer-vision model for the left and right lumbar multifidus (LM), erector spinae (ES), and psoas major (PM) from the L1 to L5 vertebral levels. METHODS Two-tailed partial Pearson correlations were generated for each muscle to assess the relationships between the muscle measures (IMF and aCSA) and age (controlling for BMI, sex, and physical activity), BMI (controlling for age, sex, and physical activity), and physical activity (controlling for age, sex, and BMI). One-way ANCOVA was used to identify sex differences in IMF and aCSA for each muscle while controlling for age, BMI, and physical activity. Similarly, one-way ANCOVA was used to identify between-group differences (no pain, acute BP, and chronic BP) for each muscle and along the superior-inferior expanse of the lumbar spine while controlling for age, BMI, sex, and physical activity (α=0.05). RESULTS Females had higher IMF (LM mean difference [MD]=11.1%, ES MD=10.2%, PM MD=0.3%, p<.001) and lower aCSA (LM MD=47.6 mm2, ES MD=350.0 mm2, PM MD=321.5 mm2, p<.001) for all muscles. Higher age was associated with higher IMF and lower aCSA for all muscles (r≥0.232, p<.001) except for LM and aCSA (r≤0.013, p≥.267). Higher BMI was associated with higher IMF and aCSA for all muscles (r≥0.174, p<.001). Higher physical activity was associated with lower IMF and higher aCSA for all muscles (r≥0.036, p≤.002) except for LM and aCSA (r≤0.010, p≥.405). People with chronic BP had higher IMF and lower aCSA than people with no pain (IMF MD≤1.6%, aCSA MD≤27.4 mm2, p<.001) and higher IMF compared to acute BP (IMF MD≤1.1%, p≤.044). The differences between people with BP and people with no pain were not spatially localized to the inferior lumbar levels but broadly distributed across the lumbar spine. CONCLUSIONS Paraspinal muscle health is associated with age, BMI, sex, and physical activity with the exception of the association between LM aCSA and age and physical activity. People with BP (chronic>acute) have higher IMF and lower aCSA than people reporting no pain. The differences were not localized but broadly distributed across the lumbar spine. When interpreting measures of paraspinal muscle health in the research or clinical setting, the associations with age, BMI, sex, and physical activity should be considered.
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Affiliation(s)
- Evert Onno Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Annelies Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; SOMT University of Physiotherapy, Softwareweg 5, 3821 BN Amersfoort, the Netherlands
| | - Benjamin De Leener
- Department of Computer Engineering and Software Engineering, Polytechnique Montreal, 2900 Edouard Montpetit Blvd, Quebec H3T 1J4, Canada
| | - Christine Sze Wan Law
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Meredith Blair Fenyo
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Gabriella Marie Ello
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Michel Willem Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, 170 Kessels Road, 4111 Brisbane, Australia
| | - James Matthew Elliott
- The University of Sydney, Faculty of Medicine and Health and the Northern Sydney Local Health District, The Kolling Institute, Reserve Road, St Leonards NSW Sydney 2065, Australia
| | - Sean Mackey
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Kenneth Arnold Weber
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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10
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Caffard T, Medina SJ, Arzani A, Chiapparelli E, Schönnagel L, Tani S, Camino-Willhuber G, Zhu J, Dalton D, Zippelius T, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Association patterns between lumbar paraspinal muscles and sagittal malalignment in preoperative patients undergoing lumbar three-column osteotomy. Spine Deform 2024; 12:801-809. [PMID: 38472693 DOI: 10.1007/s43390-024-00828-9] [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: 08/08/2023] [Accepted: 01/13/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE We aim to investigate the associations between lumbar paraspinal muscles and sagittal malalignment in patients undergoing lumbar three-column osteotomy. METHODS Patients undergoing three-column osteotomy between 2016 and 2021 with preoperative lumbar magnetic resonance imaging (MRI) and whole spine radiographs in the standing position were included. Muscle measurements were obtained using a validated custom software for segmentation and muscle evaluation to calculate the functional cross-sectional area (fCSA) and percent fat infiltration (FI) of the m. psoas major (PM) as well as the m. erector spinae (ES) and m. multifidus (MM). Spinopelvic measurements included pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), L1-S1 lordosis (LL), T4-12 thoracic kyphosis (TK), spino-sacral angle (SSA), C7-S1 sagittal vertical axis (SVA), T1 pelvic angle (TPA) and PI-LL mismatch (PI - LL). Statistics were performed using multivariable linear regressions adjusted for age, sex, and body mass index (BMI). RESULTS A total of 77 patients (n = 40 female, median age 64 years, median BMI 27.9 kg/m2) were analyzed. After adjusting for age, sex and BMI, regression analyses demonstrated that a greater fCSA of the ES was significantly associated with greater SS and SSA. Moreover, our results showed a significant correlation between a greater FI of the ES and a greater kyphosis of TK. CONCLUSION This study included a large patient cohort with sagittal alignment undergoing three-column osteotomy and is the first to demonstrate significant associations between the lumbar paraspinal muscle parameters and global sagittal alignment. Our findings emphasize the importance of the lumbar paraspinal muscles in sagittal malalignment.
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Affiliation(s)
- Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Samuel J Medina
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Gaston Camino-Willhuber
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - David Dalton
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Timo Zippelius
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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11
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Suryadevara M, Mishra GV, Parihar P, Javvaji CK, Sood A, Reddy H, Reddy NS, Shelar SS. Role of End Plate Changes and Paraspinal Muscle Pathology in Lower Back Pain: A Narrative Review. Cureus 2024; 16:e61319. [PMID: 38947594 PMCID: PMC11213362 DOI: 10.7759/cureus.61319] [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: 03/18/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Degenerative changes of the lumbar intervertebral disc are the most significant causes of enduring lower back pain. The possibility of the diagnosis is limited in people with this low back pain. Therefore, it is essential to identify the relevant back pain subgroups. The paraspinal muscles, that is, the muscles that attach to the spine, are necessary for the proper functioning of the spine and the body; insufficiency can result in back pain. Lower back pain disorders are strongly associated with altered function or structure of these paraspinal muscles, especially fibrosis and fatty infiltration. Modic changes are the bone marrow changes of the end plate in the vertebral body seen on MRI. These are strongly related to degeneration of the disc and are common in individuals with back pain symptoms. Articles were selected from Google Scholar using the terms 'Modic changes,' 'end plate changes,' 'paraspinal muscles,' and 'lower back pain. ' This article compiled different studies aiming to enhance the comprehension of biochemical processes resulting in the development of lumbar pain. Search using the keywords 'Modic changes,'' end plate changes lower back pain,' 'paraspinal muscles lower back pain,' and 'Modic changes lower back pain' on Google Scholar yielded 33000, 41000, 49400, and 17,800 results, and 958, 118, 890 and 560 results on Pubmed respectively.
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Affiliation(s)
- Manasa Suryadevara
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | | | - Anshul Sood
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshitha Reddy
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | | | - Sheetal S Shelar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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12
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Banitalebi H, Hermansen E, Hellum C, Espeland A, Storheim K, Myklebust TÅ, Indrekvam K, Brisby H, Weber C, Anvar M, Aaen J, Negård A. Preoperative fatty infiltration of paraspinal muscles assessed by MRI is associated with less improvement of leg pain 2 years after surgery for lumbar spinal stenosis. 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 2024; 33:1967-1978. [PMID: 38528161 DOI: 10.1007/s00586-024-08210-z] [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: 11/10/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Fatty infiltration (FI) of the paraspinal muscles may associate with pain and surgical complications in patients with lumbar spinal stenosis (LSS). We evaluated the prognostic influence of MRI-assessed paraspinal muscles' FI on pain or disability 2 years after surgery for LSS. METHODS A muscle fat index (MFI) was calculated (by dividing signal intensity of psoas to multifidus and erector spinae) on preoperative axial T2-weighted MRI of patients with LSS. Pain and disability 2 years after surgery were assessed using the Oswestry disability index, the Zurich claudication questionnaire and numeric rating scales for leg and back pain. Multivariate linear and logistic regression analyses (adjusted for preoperative outcome scores, age, body mass index, sex, smoking status, grade of spinal stenosis, disc degeneration and facet joint osteoarthritis) were used to assess the associations between MFI and patient-reported clinical outcomes. In the logistic regression models, odds ratios (OR) and 95% confidence intervals (CI) were calculated for associations between the MFI and ≥ 30% improvement of the outcomes (dichotomised into yes/no). RESULTS A total of 243 patients were evaluated (mean age 66.6 ± 8.5 years), 49% females (119). Preoperative MFI and postoperative leg pain were significantly associated, both with leg pain as continuous (coefficient - 3.20, 95% CI - 5.61, - 0.80) and dichotomised (OR 1.51, 95% CI 1.17, 1.95) scores. Associations between the MFI and the other outcome measures were not statistically significant. CONCLUSION Preoperative FI of the paraspinal muscles on MRI showed statistically significant association with postoperative NRS leg pain but not with ODI or ZCQ.
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Affiliation(s)
- Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Erland Hermansen
- Kysthospitalet in Hagevik. Orthopaedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik. Orthopaedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | | | - Jørn Aaen
- Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Negård
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ekşi MŞ, Berikol G, Özcan-Ekşi EE. Mo-fi-disc scoring system: Towards understanding the radiological tools to better delineate the disease process and enhancing our solutions for low back pain in artificial intelligence era. J Orthop Sci 2024:S0949-2658(24)00057-5. [PMID: 38570287 DOI: 10.1016/j.jos.2024.03.012] [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] [Received: 01/19/2024] [Revised: 02/28/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND 'Mo-fi-disc' is a new scoring system that quantifies degeneration of the lumbar spine and predicts the intensity of low back pain (LBP). However, its association with LBP-related disability is unknown. In the present study, we aimed to analyze whether 'Mo-fi-disc' scoring system could predict LBP-related disability and distinguish patients with LBP from asymptomatic subjects, while the spine medicine marching towards the era of artificial intelligence (AI). METHODS This is a cross-sectional analysis of a prospectively collected database. We included age-, gender-, and BMI-matched 132 subjects (patients: 66, asymptomatic subjects: 66). Modic changes (Mo), fatty infiltration in the paraspinal muscles (fi), and intervertebral disc degeneration (disc) were evaluated using 'Mo-fi-disc' scoring system on lumbar spine magnetic resonance imaging. Pain and disability were evaluated with visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. RESULTS A Mo-fi-disc score of 5.5 was the most appropriate cut-off value. Mo-fi-disc scoring system had an OR of 1.79 in distinguishing patients with LBP from asymptomatic subjects. One point increment in VAS and ODI had ORs of 1.82 and 1.13 for predicting higher Mo-fi-disc scores. CONCLUSION 'Mo-fi-disc' scoring system is a useful tool depicting intensity of LBP and LBP-related disability. The cut off value of Mo-fi-disc score is 5.5 to distinguish patients with LBP from asymptomatic subjects. This scoring system, with progressive improvement of its faults, could help clinicians to select appropriate patients for conservative and surgical management in the very near future, in AI-based spine medicine. IRB APPROVAL NO ATADEK 2019-12/4.
