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3D analysis of fatty infiltration of the paravertebral lumbar muscles using T2 images—a new approach

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Abstract

Purpose

Factors influencing paraspinal muscle degeneration are still not well understood. Fatty infiltration is known to be one main feature of the degeneration cascade. The aim of this cross-sectional study was to illustrate the 3D cluster of paraspinal lumbar muscle degeneration on T2-weighted MRI images using our newly developed software application ‘iSix’.

Methods

Mono- (Mm. rotatores), multi- (Mm. multifidus) and pluri-segmental (M. erector spinae) lumbar muscles groups were segmented on T2-weighted MR sequences using a novel computer-assisted technique for quantitative muscle/fat discrimination. The degree of fatty infiltration of the three predefined muscle groups was compared on a 3-dimensional basis, with regard to segment involvement and age. General linear models were utilized for statistical comparison.

Results

N = 120 segments (age: 52.7; range 16—87 years) could be included. The overall relative fatty infiltration of the mono-segmental muscles was higher (21.1 14.5%) compared to the multi-segmental (16.0 8.8% p = 0.049) and pluri-segmental muscles (8.5 8.0%; p = 0.03). Mono-segmental muscles on the levels L4/5 (22.9 ± 10.2 [CI 17.6–28.2] %) and L5/S1 (27.01 ± 15.1 [CI 21.4–32.7] %) showed a significant higher amount of fat compared to the levels L2/3 (8.2 ± 6.8 [CI 2.2–14.2] %; L4/5 vs. L2/3, p = 0.03; L5/S1 vs. L2/3, p = 0.02) and L3/4 (13.2 ± 5.4 [CI 8.6–17.7]%; L4/5 vs. L3/4, p = 0.02; L5/S1 vs. L3/4, p < 0.01). Multivariate linear regression analyses revealed age and Pfirrmann grade as independent factors for fatty muscle degeneration.

Conclusions

3D analysis of fatty infiltration is an innovative tool to study lumbar muscle degeneration. Mono-segmental muscles are more severely affected by degeneration compared to multi-/pluri-segmental muscles, especially at the L4/5 and L5/S1 level. Age and disc degeneration independently correlate with muscle degeneration.

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References

  1. Teichtahl AJ, Urquhart DM, Wang Y et al (2015) Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J 15:1593–1601. https://doi.org/10.1016/j.spinee.2015.03.039

    Article  PubMed  Google Scholar 

  2. Andersson GBJ (1999) Epidemiological features of chronic low-back pain. Lancet 354:581–585

    Article  CAS  PubMed  Google Scholar 

  3. Ward SR, Kim CW, Eng CM et al (2009) Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability. J Bone Jt Surg—Ser A. https://doi.org/10.2106/JBJS.G.01311

    Article  Google Scholar 

  4. Kulig K, Scheid AR, Beauregard R et al (2009) Multifidus morphology in persons scheduled for single-level lumbar microdiscectomy: qualitative and quantitative assessment with anatomical correlates. Am J Phys Med Rehabil 88:355–361. https://doi.org/10.1097/PHM.0b013e31819c506d

    Article  PubMed  Google Scholar 

  5. Freeman MD, Woodham MA, Woodham AW (2010) The Role of the lumbar multifidus in chronic low back pain: a review. PM R 2:142–146. https://doi.org/10.1016/j.pmrj.2009.11.006

    Article  PubMed  Google Scholar 

  6. Takayama K, Kita T, Nakamura H et al (2016) New predictive index for lumbar paraspinal muscle degeneration associated with aging. Spine (Phila Pa 1976) 41:E84–E90. https://doi.org/10.1097/BRS.0000000000001154

    Article  Google Scholar 

  7. Shahidi B, Parra CL, Berry DB et al (2017) Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000001848

    Article  Google Scholar 

  8. Jun HS, Kim JH, Ahn JH et al (2016) The effect of lumbar spinal muscle on spinal sagittal alignment: evaluating muscle quantity and quality. Neurosurgery. https://doi.org/10.1227/NEU.0000000000001269

    Article  PubMed  Google Scholar 

  9. Lee SH, Park SW, Kim YB et al (2017) The fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level. Spine J 17:81–87. https://doi.org/10.1016/j.spinee.2016.08.001

    Article  PubMed  Google Scholar 

  10. Teichtahl AJ, Urquhart DM, Wang Y et al (2016) Lumbar disc degeneration is associated with modic change and high paraspinal fat content—a 3.0T magnetic resonance imaging study. BMC Musculoskelet Disord 17:1–7. https://doi.org/10.1186/s12891-016-1297-z

    Article  Google Scholar 

  11. Rossi A, Zoico E, Goodpaster BH et al (2010) Quantification of intermuscular adipose tissue in the erector spinae muscle by MRI: agreement with histological evaluation. Obesity 18:2379–2384. https://doi.org/10.1038/oby.2010.48

    Article  PubMed  Google Scholar 

  12. Bierry G, Kremer S, Kellner F et al (2008) Disorders of paravertebral lumbar muscles: from pathology to cross-sectional imaging. Skeletal Radiol 37:967–977. https://doi.org/10.1007/s00256-008-0494-8

    Article  PubMed  Google Scholar 

  13. Ferguson S (2008) Biomechanics of the spine. In: Boos N, Aebi M (eds) Spinal disorders, fundamentals of diagnosis and treatment. Springer, Berlin, Heidelberg, pp 41–66

    Google Scholar 

  14. Faur C, Patrascu JM, Haragus H, Anglitoiu B (2019) Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain. BMC Musculoskelet Disord 20:414. https://doi.org/10.1186/s12891-019-2786-7

    Article  PubMed  PubMed Central  Google Scholar 

  15. Urrutia J, Besa P, Lobos D et al (2018) Lumbar paraspinal muscle fat infiltration is independently associated with sex, age, and inter-vertebral disc degeneration in symptomatic patients. Skeletal Radiol 47:955–961. https://doi.org/10.1007/s00256-018-2880-1

    Article  PubMed  Google Scholar 

  16. Goubert D, van Oosterwijck J, Meeus M, Danneels L (2016) Structural changes of lumbar muscles in non-specific low back pain. Pain Physician 19:E985–E1000

    PubMed  Google Scholar 

  17