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Affiliation(s)
- Murat Şakir Ekşi
- Health Sciences University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey; Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
| | - Gürkan Berikol
- Taksim Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Acıbadem Bağdat Caddesi Medical Center, Physical Therapy and Rehabilitation Unit, Istanbul, Turkey
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14
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Rummens S, Dierckx S, Brumagne S, Desloovere K, Peers K. Three-dimensional freehand ultrasonography to measure muscle volume of the lumbar multifidus: Reliability of processing technique and validity through comparison to magnetic resonance imaging. J Anat 2024; 244:601-609. [PMID: 38087647 PMCID: PMC10941570 DOI: 10.1111/joa.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 03/16/2024] Open
Abstract
There is a growing interest in muscle characteristics of the lumbar multifidus related to low back pain, but findings between studies are inconsistent. One of the issues explaining these conflicting findings might be the use of two-dimensional measures of cross-sectional area and thickness of the lumbar multifidus in most studies, which might be a suboptimal representation of the entire muscle volume. A three-dimensional volumetric assessment, combined with standardized imaging and processing measurement protocols, is highly recommended to quantify spinal muscle morphology. Three-dimensional freehand ultrasonography is a technique with large potential for daily clinical practice. It is achieved by combining conventional two-dimensional ultrasound with a motion-tracking system, recording the position and orientation of the ultrasound transducer during acquisition, resulting in a three-dimensional reconstruction. This study investigates intra- and interprocessor reliability for the quantification of muscle volume of the lumbar multifidus based on three-dimensional freehand ultrasound and its validity, in 31 patients with low back pain and 20 healthy subjects. Two processors manually segmented the lumbar multifidus on three-dimensional freehand ultrasound images using Stradwin software following a well-defined method. We assessed the concurrent validity of the measurement of multifidus muscle volume using three-dimensional freehand ultrasound compared with magnetic resonance imaging in 10 patients with low back pain. Processing reliability and agreement were determined using intraclass correlation coefficients, Bland-Altman plots, and calculation of the standard error of measurement and minimal detectable change, while validity was defined based on correlation analysis. The processing of three-dimensional freehand ultrasound images to measure lumbar multifidus volume was reliable. Good to excellent intraclass correlation coefficients were found for intraprocessor reliability. For interprocessor reliability, the intraclass correlation coefficients were moderate to good, emphasizing the importance of processing guidelines and training. A single processor analysis is preferred in clinical studies or when small differences in muscle volume are expected. The correlation between magnetic resonance imaging and three-dimensional freehand ultrasound measurements of lumbar multifidus volume was moderate to good but with a systematically smaller multifidus volume measured on three-dimensional freehand ultrasound. These results provide opportunities for both researchers and clinicians to reliably assess muscle structure using three-dimensional freehand ultrasound in patients with low back pain and to monitor changes related to pathology or interventions. To allow implementation in both research and clinical settings, guidelines on three-dimensional freehand ultrasound processing and training were provided.
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Affiliation(s)
- Sofie Rummens
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Dierckx
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Simon Brumagne
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Peers
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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15
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Xu W, Liu X, Wu L, Liang S, Zhang Y, Huang J, Zeng X, Li S, Xu F, Xiong Y. Fatty Infiltration of Multifidus Muscles: An Easily Overlooked Risk Factor for the Severity of Osteoporotic Vertebral Fractures. Orthop Surg 2024; 16:585-593. [PMID: 38238249 PMCID: PMC10925513 DOI: 10.1111/os.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES Osteoporotic vertebral fractures (OVFs) are a critical public health concern requiring urgent attention, and severe OVFs impose substantial health and economic burdens on patients and society. Analysis of the risk factors for severe OVF is imperative to actively prevent the occurrence of this degenerative disorder. This study aimed to investigate the risk factors associated with the severity of OVF, with a specific focus on changes in the paraspinal muscles. METHODS A total of 281 patients with a first-time single-level acute OVF between January 2016 and January 2023 were enrolled in the study. Clinical and radiological data were collected and analyzed. The cross-sectional area (CSA) and degree of fatty infiltration (FI) of the paraspinal muscles, including the multifidus muscles (MFMs), erector spinae muscles (ESMs), and psoas major muscles (PSMs), were measured by magnetic resonance imaging (MRI) of the L4/5 intervertebral discs. According to the classification system of osteoporotic fractures (OF classification) and recommended treatment plan, OVFs were divided into a low-grade OF group and a high-grade OF group. Univariate and multivariate logistic regression analyse s were performed to identify risk factors associated with the severity of OVF. RESULTS Ninety-eight patients were included in the low-grade OF group, and 183 patients were included in the high-grade OF group. Univariate analysis revealed a significantly higher incidence of a high degree of FI of MFMs (OR = 1.71, p = 0.002) and ESMs (OR = 1.56, p = 0.021) in the high-grade OF group. Further multivariate logistic regression analysis demonstrated that a high degree of FI of the MFMs (OR = 1.71, p = 0.002) is an independent risk factor for the severity of OVF. CONCLUSION A high degree of FI of the MFMs was identified as an independent risk factor for the severity of OVF. Decreasing the degree of FI in the MFMs might lower the incidence of the severity of OVF, potentially reducing the necessity for surgical intervention in OVF patients.
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Affiliation(s)
- Wuyan Xu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Xiaowen Liu
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
| | - Li Wu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Shaohua Liang
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Ye Zhang
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Junbing Huang
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Xuwen Zeng
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Siming Li
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Fan Xu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Yuchao Xiong
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
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16
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Camino-Willhuber G, Schönnagel L, Chiapparelli E, Amoroso K, Tani S, Caffard T, Arzani A, Guven AE, Verna B, Zhu J, Shue J, Zelenty WD, Sokunbi G, Bendersky M, Girardi FP, Sama AA, Cammisa FP, Hughes AP. Association between lumbar intervertebral vacuum phenomenon severity and posterior paraspinal muscle atrophy in patients undergoing spine surgery. 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 2024; 33:1013-1020. [PMID: 38267734 DOI: 10.1007/s00586-023-08120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE Intervertebral vacuum phenomenon (IVP) and paraspinal muscular atrophy are age-related changes in the lumbar spine. The relationship between both parameters has not been investigated. We aimed to analyze the correlation between IVP and paraspinal muscular atrophy in addition to describing the lumbar vacuum severity (LVS) scale, a new parameter to estimate lumbar degeneration. METHODS We analyzed patients undergoing spine surgery between 2014 and 2016. IVP severity was assessed utilizing CT scans. The combination of vacuum severity on each lumbar level was used to define the LVS scale, which was classified into mild, moderate and severe. MRIs were used to evaluate paraspinal muscular fatty infiltration of the multifidus and erector spinae. The association of fatty infiltration with the severity of IVP at each lumbar level was assessed with a univariable and multivariable ordinal regression model. RESULTS Two hundred and sixty-seven patients were included in our study (128 females and 139 males) with a mean age of 62.6 years (55.1-71.2). Multivariate analysis adjusted for age, BMI and sex showed positive correlations between LVS-scale severity and fatty infiltration in the multifidus and erector spinae, whereas no correlation was observed in the psoas muscle. CONCLUSION IVP severity is positively correlated with paraspinal muscular fatty infiltration. This correlation was stronger for the multifidus than the erector spinae. No correlations were observed in the psoas muscle. The lumbar vacuum severity scale was significantly correlated with advanced disc degeneration with vacuum phenomenon.
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Affiliation(s)
- Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Soji Tani
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Artine Arzani
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Ali E Guven
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Bruno Verna
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - William D Zelenty
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Gbolabo Sokunbi
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Intraoperative Monitoring, Pediatric Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St, New York City, NY, 10021, USA.
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17
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Ekşi MŞ, Özcan-Ekşi EE. Fatty infiltration of the erector spinae at the upper lumbar spine could be a landmark for low back pain. Pain Pract 2024; 24:278-287. [PMID: 37830410 DOI: 10.1111/papr.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/03/2023] [Accepted: 10/01/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end-plates, and fatty infiltration in their paraspinal muscles. METHODS Consecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age-, gender- and BMI-matched asymptomatic controls. RESULTS Low back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels. CONCLUSION Severe IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration.
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Affiliation(s)
- Murat Şakir Ekşi
- Neurosurgery Clinic, FSM Training and Research Hospital, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, Istanbul, Turkey
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18
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Han G, Wang W, Yue L, Fan Z, Li Z, Li J, Sun Z, Li W. Age-Dependent Differences of Paraspinal Muscle Endurance and Morphology in Chinese Community Population Without Chronic Low Back Pain. Global Spine J 2024; 14:235-243. [PMID: 35584688 PMCID: PMC10676164 DOI: 10.1177/21925682221103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES Our aim was to describe age-dependent changes of lumbar paraspinal muscle endurance and morphology in Chinese healthy population. We also explored the relationship between paraspinals endurance and morphology. METHODS A total of 181 participants from Chinese community population without chronic low back pain were included. The participants were divided into three groups: young (20-39 years old, n = 29), middle (40-59 years old, n = 93), and elderly (≥ 60 years old, n = 59). The Ito test was performed to evaluate the isometric endurance of paraspinal muscles. The total cross-sectional area (TCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES) were measured at L1-L5 levels on magnetic resonance imaging. Physical activity level was evaluated using the physical activity index and comorbidities were assessed by the modified 5-item frailty index. RESULTS The elderly group had a shorter performance time of endurance test than the young group and middle-aged group. Correlation analysis showed that age had a significant correlation with endurance test, the average MF TCSA, MF FI, ES TCSA and ES FI of L1-5. In addition, PAI had a significant correlation with endurance test and MF FI. In multiple linear regression analysis, paraspinals endurance was associated with MF FI, ES FI, physical activity level and comorbidities. CONCLUSION Age-related decreases in paraspinals endurance and TCSA, and an increase in FI were revealed. Besides, paraspinal muscles FI, but not TCSA, was negatively associated with the endurance of paraspinals.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Tianjin Hospital, Beijing, China
| | - Lihao Yue
- Peking University Health Science Center, Beijing, China
| | - Zheyu Fan
- Peking University Health Science Center, Beijing, China
| | - Zonglin Li
- Peking University Health Science Center, Beijing, China
| | - Jiaming Li
- Peking University Health Science Center, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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19
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Chen P, Zhou Z, Sun L, Yu X, Li K, Li J, He M, Zhou X, Luo F, Zhao J, Chen W. Quantitative multi-parameter assessment of age- and gender-related variation of back extensor muscles in healthy adults using Dixon MR imaging. Eur Radiol 2024; 34:69-79. [PMID: 37537425 DOI: 10.1007/s00330-023-09954-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/07/2023] [Accepted: 05/20/2023] [Indexed: 08/05/2023]
Abstract
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).
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Affiliation(s)
- Pinzhen Chen
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China
| | - Zhou Zhou
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China
| | - Li Sun
- Health Management Center, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China
| | - Xueke Yu
- Department of Orthopedics, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China
| | - Kai Li
- Department of Orthopedics, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China
| | - Jin Li
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China
| | - Min He
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China
| | - Xiaoyue Zhou
- MR Collaboration NEA, Siemens Healthcare Ltd, Shanghai, 201318, China
| | - Fei Luo
- Department of Orthopedics, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China
| | - Jun Zhao
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China.
| | - Wei Chen
- Department of Radiology, The First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China.
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Newell E, Chorney H, Tiegs-Heiden CA, Benson JC, Ouellet J, Driscoll M. Augmentation of musculoskeletal soft tissue morphology within low back pain patients may suggest the presence of physiological stress shielding: An in vivo study. J Biomech 2024; 162:111894. [PMID: 38070295 DOI: 10.1016/j.jbiomech.2023.111894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION The pathomechanism of low back pain (LBP) remains unknown. However, changes to mechanical properties of soft tissues affected by LBP may indicate the presence of stress shielding, which may manifest via tissue remodeling. This study investigates the potential for physiological stress shielding within the lumbar spine by examining differences within lumbar soft tissue morphology between control and LBP subjects. METHODS Through MRI, the total and functional cross-sectional area (tCSA, fCSA) and fatty infiltration (FI) of the lumbar multifidus (MF), erector spinae (ES), quadratus lumborum (QL), psoas major (PM), and thoracolumbar fascia (TLF) were measured from the L1/L2 to L5/S1 intervertebral disc levels of 69 subjects (36 LBP and 33 control subjects). Statistical analysis was conducted using Mann-Whitney U. P < 0.05 denoted significance. RESULTS Comparison of male LBP patients and male healthy controls yielded an increase in tCSA and fCSA within the L4/L5 PM (p < 0.01), and the L4/L5 ES (p = 0.02) and PM (p < 0.01), respectively, of LBP patients. Female LBP patients' FI compared to female controls increased within the L1/L2 MF (p = 0.03), L3/L4 MF (p = 0.04) and ES (p = 0.02), and L4/L5 QL (p = 0.01). The L3/L4 TLF also demonstrated an 8% increase in LBP subjects. CONCLUSION Male patients' results suggest elevated tissue loading during motion yielding hypertrophy in the L4/L5 ES and PM fCSA, and PM tCSA. Female LBP patients' MF, ES, and PM at L3/L4 demonstrating elevated FI coupled with TLF tCSA hypertrophy may suggest irregular stress distributions and lay the foundation for stress shielding within musculoskeletal soft tissues.
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Affiliation(s)
- Emily Newell
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada; Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Quebec, Canada.
| | - Harriet Chorney
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada; Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Quebec, Canada.
| | | | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - Jean Ouellet
- Department of Paediatric Surgery, McGill University, Montreal, Quebec, Canada; Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada; Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Quebec, Canada.
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21
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Vitale J, Sconfienza LM, Galbusera F. Cross-sectional area and fat infiltration of the lumbar spine muscles in patients with back disorders: a deep learning-based big data analysis. 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 2024; 33:1-10. [PMID: 37875679 DOI: 10.1007/s00586-023-07982-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/30/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Validated deep learning models represent a valuable option to perform large-scale research studies aiming to evaluate muscle quality and quantity of paravertebral lumbar muscles at the population level. This study aimed to assess lumbar spine muscle cross-sectional area (CSA) and fat infiltration (FI) in a large cohort of subjects with back disorders through a validated deep learning model. METHODS T2 axial MRI images of 4434 patients (n = 2609 females, n = 1825 males; mean age: 56.7 ± 16.8) with back disorders, such as fracture, spine surgery or herniation, were retrospectively collected from a clinical database and automatically segmented. CSA, expressed as the ratio between total muscle area (TMA) and the vertebral body area (VBA), and FI, in percentages, of psoas major, quadratus lumborum, erector spinae, and multifidus were analyzed as primary outcomes. RESULTS Male subjects had significantly higher CSA (6.8 ± 1.7 vs. 5.9 ± 1.5 TMA/VBA; p < 0.001) and lower FI (21.9 ± 8.3% vs. 15.0 ± 7.3%; p < 0.001) than females. Multifidus had more FI (27.2 ± 10.6%; p < 0.001) than erector spinae (22.2 ± 9.7%), quadratus lumborum (17.5 ± 7.0%) and psoas (13.7 ± 5.8%) whereas CSA was higher in erector spinae than other lumbar muscles. A high positive correlation between age and total FI was detected (rs = 0.73; p < 0.001) whereas a negligible negative correlation between total CSA and age was observed (rs = - 0.24; p < 0.001). Subjects with fractures had lower CSA and higher FI compared to those with herniations, surgery and with no clear pathological conditions. CONCLUSION CSA and FI values of paravertebral muscles vary a lot in accordance with subjects' sex, age and clinical conditions. Given also the large inter-muscle differences in CSA and FI, the choice of muscles needs to be considered with attention by spine surgeons or physiotherapists when investigating changes in lumbar muscle morphology in clinical practice.
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Affiliation(s)
- Jacopo Vitale
- Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
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22
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Liang X, Yang P, Yuan H, Huo Y, Yang D, Wang H, Ding W. Sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis: a cross-sectional study. J Orthop Surg Res 2023; 18:980. [PMID: 38129855 PMCID: PMC10734110 DOI: 10.1186/s13018-023-04357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND To evaluate the sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis (DLS) and to explore whether the difference is helpful in investigating the etiology and progression of DLS. METHOD A retrospective review of 199 patients (41 males, 158 females) with DLS was included. Patient demographics including age, gender, bone mineral density were collected. Back and leg pain was assessed by visual analog scale, and general physical condition was assessed by Oswestry Disability Index. Cobb's angle was measured, and direction of scoliosis, position of the superior, inferior and apex vertebrae, number of vertebrae included in the scoliosis, rotation of apex vertebrae (Nash-Mo index), translation of apex vertebrae were recorded. Sagittal longitudinal axis, thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence angle (PI), sacral slope, apex of lumbar lordosis and coronal balance distance were measured by whole spine lateral radiographs, and type of coronal imbalance was evaluated in all patients. Fat infiltration rate (FIR) of the paraspinal muscles at the vertebral apex was measured by MRI. RESULT Compared to female patients, male patients showed more back and leg pain on clinical presentation and smaller Cobb angle, less parietal rotation, larger LL, smaller PI-LL and lower paravertebral muscle FIR on radiologic features. CONCLUSION Gender differences do exist in DLS patients with regard to clinical and radiological presentation, low back pain was more pronounced in male patients, and scoliosis was more severe in female patients based on this cross-sectional study.
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Affiliation(s)
- Xiao Liang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Puxin Yang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Hongru Yuan
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Yachong Huo
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Dalong Yang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Hui Wang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China.
| | - Wenyuan Ding
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China.
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23
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Schönnagel L, Zhu J, Guven AE, Camino-Willhuber G, Tani S, Caffard T, Haffer H, Muellner M, Chiapparelli E, Amoroso K, Arzani A, Moser M, Shue J, Tan ET, Carrino JA, Jöns T, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Understanding the Interplay Between Paraspinal Muscle Atrophy and Lumbar Endplate Degeneration: A 3-Year Longitudinal Study. Spine (Phila Pa 1976) 2023; 48:1627-1634. [PMID: 37698271 DOI: 10.1097/brs.0000000000004826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
STUDY DESIGN Retrospective analysis of longitudinal data. OBJECTIVE To assess the association between the paraspinal musculature (PM) and lumbar endplate degeneration. BACKGROUND The PM is essential for spinal stability, while the vertebral endplate is pivotal for nutrient transport and force distribution. The clinical importance of both has been highlighted in recent literature, though little is known about their interaction. METHODS We identified patients with lumbar MRI scans due to low back pain, with a 3-year interval between MRI scans. Endplate damage was assessed by the total endplate score (TEPS) at each lumbar level. The PM was evaluated for its functional cross-sectional area and fatty infiltration (FI) at the L4 level. We used a generalized mixed model to analyze the association between PM parameters and TEPS at timepoint one, adjusting for age, sex, BMI, diabetes, hypertension, and smoking status. The association with the progression of endplate damage was analyzed through an ordinal regression model, additionally adjusted for TEPS at baseline. RESULTS In all, 329 patients were included, with a median follow-up time of 3.4 years. Participants had a median age of 59 and a BMI of 25.8 kg/m 2 . In the univariate analysis, FI of the posterior PM was significantly associated with TEPS at baseline (β: 0.08, P <0.001) and progression of TEPS [Odds Ratio (OR): 1.03, P =0.020] after adjustment for confounders. The β and OR in this analysis are per percent of FI. In a binary analysis, patients with FI≥40% had an OR of 1.92 ( P =0.006) for the progression of TEPS. CONCLUSIONS This is the first longitudinal study assessing the relationship between PM and endplate degeneration, demonstrating the association between PM atrophy and the progression of endplate degeneration. This insight may aid in identifying patients at risk for degenerative lumbar conditions and guide research into preventive measures.
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Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Henryk Haffer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Manuel Moser
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Neurosurgery, Cantonal Hospital Graubünden, Loëstrasse, Chur, Switzerland
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY
| | - Thomas Jöns
- Berlin Simulation & Training Center, Department of Anatomy Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
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Butowicz CM, Helgeson MD, Pisano AJ, Cook JW, Dearth CL, Hendershot BD. Lumbar Degenerative Disease and Muscle Morphology Before and After Lower Limb Loss in Four Military Patients. Mil Med 2023; 188:e3349-e3355. [PMID: 36564935 DOI: 10.1093/milmed/usac399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/12/2022] [Accepted: 12/02/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is highly prevalent after lower limb amputation (LLA). Reports describing longitudinal changes in spine health before and after amputation are rare. This study describes lumbar spine pathology, muscle morphology, and the continuum of care for LBP before and after LLA. MATERIALS AND METHODS We queried electronic medical records of patients who sought care for LBP before and after unilateral LLA between January 2002 and April 2020 and who had documented lumbar imaging pre- and post-LLA. Patient demographics, muscle morphology, spinal pathology, premorbid and comorbid conditions, self-reported pain, and treatment interventions were assessed. RESULTS Four patients with LBP and imaging before and after LLA were identified. Intervertebral disc degeneration progressed after amputation in three patients, whereas facet arthrosis progressed in both female patients. The fat content of lumbar musculature generally increased after amputation. Conservative management of LBP before and after amputation was standard, with progression to steroidal injections. CONCLUSIONS Lumbar spine health may degrade after amputation. Here, lumbar muscle size did not change after LLA, yet the fat content increased in combination with increases in facet and intervertebral disc degeneration.
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Affiliation(s)
- Courtney M Butowicz
- Neuromusculoskeletal Outcomes Lead Walter Reed National Military Medical Center, Research and Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Research & Engineering Directorate, Defense Health Agency, Building 19, Room B312, Bethesda, MD 20889, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Melvin D Helgeson
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Alfred J Pisano
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - John W Cook
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher L Dearth
- Neuromusculoskeletal Outcomes Lead Walter Reed National Military Medical Center, Research and Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Research & Engineering Directorate, Defense Health Agency, Building 19, Room B312, Bethesda, MD 20889, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Brad D Hendershot
- Neuromusculoskeletal Outcomes Lead Walter Reed National Military Medical Center, Research and Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Research & Engineering Directorate, Defense Health Agency, Building 19, Room B312, Bethesda, MD 20889, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
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25
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Muellner M, Haffer H, Chiapparelli E, Dodo Y, Shue J, Tan ET, Zhu J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine. BMC Musculoskelet Disord 2023; 24:846. [PMID: 37891498 PMCID: PMC10604445 DOI: 10.1186/s12891-023-06967-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The function of the paraspinal muscles and especially the psoas muscle in maintaining an upright posture is not fully understood. While usually considered solely as a hip flexor, the psoas muscle and its complex anatomy suggest that the muscle has other functions involved in stabilizing the lumbar spine. The aim of this study is to determine how the psoas muscle and the posterior paraspinal muscles (PPM; erector spinae and multifidus) interact with each other. METHODS A retrospective review including patients undergoing posterior lumbar fusion surgery between 2014 and 2021 at a tertiary care center was conducted. Patients with a preoperative lumbar magnetic resonance imaging (MRI) scan performed within 12 months prior to surgery were considered eligible. Exclusion criteria included previous spinal surgery at any level, lumbar scoliosis with a Cobb Angle > 20° and patients with incompatible MRIs. MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA) and the fat area (FAT) at L4 was conducted. The degree of fat infiltration (FI) was further calculated. FI thresholds for FIPPM were defined according to literature and patients were divided into two groups (< or ≥ 50% FIPPM). RESULTS One hundred ninetypatients (57.9% female) with a median age of 64.7 years and median BMI of 28.3 kg/m2 met the inclusion criteria and were analyzed. Patients with a FIPPM ≥ 50% had a significantly lower FI in the psoas muscle in both sexes. Furthermore, a significant inverse correlation was evident between FIPPM and FIPsoas for both sexes. A significant positive correlation between FATPPM and fCSAPsoas was also found for both sexes. No significant differences were found for both sexes in both FIPPM groups. CONCLUSION As the FIPPM increases, the FIPsoas decreases. Increased FI is a surrogate marker for a decrease in muscular strength. Since the psoas and the PPM both segmentally stabilize the lumbar spine, these results may be indicative of a potential compensatory mechanism. Due to the weakened PPM, the psoas may compensate for a loss in strength in order to stabilize the spine segmentally.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA.
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, 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, New York City, NY, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
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26
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Guo C, Xu S, Liang Y, Zheng B, Zhu Z, Liu H. Correlation between Degenerative Thoracolumbar Kyphosis and Lumbar Posterior Muscle. J Pers Med 2023; 13:1503. [PMID: 37888114 PMCID: PMC10608706 DOI: 10.3390/jpm13101503] [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: 08/07/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
The relationship between spinal alignment, particularly degenerative thoracolumbar kyphosis (DTLK) combined with lumbar spine stenosis (LSS), and paraspinal muscle content remains underexplored. This study aimed to elucidate the characteristics of paraspinal muscle distribution in DTLK patients and its association with lumbar lordosis (LL) and body mass index (BMI). METHODS A case-control study was conducted comparing 126 patients with DTLK and LSS against 87 control patients. The lumbar crossing indentation value (LCIV) was introduced as a novel measurement for paraspinal muscle content, and its relationship with thoracolumbar kyphosis (TLK), BMI, and LL was assessed. RESULTS LCIV in DTLK patients was found to be lower than in the control group, with a progressive increase from the upper to lower lumbar spine. In the control group, paraspinal muscle content was observed to increase with age and BMI, and LCIV was higher in males. However, the DTLK group showed no gender difference. LCIV in the DTLK group was more pronounced in patients with increased LL. The degree of TLK was not influenced by BMI but was associated with the content of the paravertebral muscle. CONCLUSIONS Paraspinal muscle content, as measured by LCIV, is significantly associated with DTLK and LSS. The study emphasizes the importance of considering paraspinal muscle health in DTLK patients and offers valuable insights for diagnosis and therapeutic interventions.
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Affiliation(s)
| | | | | | | | | | - Haiying Liu
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing 100044, China; (C.G.); (S.X.); (Y.L.); (B.Z.); (Z.Z.)
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27
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Engelke K, Chaudry O, Gast L, Eldib MAB, Wang L, Laredo JD, Schett G, Nagel AM. Magnetic resonance imaging techniques for the quantitative analysis of skeletal muscle: State of the art. J Orthop Translat 2023; 42:57-72. [PMID: 37654433 PMCID: PMC10465967 DOI: 10.1016/j.jot.2023.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is the dominant 3D imaging modality to quantify muscle properties in skeletal muscle disorders, in inherited and acquired muscle diseases, and in sarcopenia, in cachexia and frailty. Methods This review covers T1 weighted and Dixon sequences, introduces T2 mapping, diffusion tensor imaging (DTI) and non-proton MRI. Technical concepts, strengths, limitations and translational aspects of these techniques are discussed in detail. Examples of clinical applications are outlined. For comparison 31P-and 13C-MR Spectroscopy are also addressed. Results MRI technology provides a rich toolset to assess muscle deterioration. In addition to classical measures such as muscle atrophy using T1 weighted imaging and fat infiltration using Dixon sequences, parameters characterizing inflammation from T2 maps, tissue sodium using non-proton MRI techniques or concentration or fiber architecture using diffusion tensor imaging may be useful for an even earlier diagnosis of the impairment of muscle quality. Conclusion Quantitative MRI provides new options for muscle research and clinical applications. Current limitations that also impair its more widespread use in clinical trials are lack of standardization, ambiguity of image segmentation and analysis approaches, a multitude of outcome parameters without a clear strategy which ones to use and the lack of normal data.
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Affiliation(s)
- Klaus Engelke
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
- Clario Inc, Germany
| | - Oliver Chaudry
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Lena Gast
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | | | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Jean-Denis Laredo
- Service d’Imagerie Médicale, Institut Mutualiste Montsouris & B3OA, UMR CNRS 7052, Inserm U1271 Université de Paris-Cité, Paris, France
| | - Georg Schett
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Armin M. Nagel
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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28
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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.
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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.
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Haffer H, Muellner M, Chiapparelli E, Dodo Y, Zhu J, Han YX, Donnelly E, Tan ET, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Osteosarcopenia in the Spine Beyond Bone Mineral Density: Association Between Paraspinal Muscle Impairment and Advanced Glycation Endproducts. Spine (Phila Pa 1976) 2023; 48:984-993. [PMID: 37036285 PMCID: PMC10330153 DOI: 10.1097/brs.0000000000004683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
STUDY DESIGN Prospective cross-sectional study. OBJECTIVE To determine if an accumulation of advanced glycation endproducts (AGEs) is associated with impaired paraspinal muscle composition. BACKGROUND Impaired bone integrity and muscle function are described as osteosarcopenia. Osteosarcopenia is associated with falls, fragility fractures, and reduced quality of life. Bone integrity is influenced by bone quantity (bone mineral density) and quality (microarchitecture and collagen). The accumulation of AGEs stiffens collagen fibers and increases bone fragility. The relationship between paraspinal muscle composition and bone collagen properties has not been evaluated. METHODS Intraoperative bone biopsies from the posterior superior iliac spine were obtained and evaluated with multiphoton microscopy for fluorescent AGE cross-link density (fAGEs). Preoperative magnetic resonance imaging measurements at level L4 included the musculus (m.) psoas and combined m. multifidus and m. erector spinae (posterior paraspinal musculature, PPM). Muscle segmentation on axial images (cross-sectional area, CSA) and calculation of a pixel intensity threshold method to differentiate muscle (functional cross-sectional area, fCSA) and intramuscular fat (FAT). Quantitative computed tomography was performed at the lumbar spine. Univariate and multivariable regression models were used to investigate associations between fAGEs and paraspinal musculature. RESULTS One hundred seven prospectively enrolled patients (50.5% female, age 60.7 y, BMI 28.9 kg/m 2 ) were analyzed. In all, 41.1% and 15.0% of the patients demonstrated osteopenia and osteoporosis, respectively. Univariate linear regression analysis demonstrated a significant association between cortical fAGEs and CSA in the psoas (ρ=0.220, P =0.039) but not in the PPM. Trabecular fAGEs revealed no significant associations to PPM or psoas musculature. In the multivariable analysis, higher cortical fAGEs were associated with increased FAT (β=1.556; P =0.002) and CSA (β=1.305; P =0.005) in the PPM after adjusting for covariates. CONCLUSION This is the first investigation demonstrating that an accumulation of nonenzymatic collagen cross-linking product fAGEs in cortical bone is associated with increased intramuscular fat in the lumbar paraspinal musculature.
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Affiliation(s)
- Henryk Haffer
- Department of Orthopaedic Surgery, 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 and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maximilian Muellner
- Department of Orthopaedic Surgery, 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 and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Yusuke Dodo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Yi Xin Han
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
- Musculoskeletal Integrity Program, Research Institute, Hospital for Special Surgery, Weill Cornell Medicine New York City, NY, USA
| | - Ek T. Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A. Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P. Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P. Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Alexander P. Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
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Elliott JM, Walton DM, Albin SR, Courtney DM, Siegmund GP, Carroll LJ, Weber KA, Smith AC. Biopsychosocial sequelae and recovery trajectories from whiplash injury following a motor vehicle collision. Spine J 2023; 23:1028-1036. [PMID: 36958668 PMCID: PMC10330498 DOI: 10.1016/j.spinee.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND CONTEXT Five out of 10 injured in a motor vehicle collision (MVC) will develop persistent pain and disability. It is unclear if prolonged symptoms are related to peritraumatic pain/disability, psychological distress, muscle fat, lower extremity weakness. PURPOSE To test if widespread muscle fat infiltration (MFI) was (1) unique to those with poor recovery, (2) present in the peritraumatic stage, (3) related to known risk factors. STUDY DESIGN/SETTING A cohort study, single-center academic hospital. PATIENT SAMPLES A total of 97 men and women (age 18-65) presenting to an urban academic emergency medicine department following MVC, but not requiring inpatient hospitalization. PRIMARY OUTCOME MEASURE Neck disability at 12-months. METHODS Participants underwent magnetic resonance imaging (MRI) to quantify neck and lower extremity MFI, completed questionnaires on pain/disability and psychological distress (< 1-week, 2-weeks, 3-, and 12-months) and underwent maximum volitional torque testing of their lower extremities (2-weeks, 3-, and 12-months). Percentage score on the Neck Disability Index at 12-months was used for a model of (1) Recovered (0%-8%), (2) Mild (10%-28%), and (3) Moderate/Severe (≥ 30%). This model was adjusted for BMI and age. RESULTS Significant differences for neck MFI were revealed, with the Recovered group having significantly lower neck MFI than the Mild and Moderate/Severe groups at all time points. The Mild group had significantly more leg MFI at 12-months (p=.02) than the Recovered group. There were no other significant differences at any other time point. Lower extremity torques revealed no group differences. The Traumatic Injury Distress Scale (TIDS) and MFI of the neck at 1-week postinjury significantly predicted NDI score at 12-months. CONCLUSIONS Higher neck MFI and distress may represent a risk factor though it is unclear whether this is a pre-existing phenotype or result of the trauma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02157038.
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Affiliation(s)
- J M Elliott
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, The Kolling Institute, 10 Westbourne St, St Leonards, New South Wales, 2065, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Chicago, IL 60611, USA.
| | - D M Walton
- Faculty of Health Sciences, School of Physical Therapy, Western University Canada Schulich School of Medicine and Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada; Department of Psychiatry, Western University Canada, 151 Richmond St, London, Ontario N6A 5C1, Canada
| | - S R Albin
- School of Physical Therapy, Regis University, 3333 Regis Boulevard Denver, CO 80221-1099, USA
| | - D M Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - G P Siegmund
- MEA Forensics, 11151 Horseshoe Way, Richmond, British Columbia V7A 4S5, Canada
| | - L J Carroll
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - K A Weber
- Division of Pain Medicine, Stanford School of Medicine, 900 Blake Wilbur Dr, Palo Alto, CA 94304, USA
| | - A C Smith
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, 12631 E 17th Ave, Aurora, CO 80045, USA
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Lee DG, Bae JH. Fatty infiltration of the multifidus muscle independently increases osteoporotic vertebral compression fracture risk. BMC Musculoskelet Disord 2023; 24:508. [PMID: 37349814 DOI: 10.1186/s12891-023-06640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Vertebral compression fractures decrease daily life activities and increase economic and social burdens. Aging decreases bone mineral density (BMD), which increases the incidence of osteoporotic vertebral compression fractures (OVCFs). However, factors other than BMD can affect OVCFs. Sarcopenia has been a noticeable factor in the aging health problem. Sarcopenia, which involves a decrease in the quality of the back muscles, influences OVCFs. Therefore, this study aimed to evaluate the influence of the quality of the multifidus muscle on OVCFs. METHODS We retrospectively studied patients aged 60 years and older who underwent concomitant lumbar MRI and BMD in the university hospital database, with no history of structurally affecting the lumbar spine. We first divided the recruited people into a control group and a fracture group according to the presence or absence of OVCFs, and further divided the fracture group into an osteoporosis BMD group and an osteopenia BMD group based on the BMD T-score of -2.5. Using images of lumbar spine MRI, the cross-sectional area and percentage of muscle fiber (PMF) of the multifidus muscle were obtained. RESULTS We included 120 patients who had visited the university hospital, with 45 participants in the control group and 75 in the fracture group (osteopenia BMD: 41, osteoporosis BMD: 34). Age, BMD, and the psoas index significantly differed between the control and fracture groups. The mean cross-sectional area (CSA) of multifidus muscles measured at L4-5 and L5-S1, respectively, did not differ among the control, P-BMD, and O-BMD groups. On the other hand, the PMF measured at L4-5 and L5-S1 showed a significant difference among the three groups, and the value of the fracture group was lower than that of the control group. Logistic regression analysis showed that the PMF value, not the CSA, of the multifidus muscle at L4-5 and L5-S1 affected the risk of OVCFs, with and without adjusting for other significant factors. CONCLUSIONS High percentage of fatty infiltration of the multifidus muscle increases the spinal fracture risk. Therefore, preserving the quality of the spinal muscle and bone density is essential for preventing OVCFs.
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Affiliation(s)
- Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
| | - Jae Hwa Bae
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea.
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Naruse M, Trappe S, Trappe TA. Human skeletal muscle-specific atrophy with aging: a comprehensive review. J Appl Physiol (1985) 2023; 134:900-914. [PMID: 36825643 PMCID: PMC10069966 DOI: 10.1152/japplphysiol.00768.2022] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Age-related skeletal muscle atrophy appears to be a muscle group-specific process, yet only a few specific muscles have been investigated and our understanding in this area is limited. This review provides a comprehensive summary of the available information on age-related skeletal muscle atrophy in a muscle-specific manner, nearly half of which comes from the quadriceps. Decline in muscle-specific size over ∼50 yr of aging was determined from 47 cross-sectional studies of 982 young (∼25 yr) and 1,003 old (∼75 yr) individuals and nine muscle groups: elbow extensors (-20%, -0.39%/yr), elbow flexors (-19%, -0.38%/yr), paraspinals (-24%, -0.47%/yr), psoas (-29%, -0.58%/yr), hip adductors (-13%, -0.27%/yr), hamstrings (-19%, -0.39%/yr), quadriceps (-27%, -0.53%/yr), dorsiflexors (-9%, -0.19%/yr), and triceps surae (-14%, -0.28%/yr). Muscle-specific atrophy rate was also determined for each of the subcomponent muscles in the hamstrings, quadriceps, and triceps surae. Of all the muscles included in this review, there was more than a fivefold difference between the least (-6%, -0.13%/yr, soleus) to the most (-33%, -0.66%/yr, rectus femoris) atrophying muscles. Muscle activity level, muscle fiber type, sex, and timeline of the aging process all appeared to have some influence on muscle-specific atrophy. Given the large range of muscle-specific atrophy and the large number of muscles that have not been investigated, more muscle-specific information could expand our understanding of functional deficits that develop with aging and help guide muscle-specific interventions to improve the quality of life of aging women and men.
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Affiliation(s)
- Masatoshi Naruse
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Todd A Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
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Ordaz A, Anderson B, Zlomislic V, Allen RT, Garfin SR, Schuepbach R, Farshad M, Schenk S, Ward SR, Shahidi B. Paraspinal muscle gene expression across different aetiologies in individuals undergoing surgery for lumbar spine pathology. 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; 32:1123-1131. [PMID: 36740606 PMCID: PMC10448537 DOI: 10.1007/s00586-023-07543-5] [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: 04/08/2022] [Revised: 12/12/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to understand potential baseline transcriptional expression differences in paraspinal skeletal muscle from patients with different underlying lumbar pathologies by comparing multifidus gene expression profiles across individuals with either disc herniation, facet arthropathy, or degenerative spondylolisthesis. METHODS Multifidus biopsies were obtained from patients (n = 44) undergoing lumbar surgery for either disc herniation, facet arthropathy, or degenerative spondylolisthesis. Diagnostic categories were based on magnetic resonance images, radiology reports, and intraoperative reports. Gene expression for 42 genes was analysed using qPCR. A one-way analysis of variance was performed for each gene to determine differences in expression across diagnostic groups. Corrections for multiple comparisons across genes (Benjamini-Hochberg) and for between-group post hoc comparisons (Sidak) were applied. RESULTS Adipogenic gene (ADIPOQ) expression was higher in the disc herniation group when compared to the facet arthropathy group (p = 0.032). Adipogenic gene (PPARD) expression was higher in the degenerative spondylolisthesis group when compared to the disc herniation group (p = 0.013), although absolute gene expression levels for all groups was low. Fibrogenic gene (COL3A1) had significantly higher expression in the disc herniation group and facet arthropathy group when compared to the degenerative spondylolisthesis group (p < 0.001 and p = 0.038, respectively). When adjusted for multiple comparisons, only COL3A1 remained significant (p = 0.012). CONCLUSION Individuals with disc herniation and facet arthropathy demonstrate higher COL3A1 gene expression compared to those with degenerative spondylolisthesis. Future research is required to further understand the biological relevance of these transcriptional differences.
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Affiliation(s)
- Angel Ordaz
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA.
| | - Brad Anderson
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Vinko Zlomislic
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - R Todd Allen
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Steven R Garfin
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Regula Schuepbach
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
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Wesselink EO, Pool JJM, Mollema J, Weber KA, Elliott JM, Coppieters MW, Pool-Goudzwaard AL. Is fatty infiltration in paraspinal muscles reversible with exercise in people with low back pain? A systematic review. 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; 32:787-796. [PMID: 36459201 PMCID: PMC10515728 DOI: 10.1007/s00586-022-07471-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Increased fatty infiltration in paraspinal muscles has been recognized as a feature of muscle quality loss in people with Low Back Pain (LBP) and is highly associated with the severity of LBP and dysfunction. Reducing fatty infiltration has been recognized as a rehabilitation aim. An earlier systematic review published in 2014 revealed conflicting evidence for the reversibility of paraspinal muscle quality by means of exercise and no updates have been published since. A new systematic literature search is warranted. METHOD Pubmed, CINAHL and Embase were searched from inception to July 2022. Randomized, non-randomized controlled trials (RCT and non-RCT) and single-arm trials were included if they reported the effect of exercise on paraspinal fatty infiltration in people with LBP. Effect sizes and statistical power were calculated for (1) exercise versus control, and (2) pre-post exercise changes. Available data from the RCTs were pooled via meta-analysis when appropriate. Otherwise, data were synthesized qualitatively. RESULTS Two RCTs, one non-RCT and three single-arm trials met the selection criteria. Data were not pooled due to substantial clinical heterogeneity. Effect sizes from the RCTs revealed no significant difference for exercise versus control. One single-arm trial with high risk of bias demonstrated a significant pre-post difference with moderate effect size, but only at one (T12-L1) of the investigated levels. CONCLUSION Moderate quality evidence is available that paraspinal fatty infiltration is not reversible with exercise in people with LBP. More larger RCT's are needed to draw firmer conclusions.
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Affiliation(s)
- E O Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - J J M Pool
- Institute of Movement Sciences, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - J Mollema
- Institute of Movement Sciences, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - K A Weber
- Systems Neuroscience and Pain Lab, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - J M Elliott
- The University of Sydney, Faculty of Medicine and Health, Northern Sydney Local Health District, Kolling Research Institute, Sydney, Australia
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M W Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - A L Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
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35
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Kameyama K, Ohba T, Endo T, Katsu M, Koji F, Kensuke K, Oda K, Tanaka N, Haro H. Radiological Assessment of Postoperative Paraspinal Muscle Changes After Lumbar Interbody Fusion With or Without Minimally Invasive Techniques. Global Spine J 2023; 13:295-303. [PMID: 33657897 PMCID: PMC9972276 DOI: 10.1177/2192568221994794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. BACKGROUND Percutaneous pedicle screws (PPS) have the advantage of being able to better preserve the paraspinal muscles when compared with a traditional open approach. However, the nature of changes in postoperative paraspinal muscle after damage by lumbar fusion surgery has remained largely unknown. It is clinically important to clarify and compare changes in paraspinal muscles after the various surgeries. OBJECTIVE (1) To determine postoperative changes of muscle density and cross-sectional area using computed tomography (CT), and (2) to compare paraspinal muscle changes after posterior lumbar interbody fusion (PLIF) with traditional open approaches and minimally invasive lateral lumbar interbody fusions (LLIF) with PPS. METHODS We included data from 39 consecutive female patients who underwent open PLIF and 23 consecutive patients who underwent single-staged treatment with LLIF followed by posterior PPS fixation at a single level (L4-5). All patients underwent preoperative, 6 months postoperative, and 1-year postoperative CT imaging. Measurements of the cross-sectional area (CSA) and muscle densities of paraspinal muscles were obtained using regions of interest defined by manual tracing. RESULTS We did not find any decrease of CSA in any paraspinal muscles. We did find a decrease of muscle density in the multifidus at 1 year after surgery in patients in the PILF group, but not in those in LLIF/PPS group. CONCLUSIONS One year after surgery, a significant postoperative decrease of muscle density of the multifidi was observed only in patients who underwent open PLIF, but not in those who underwent LLIF/PPS.
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Affiliation(s)
- Keigo Kameyama
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan,Tetsuro Ohba, MD, PhD, Department of
Orthopaedics, University of Yamanashi, Shimokato, Chuo, Yamanashi 409-3898,
Japan.
| | - Tomoka Endo
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Marina Katsu
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Fujita Koji
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Koyama Kensuke
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Nobuki Tanaka
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
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Cheng Z, Li Y, Li M, Huang J, Huang J, Liang Y, Lu S, Liang C, Xing T, Su K, Wen G, Zeng W, Huang L. Correlation between posterior paraspinal muscle atrophy and lumbar intervertebral disc degeneration in patients with chronic low back pain. INTERNATIONAL ORTHOPAEDICS 2023; 47:793-801. [PMID: 36352306 DOI: 10.1007/s00264-022-05621-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although enormous studies have been devoted to solving the problem of intervertebral disc degeneration/herniation, little attention is paid to the effect of paraspinal muscles on it. We aimed to investigate the correlation between paraspinal muscle atrophy and lumbar disc degeneration to recognize paraspinal muscle atrophy and its importance to the spine. PATIENTS AND METHODS A total of 107 patients were enrolled in the study (65 females, 42 males; age 50.87 ± 15.391 years old). Cross-sectional area, functional cross-sectional area, and fatty infiltration of the posterior paraspinal muscles were measured at the level of L4/5, and the degree of facet joint degeneration was evaluated at the levels of L3/4, L4/5, and L5/S1 by MRI. After controlling the confounding factors by multiple linear regression, the correlations among paraspinal muscle atrophy, disc degeneration, and facet joint degeneration were analyzed. Meanwhile, Pearson/Spearson rank analysis was used to analyze the correlation between clinical symptoms (VAS and ODI) and paraspinal muscle atrophy. RESULTS There was a strong correlation between paraspinal muscle atrophy and disc degeneration after controlling the confounding factors (p < 0.05, R > 0.5). There was a weak correlation between paraspinal muscle atrophy and facet joint degeneration (p < 0.05, R < 0.5). There was a significant correlation between facet joint degeneration and intervertebral disc degeneration (p < 0.05, R > 0.7). The fatty infiltration of paraspinal muscle was weakly correlated with ODI (p < 0.05, R < 0.3), but VAS was not. CONCLUSIONS The degree of paraspinal muscle atrophy increased with lumbar disc degeneration and facet joint degeneration and fatty infiltration of multifidus was more susceptible to weight.
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Affiliation(s)
- Ziying Cheng
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Yuxi Li
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Ming Li
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Junshen Huang
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Jiajun Huang
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Yuwei Liang
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Shixin Lu
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Changchun Liang
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Tong Xing
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Kaihui Su
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Guoming Wen
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China
| | - Weike Zeng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, Guangdong Province, China.
| | - Lin Huang
- Department of Orthopedics, Guangdong Province, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, China. .,Department of Orthopedics, First Hospital of Nanchang, Nanchang, Jiangxi Province, China.
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Wu W, Zhang S, Yan T. Initial clinical experiences of the muscle-preserving double door cervical laminoplasty with adjustable mini plates. Front Surg 2023; 9:1049937. [PMID: 36726947 PMCID: PMC9885206 DOI: 10.3389/fsurg.2022.1049937] [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: 09/21/2022] [Accepted: 10/27/2022] [Indexed: 01/17/2023] Open
Abstract
Shirashi's double door laminoplasty method was a popular decompression procedure for cervical myelopathy. In this paper, we introduced a modified double door laminoplasty based on Shirashi's method with preliminary results. This study retrospectively analyzed 22 patients who underwent modified double door laminoplasty. During procedure, a single segment of the unilateral lamina was separated from the cervical semispinalis muscle and the multifidus muscle space for the preparation of lamina groove. A self-developed mini titanium plate was used to fix the inner side of the spinous process to complete the fixation after open-door process. The VAS, JOA scores and QoL scale were recorded for pain assessment, neurological and functional recovery. The overall curvature and range of motion of C2-C7 were measured with x-ray images. Changes in sagittal diameter of spinal canal were measured by CT scans. MRI was used to measure the cross-sectional area of cervical paravertebral muscles. All 22 patients successfully recovered with this procedure. The mean operation time, blood loss and follow-up durations were 117 ± 25 min, 149 ± 32 ml and 16.1 ± 3.6 months respectively. The preoperative, 3-month postoperative and 12-month postoperative JOA scores were 9.35 ± 3.25, 13.74 ± 4.86 and 15.73 ± 5.19 respectively. with improvement rates of 57.4% and 83.4%. Mean VAS scores before, 3 months after and 12 months after surgery were 1.81 ± 0.79, 2.82 ± 1.56 and 2.18 ± 1.34 respectively. The C2-7 lordotic angle and overall range of motion shows no statistical difference preoperatively and 12 post-surgery. The average sagittal diameter of the cervical spinal canal was enlarged from 9.15 ± 1.55 mm to 14.25 ± 1.46 mm. The average area of cervical paravertebral volume measured preoperatively and 3 months post operation was 84% of pre-operative value respectively. This value was improved to 93% of the preoperative value at 12 months post-surgery. This paper introduced initial experience on a modified posterior cervical double-door laminoplasty that was based on Shirashi's method, featuring creating bilateral laminar grooves on both sides and fixing central gap with self-developed mini plates. This procedure prevented obvious axial symptoms and improved patients' quality of life, which provided a baseline for further research with larger cohorts.
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Chen Z, Shi T, Li W, Sun J, Yao Z, Liu W. Role of paraspinal muscle degeneration in the occurrence and recurrence of osteoporotic vertebral fracture: A meta-analysis. Front Endocrinol (Lausanne) 2023; 13:1073013. [PMID: 36686478 PMCID: PMC9845601 DOI: 10.3389/fendo.2022.1073013] [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: 10/19/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Recently, the effects of paraspinal muscle degeneration on osteoporotic vertebral fractures (OVFs) have attracted the attention of researchers; however, studies are limited, and their results vary. Hence, this study aimed to determine the role of paraspinal muscle degeneration in the occurrence and recurrence of OVF. Methods Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline, the PubMed, Embase, Web of Science, Wanfang Data, China National Knowledge Infrastructure, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies comparing the cross-sectional area (CSA) or fatty infiltration (FI) of the paraspinal muscles (including the psoas (PS), erector spinae plus multifidus (ES+MF), quadratus lumborum) in patients with and without initial OVF, or with and without recurrent OVF were included and analyzed. Results Eleven studies were included in the meta-analysis. Seven studies investigated the effects of paraspinal muscles on initial OVF, and the overall results revealed significantly lower CSAES+MF (SMD: -0.575, 95% CI: -0.866 to -0.285) and CSAPS (SMD: -0.750, 95% CI: -1.274 to -0.226), and higher FI (SMD: 0.768, 95% CI: 0.475 to 1.062) in the fracture group. Meanwhile, four studies evaluated the effects of the paraspinal muscles on recurrent OVF, and the pooled results demonstrated significantly higher FI (SMD:0.720, 95% CI: 0.258 to 1.182) in the refracture group, although no significant difference in CSAES+MF (SMD: -0.103, 95% CI: -0.395 to 0.189) was observed between the two groups. Conclusions Paraspinal muscle degeneration plays a role in the occurrence and recurrence of OVF. Assessing the paraspinal muscles may be useful for identifying high-risk populations. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier (CRD42021276681).
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Affiliation(s)
- Zhi Chen
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Tengbin Shi
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wenwen Li
- The School of Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Sun
- Department of Emergency, Zhaotong Traditional Chinese Medicine Hospital, Zhaotong, Yunnan, China
| | - Zhipeng Yao
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wenge Liu
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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Quantitative Study of Vertebral Body and Paravertebral Muscle Degeneration Based on Dual-Energy Computed Tomography: Correlation With Bone Mineral Density. J Comput Assist Tomogr 2023; 47:86-92. [PMID: 36668981 PMCID: PMC9869939 DOI: 10.1097/rct.0000000000001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study aimed to quantify the degeneration of the vertebral body and paravertebral muscles using dual-energy computed tomography (DECT) and study its relationship with osteoporosis. METHODS A total of 130 patients with chronic low back pain were included in this study, and DECT scanning of the lumbar region was undertaken prospectively. By placing a standard quantitative computed tomography corrected phantom under the waist during the DECT procedure, bone mineral density (BMD) and the following quantitative parameters were obtained: calcium density (CaD), vertebral fat fraction (VFF), psoas major area, psoas major fat fraction, erector spinalis area, and erector spinalis fat fraction (ESFF). Independent sample t test and 1-way analysis of variance were used between different age-BMD groups. Pearson test was applied to determine correlations for all measurements, and a mathematical model of BMD was established through regression analysis. RESULTS Calcium density, VFF, psoas major area, psoas major fat fraction, erector spinalis area, and ESFF were significantly different among the age-BMD groups (P < 0.05), and BMD was significantly correlated with these parameters (P < 0.05). Calcium density, VFF, and ESFF were included in the BMD regression equation: BMD = 69.062 + 11.637 × CaD - 1.018 × VFF - 0.726 × ESFF (R2 = 0.860, F = 125.979, P < 0.001). CONCLUSIONS Degeneration of the vertebral body and paravertebral muscles can be quantitatively analyzed using DECT, and CaD, VFF, and ESFF were independent influencing factors of BMD.
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Jung M, Rospleszcz S, Löffler MT, Walter SS, Maurer E, Jungmann PM, Peters A, Nattenmüller J, Schlett CL, Bamberg F, Kiefer LS, Diallo TD. Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study. Eur Radiol 2023; 33:1501-1512. [PMID: 36241920 PMCID: PMC9935727 DOI: 10.1007/s00330-022-09140-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the association of lumbar bone marrow adipose tissue fat fraction (BMAT-FF) and paraspinal muscle proton density fat fraction (PDFF) and their interplay with intervertebral disc degeneration (IVDD). METHODS In this retrospective cross-sectional study based on a prospective population-based cohort, BMAT-FF and PDFF of asymptomatic individuals were calculated based on 3T-MRI dual-echo and multi-echo Dixon VIBE sequences. IVDD was assessed at motion segments L1 to L5 and dichotomized based on Pfirrmann grade ≥ 4 and/or presence of other severe degenerative changes or spinal abnormalities at least at one segment. Pearson's correlation coefficients were calculated for BMAT-FF and PDFF. Univariable and multivariable logistic regression models for IVDD were calculated. RESULTS Among 335 participants (mean age: 56.2 ± 9.0 years, 43.3% female), the average BMI was 27.7 ± 4.5 kg/m2 and the prevalence of IVDD was high (69.9%). BMAT-FF and PDFF were significantly correlated (r = 0.31-0.34; p < 0.001). The risk for IVDD increased with higher PDFF (OR = 1.45; CI 1.03, 2.04) and BMAT-FF (OR = 1.56; CI 1.16, 2.11). Pairwise combinations of PDFF and BMAT-FF quartiles revealed a lower risk for IVDD in individuals in the lowest BMAT-FF and PDFF quartile (OR = 0.21; CI 0.1, 0.48). Individuals in the highest BMAT-FF and PDFF quartile showed an increased risk for IVDD (OR = 5.12; CI 1.17, 22.34) CONCLUSION: Lumbar BMAT-FF and paraspinal muscle PDFF are correlated and represent both independent and additive risk factors for IVDD. Quantitative MRI measurements of paraspinal myosteatosis and vertebral bone marrow fatty infiltration may serve as imaging biomarkers to assess the individual risk for IVDD. KEY POINTS • Fat composition of the lumbar vertebral bone marrow is positively correlated with paraspinal skeletal muscle fat. • Higher fat-fractions of lumbar vertebral bone marrow and paraspinal muscle are both independent as well as additive risk factors for intervertebral disc degeneration. • Quantitative magnetic resonance imaging measurements of bone marrow and paraspinal muscle may serve as imaging biomarkers for intervertebral disc degeneration.
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Affiliation(s)
- Matthias Jung
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Susanne Rospleszcz
- grid.4567.00000 0004 0483 2525Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Oberschleißheim, Germany ,grid.5252.00000 0004 1936 973XDepartment of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University München, Munich, Germany
| | - Maximilian T. Löffler
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany ,grid.6936.a0000000123222966Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Sven S. Walter
- grid.10392.390000 0001 2190 1447Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.137628.90000 0004 1936 8753Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 USA
| | - Elke Maurer
- grid.482867.70000 0001 0211 6259Department of Trauma and Reconstructive Surgery, BG Unfallklinik, Schnarrenbergstraße 95, 72070 Tuebingen, Germany
| | - Pia M. Jungmann
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Annette Peters
- grid.4567.00000 0004 0483 2525Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Oberschleißheim, Germany ,grid.5252.00000 0004 1936 973XDepartment of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University München, Munich, Germany
| | - Johanna Nattenmüller
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Christopher L. Schlett
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Fabian Bamberg
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Lena S. Kiefer
- grid.10392.390000 0001 2190 1447Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Thierno D. Diallo
- grid.5963.9Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
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Tan B, Yang QY, Fan B, Xiong C. Decompression via unilateral biportal endoscopy for severe degenerative lumbar spinal stenosis: A comparative study with decompression via open discectomy. Front Neurol 2023; 14:1132698. [PMID: 36908592 PMCID: PMC9994538 DOI: 10.3389/fneur.2023.1132698] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Background Previous studies have shown that the Unilateral Biportal Endoscopy is an effective and safety surgery for sufficient decompression of degenerative lumbar spinal stenosis. However, data are lacking in terms of its benefits when compared with conventional open lumbar discectomy (OLD), especially in patients with severe degenerative lumbar spinal stenosis (DLSS). Aim To compare the clini cal outcomes of two types decompressive surgery: unilateral biportal endoscopy-unilateral laminectomy bilateral decompression (UBE-ULBD) and conventional open lumbar discectomy (OLD) in severe degenerative lumbar spinal stenosis (DLSS). Methods We retrospectively analyzed patients who underwent UBE-ULBD (n = 50, operated at 50 levels; UBE-ULBD group) and conventional open lumbar discectomy (n = 59, operated at 47 levels; OLD group) between February 2019 and July 2021. All patients were diagnosed with severe stenosis based on the Schizas classification (Grade C or D) on MRI. We compared radiographic and clinical outcome scores [including the visual analog scale (VAS), Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ)] between the 2 groups at 1 year of follow-up. The radiographic evaluation included the cross-sectional area (CSA) of the thecal sac and paraspinal muscles on MRI. Fasting blood was drawn before and 1 and 7 days after the operation to detect creatine kinase (CK). Surgical data perioperative complications were also investigated. Results The baseline demographic data of the 2 groups were comparable, including VAS, ODI and ZCQ scores, the cross-sectional area of the thecal sac and paraspinal muscles and creatine kinase levels. The dural sac CSA significantly increased post -operatively in both groups, which confirmed they benefited from comparable decompressive effects. The operative duration in the OLD group was less than the UBE-ULBD group (43.9 ± 5.6 min vs. 74.2 ± 9.3 min, p < 0.05). The OLD group was associated with more estimated blood loss than the UBE-ULBD group (111.2 ± 25.0 ml vs. 41.5 ± 22.2 ml, P < 0.05). The length of hospital stay (HS) was significantly longer in the OLD group than in the UBE-ULBD group (6.8 ± 1.6 vs. 4.0 ± 1.4 days, P < 0.05). The VAS, ODI, and ZCQ scores improved in both groups after the operation. Serum creatine kinase values in the UBE-ULBD group were significantly lower than in the OLD group at 1 day after surgery (108. 1 ± 11.9 vs. 347.0 ± 19.5 U/L, P < 0.05). The degree of paraspinal muscle atrophy in the UBE-ULBD group was significantly lower than in the OLD group at 1 year (4.50 ± 0.60 vs. 11.42 ± 0.87, P < 0.05). Conclusions UBE-ULBD and conventional OLD demonstrate comparable short-term clinical outcomes in treating severe DLSS. However, UBE-ULBD surgery was associated with a shorter hospital stay, less EBL and paravertebral muscle injury than OLD surgery.
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Affiliation(s)
- Bing Tan
- Department of Spine Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China.,Department of Orthopedic, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi-Yuan Yang
- Department of Spine Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Bin Fan
- Department of Spine Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Chuang Xiong
- Department of Orthopedic, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Doi T, Ohtomo N, Oguchi F, Tozawa K, Nakarai H, Nakajima K, Sakamoto R, Okamoto N, Nakamoto H, Kato S, Taniguchi Y, Matsubayashi Y, Oka H, Matsudaira K, Tanaka S, Oshima Y. Association Between Deep Posterior Cervical Paraspinal Muscle Morphology and Clinical Features in Patients With Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J 2023; 13:8-16. [PMID: 33504203 PMCID: PMC9837499 DOI: 10.1177/2192568221989655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN A retrospective observational study. OBJECTIVE To clarify the association of the paraspinal muscle area and composition with clinical features in patients with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS Consecutive patients with cervical OPLL who underwent cervical magnetic resonance imaging (MRI) before surgery were reviewed. The cross-sectional area (CSA) and fatty infiltration ratio (FI%) of deep posterior cervical paraspinal muscles (multifidus [MF] and semispinalis cervicis [SCer]) were examined. We assessed the association of paraspinal muscle measurements with the clinical characteristics and clinical outcomes, such as Neck Disability Index (NDI) score. Moreover, we divided the patients into 2 groups according to the extent of the ossified lesion (segmental and localized [OPLL-SL] and continuous and mixed [OPLL-CM] groups) and compared these variables between the 2 groups. RESULTS 49 patients with cervical OPLL were enrolled in this study. The FI% of the paraspinal muscles was significantly associated with the number of vertebrae (ρ = 0.283, p = 0.049) or maximum occupancy ratio of OPLL (ρ = 0.397, p = 0.005). The comparative study results indicated that the NDI score was significantly worse (OPLL-SL, 22.9 ± 13.7 vs. OPLL-CM, 34.4 ± 13.7) and FI% of SCer higher (OPLL-SL, 9.1 ± 1.7% vs. OPLL-CM, 11.1 ± 3.7%) in the OPLL-CM group than those in the OPLL-SL group. CONCLUSIONS Our results suggest that OPLL severity may be associated with fatty infiltration of deep posterior cervical paraspinal muscles, which could affect neck disability in patients with cervical OPLL.
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Affiliation(s)
- Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Fumihiko Oguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Nakarai
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Ryuji Sakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Naoki Okamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Hiroyuki Oka
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center,
Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center,
Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan,Yasushi Oshima, Department of Orthopaedic
Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Yazici A, Yerlikaya T. The relationship between the degeneration and asymmetry of the lumbar multifidus and erector spinae muscles in patients with lumbar disc herniation with and without root compression. J Orthop Surg Res 2022; 17:541. [PMID: 36514168 PMCID: PMC9749279 DOI: 10.1186/s13018-022-03444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The determination of muscle pathologies in lumbar disc herniation (LDH) and other conditions with low back pain is important for understanding low back problems and determining appropriate treatment methods. In patients with lumbar disc herniation with radiculopathy, elucidating the effect of root compression on the severity of muscle degeneration may predict the importance of alleviating root compression. For this purpose, magnetic resonance imaging (MRI) was used to compare the degeneration and asymmetries of the lumbar musculus multifidus (MF) and lumbar musculus erector spinae (ES) muscles in patients with lumbar discopathy without root compression (radiculopathy) and in patients with lumbar discopathy with root compression (radiculopathy). METHODS The patients were examined in two groups: 56 patients with lumbar discopathy and no radiculopathy (Non-rad group) and 51 patients with lumbar discopathy and radiculopathy (Rad group). On axial MRI sections passing through the centre of the disc at the L3-S1 level, the asymmetry, cross-sectional area (CSA), fat infiltration, and total CSA (TCSA = MF + ES) of the MF and ES muscles were measured and compared. RESULTS No difference was seen between the groups with respect to the CSA values of the right and left MF and left ES, but a significant difference was found in the right ES CSA (p = 0.021). The CSA and TCSA of the MF and ES showed no asymmetry according to group. Severe fat infiltration of > 50% in the right and left MF and left ES was found in the Rad group at a higher rate than in the Non-rad group. Fat infiltration was significantly positively correlated with age, body mass index, and the duration of pain (p < 0.001, p < 0.001, p = 0.004, respectively). CONCLUSIONS The study results showed a correlation between LDH and paraspinal muscle degeneration, while no correlation was found with asymmetry. Severe (> 50%) fat infiltration is associated with root compression, and the severity of fat filtration increases in the presence of root compression. The development of more severe degeneration due to denervation associated with root compression plays a role in the emergence of this situation. Therefore, in patients with lumbar disc herniation with radiculopathy, it can be foreseen that to stop and correct severe fat infiltration and muscle degeneration, first, nerve root compression should be corrected with appropriate medical treatment methods, and in patients in whom there is no response, the pressure should be alleviated with appropriate surgical methods.
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Affiliation(s)
- Alikemal Yazici
- grid.412132.70000 0004 0596 0713Faculty of Medicine, Orthopaedics and Traumatology Department, Near East University, Nicosia, Cyprus ,Orthopaedics and Traumatology Department, Buyuk Anadolu Hospital, Samsun, Turkey
| | - Tuba Yerlikaya
- grid.412132.70000 0004 0596 0713Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Near East University, Nicosia, Cyprus
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Carvalho V, Santos J, Santos Silva P, Vaz R, Pereira P. Relationship between fatty infiltration of paraspinal muscles and clinical outcome after lumbar discectomy. BRAIN & SPINE 2022; 2:101697. [PMID: 36605389 PMCID: PMC9808467 DOI: 10.1016/j.bas.2022.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/02/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
Introduction Cross sectional area (CSA) and fat infiltration (FI) are important parameters to assess paravertebral muscle atrophy. However, the relationship of muscular fat infiltration in patients with symptomatic lumbar disc herniation undergoing surgery remains unclear. Research question Does lumbar paravertebral muscle atrophy have prognostic value regarding the clinical outcome for patients with symptomatic lumbar disc herniation undergoing surgery? Methods Patients over 18 years of age with lumbar disc herniation and radicular pain who underwent single-level discectomy were included. Multifidus, erector spinae and psoas cross-sectional area (CSA) and fatty infiltration (FI) were measured by ImageJ software at the levels of L3-L4, L4-L5 and L5-S1 from T2-weighted Magnetic Resonance axial images. Clinical status was assessed preoperatively and one-year after surgery with patient reported outcome measurements (PROMS), that included Numeric Rating Score for back and leg pain, Core Outcome Measurement Index (COMI), Oswestry Disability Index and EuroQoL-5D. Univariate and multiple linear regressions were performed. Results Erector spinae FI was the only muscle-related factor that correlated to postoperative PROMS. Postoperative COMI was higher in patients with FI>30% (median: 4.4, IQR: 3.2) and lower when FI<15% (median: 1.2, IQR: 1.6) (Kruskal-Wallis, p < 0.001). Male gender was associated with better outcome as well as erector spinae FI<15%, while FI >30% was related to worse postoperative status. Conclusions In the current study, increased fat infiltration of erector spinae muscles correlated to less favorable clinical outcomes following lumbar discectomies.
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Affiliation(s)
- Vasco Carvalho
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal,Faculty of Medicine of the University of Porto, Portugal,Corresponding author. Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal.
| | - Juliana Santos
- Faculty of Medicine of the University of Porto, Portugal
| | - Pedro Santos Silva
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal,Faculty of Medicine of the University of Porto, Portugal
| | - Rui Vaz
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal,Faculty of Medicine of the University of Porto, Portugal
| | - Paulo Pereira
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal,Faculty of Medicine of the University of Porto, Portugal
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Muellner M, Haffer H, Moser M, Chiapparelli E, Dodo Y, Adl Amini D, Carrino JA, Tan ET, Shue J, Zhu J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Paraspinal musculature impairment is associated with spinopelvic and spinal malalignment in patients undergoing lumbar fusion surgery. Spine J 2022; 22:2006-2016. [PMID: 35944826 PMCID: PMC10623672 DOI: 10.1016/j.spinee.2022.07.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/05/2022] [Accepted: 07/30/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The concept of sagittal spinal malalignment is well established in spinal surgery. However, the effect of musculature on its development has not been fully considered and the position of the pelvis is mostly seen as compensatory and not necessarily a possible cause of sagittal imbalance. PURPOSE This study aimed to investigate the influence of the posterior paraspinal muscles (PPM, erector spinae, and multifidus) and the psoas muscle on spinopelvic and spinal alignment. STUDY DESIGN/SETTING Retrospective cross-sectional study. PATIENT SAMPLE Patients undergoing posterior lumbar fusion between 2014 and 2021 for degenerative conditions at a tertiary care center, with preoperative lumbar magnetic resonance imaging (MRI) within 12 months prior the surgery and a preoperative whole spine radiograph were included. OUTCOME MEASURES PPM and psoas muscle measurements including the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the amount of intramuscular fat (FAT), and the percentage of fat infiltration (FI). Spinopelvic measurements including lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and sagittal vertical axis (SVA). METHODS A T2-weighted MRI-based quantitative assessment of the CSA, the fCSA and the amount FAT was conducted, and FI was further calculated. The regions of interest included the psoas muscle and the PPM on both sides at the L4 level that were summarized and normalized by the patient's height (cm2/m2). LL, PT, SS, PI, and SVA were determined on standing lateral radiographs. Spearman correlation was used to calculate the crude relationship between spinopelvic and muscle parameters. Multiple linear regression models with age, sex, LL, PT, SS, and SVA set as independent variables were established to determine the association with spinal muscle outcome measures. RESULTS A total of 150 patients (53.3% female) were included in the final analysis with a median age of 65.6 years and a median BMI of 28.2 kg/m2. Significant positive correlations were observed between PT (ρ=0.327), SVA (ρ=0.256) and PI (ρ=0.202) and the FIPPM. Significant negative correlations were detected for the PT and the fCSAPPM (ρ=-0.202) and PT and the fCSAPsoas (ρ=-0.191). Furthermore, a negative correlation was seen for PI and SVA and FIPsoas. PT (β=0.187; p=.006), SVA (β=0.155; p=.035), age (β=0.468; p<.001) and sex (β=0.235; p<.001) significantly predict FIPPM (corrected R2=0.393) as independent variables. CONCLUSIONS This study demonstrated the potential role of posterior paraspinal muscles and psoas muscle on pelvic retroversion and elucidated the relation to sagittal spinal malalignment. Although we cannot establish causality, we propose that increasing FIPPM, representing loss of muscular strength, may lead to increased pelvic retroversion and thus might be the initiating point for the development of the sagittal imbalance. These findings might challenge the well-known theory of increased pelvic retroversion being a compensatory mechanism for sagittal spinal balance. Thus, muscular weakness might be a factor involved in the development of sagittal spinal malalignment.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, 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, 535 East 70th St, New York City, NY 10021, USA; Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA.
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Snodgrass SJ, Stanwell P, Weber KA, Shepherd S, Kennedy O, Thompson HJ, Elliott JM. Greater muscle volume and muscle fat infiltrate in the deep cervical spine extensor muscles (multifidus with semispinalis cervicis) in individuals with chronic idiopathic neck pain compared to age and sex-matched asymptomatic controls: a cross-sectional study. BMC Musculoskelet Disord 2022; 23:973. [PMID: 36357864 PMCID: PMC9647973 DOI: 10.1186/s12891-022-05924-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Muscle size and composition (muscle volume and muscle fat infiltrate [MFI]) may provide insight into possible mechanisms underpinning chronic idiopathic neck pain, a common condition with no definitive underlying pathology. In individuals with chronic idiopathic neck pain > 3 months and age- and sex-matched asymptomatic controls, muscle volumes of levator scapulae, multifidus including semispinalis cervicis (MFSS), semispinalis capitis, splenius capitis including splenius cervicis (SCSC), sternocleidomastoid and longus colli from C3 through T1 were quantified from magnetic resonance imaging. Between-group differences were determined using linear mixed models, accounting for side (left or right), muscle, spinal level, sex, age, and body mass index (BMI). Individuals with pain had greater muscle volume (mean difference 76.8mm3; 95% CI 26.6-127.0; p = .003) and MFI (2.3%; 0.2-4.5; p = .034) of the MFSS compared to matched controls with no differences in relative volume, accounting for factors associated with the outcomes: muscle, spinal level, side (left had smaller volume, relative volume and MFI than right), sex (females had less volume and relative volume than males), age (older age associated with less relative volume and greater MFI), and BMI (higher BMI associated with greater muscle volume and MFI). Greater MFI in individuals with chronic idiopathic neck pain suggests a possible underlying mechanism contributing to neck pain. Perspective: These findings suggest MFI in the MFSS may be radiologic sign, potentially identifying patients with a less favourable prognosis. Future studies are needed to confirm this finding and determine if MFI is a contributor to the development or persistence of neck pain, or consequence of neck pain.
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Affiliation(s)
- Suzanne J Snodgrass
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, Australia
| | - Peter Stanwell
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, Australia
| | - Kenneth A. Weber
- grid.168010.e0000000419368956Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA USA
| | - Samala Shepherd
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia
| | - Olivia Kennedy
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia
| | - Hannah J Thompson
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia
| | - James M Elliott
- grid.1013.30000 0004 1936 834XThe University of Sydney, Faculty of Medicine and Health & The Northern Sydney Local Health District - The Kolling Institute, Level 13, NSW St Leonards, Australia ,grid.16753.360000 0001 2299 3507Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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Muellner M, Haffer H, Chiapparelli E, Dodo Y, Tan ET, Shue J, Zhu J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Differences in lumbar paraspinal muscle morphology in patients with sagittal malalignment undergoing posterior lumbar fusion surgery. 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 2022; 31:3109-3118. [PMID: 36038784 PMCID: PMC10585706 DOI: 10.1007/s00586-022-07351-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/13/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate whether (1) there is a difference between patients with normal or sagittal spinal and spinopelvic malalignment in terms of their paraspinal muscle composition and (2) if sagittal malalignment can be predicted using muscle parameters. METHODS A retrospective review of patients undergoing posterior lumbar fusion surgery was conducted. A MRI-based muscle measurement technique was used to assess the cross-sectional area, the functional cross-sectional area, the intramuscular fat and fat infiltration (FI) for the psoas and the posterior paraspinal muscles (PPM). Intervertebral disc degeneration was graded for levels L1 to S1. Sagittal vertical axis (SVA; ≥ 50 mm defined as spinal malalignment), pelvic incidence (PI) and lumbar lordosis (LL) were measured, and PI-LL mismatch (PI-LL; ≥ 10° defined as spinopelvic malalignment) was calculated. A receiver operating characteristic (ROC) analysis was conducted to determine the specificity and sensitivity of the FIPPM for predicting sagittal malalignment. RESULTS One hundred and fifty patients were analysed. The PI-LL and SVA malalignment groups were found to have a significantly higher FIPPM (PI-LL:47.0 vs. 42.1%; p = 0.019; SVA: 47.7 vs. 41.8%; p = 0.040). ROC analysis predicted sagittal spinal malalignment using FIPPM (cut-off value 42.69%) with a sensitivity of 73.4% and a specificity of 54.1% with an area under the curve of 0.662. CONCLUSION Significant differences in the muscle composition between normal and malalignment groups with respect to FIPPM in both sagittal spinal and spinopelvic alignment were found. This work underlines the imminent impact of the paraspinal musculature on the sagittal alignment.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of 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 City, NY, 10021, 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, 535 East 70th Street, New York City, NY, 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, 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, 535 East 70th Street, New York City, NY, 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, 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, 535 East 70th Street, New York City, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York City, NY, 10021, USA.
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Zhou S, Chen S, Zhu X, You T, Li P, Shen H, Gao H, He Y, Zhang K. Associations between paraspinal muscles fatty infiltration and lumbar vertebral bone mineral density - An investigation by fast kVp switching dual-energy CT and QCT. Eur J Radiol Open 2022; 9:100447. [PMID: 36277658 PMCID: PMC9579482 DOI: 10.1016/j.ejro.2022.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 10/27/2022] Open
Abstract
Purpose To investigate the relationship between paraspinal muscles fat content and lumbar bone mineral density (BMD). Methods A total of 119 participants were enrolled in our study (60 males, age: 50.88 ± 17.79 years, BMI: 22.80 ± 3.80 kg·m-2; 59 females, age: 49.41 ± 17.69 years, BMI: 22.22 ± 3.12 kg·m-2). Fat content of paraspinal muscles (erector spinae (ES), multifidus (MS), and psoas (PS)) were measured at (ES L1/2-L4/5; MS L2/3-L5/S1; PS L2/3-L5/S1) levels using dual-energy computed tomography (DECT). Quantitative computed tomography (QCT) was used to assess BMD of L1 and L2. Linear regression analysis was used to assess the relationship between BMD of the lumbar spine and paraspinal muscles fat content with age, sex, and BMI. The variance inflation factor (VIF) was used to detect the degree of multicollinearity among the variables. P < .05 was considered to indicate a statistically significant difference. Results The paraspinal muscles fat content had a fairly significant inverse association with lumbar BMD after controlling for age, sex, and BMI (adjusted R 2 = 0.584-0.630, all P < .05). Conclusion Paraspinal muscles fat content was negatively associated with BMD.Paraspinal muscles fatty infiltration may be considered as a potential marker to identify BMD loss.
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Key Words
- ASiR-V, Adaptive statistical iterative reconstruction-Veo
- BIA, Bioimpedance analysis
- BMD, Bone mineral density
- Bone density
- CNR, Contrast-to-noise ratio
- DECT, Dual-energy computed tomography
- DXA, Dual-energy x-ray absorptiometry
- EMCL, extramyocellular lipids
- ES, Erector spinae
- FF, fat fraction
- FI %, Fatty infiltration ratio
- FM, Fat mass
- GSI, Gemstone spectral imaging
- IMCL, intramyocellular lipids
- LM, Lean mass
- MD, Material decomposition
- MRI, Magnetic resonance imaging
- MS, Multifidus
- MSK, Musculoskeletal
- Osteoporosis
- PDFF, Proton density fat fractions
- PS, Psoas
- Paraspinal muscles
- QCT, Quantitative computed tomography
- Tomography
- VIF, Variance inflation factor
- X-Ray computed
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Affiliation(s)
- Shuwei Zhou
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China,The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, PR China
| | - Suping Chen
- GE Healthcare (Shanghai) Co., Ltd., Shanghai 201203, PR China
| | - Xu Zhu
- The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, PR China
| | - Tian You
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Ping Li
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Hongrong Shen
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Hui Gao
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Yewen He
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China
| | - Kun Zhang
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, PR China,The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, PR China,Corresponding author at: Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007 PR China.
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Sun D, Wang Z, Mou J, Tian F, Cao J, Guo L, Liu P. Characteristics of paraspinal muscle degeneration in degenerative diseases of the lumbar spine at different ages. Clin Neurol Neurosurg 2022; 223:107484. [DOI: 10.1016/j.clineuro.2022.107484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/03/2022]
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Muellner M, Chiapparelli E, Moser M, Haffer H, Dodo Y, Adl Amini D, Carrino JA, Tan ET, Shue J, Zhu J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The effect of age on psoas and paraspinal muscle morphology in patients undergoing posterior lumbar fusion surgery. 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 2022; 31:2619-2628. [PMID: 35984509 PMCID: PMC10583000 DOI: 10.1007/s00586-022-07346-0] [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: 04/14/2022] [Revised: 06/16/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to determine the effect of age on the psoas and posterior paraspinal muscles (PPM; multifidus muscle and erector spinae) and to evaluate potential sex-related differences. METHODS MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the fat area (FAT) and the proportion of intramuscular fat (FI) were conducted on patients undergoing lumbar fusion surgery between 2014 and 2021. The regions of interest were the psoas muscle and the PPM at the superior endplate of L4. The left and right sides of the muscle groups were summarized and normalized by the patient's height (cm2/m2). The relationships between age and muscular parameters were analyzed stratified by sex. RESULTS A total of 195 patients (57.9%female) with a median age of 64.2 years and a body mass index of 28.3 kg/m2 were analyzed. The CSAPsoas was 7.7 cm2/m2 and differed significantly between females and males (p < 0.001); likewise, the fCSAPsoas differed significantly between the sexes. The CSAPPM was 18.8 cm2/m2 with no sex-specific differences. Significant differences were found in the FIPPM (males: 41.1% vs. females: 47.9%; p < 0.001), but not in the FIPsoas (males: 3.7% vs. females: 4.5%; p = 0.276). Considering the effect of age on FI, a significant positive correlation was observed for the PPMs for both sexes. Only in women, there was a negative correlation between age and CSAPsoas (ρ = - 0.248; p = 0.008), FATPsoas (ρ = - 0.421; p < 0.001) and FIPsoas (ρ = - 0.371; p < 0.001). CONCLUSION This study demonstrated sex-specific differences in spinal muscle morphology in relation to patient age. With increasing age there was a decrease in FIPsoas in women only, unlike in the PPMs in which there was increased FI that was significantly higher in women compared to men.
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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, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - 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, Lucerne, Switzerland
| | - 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, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- 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, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - 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, 535 East 70th Street, New York, NY, 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - 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.
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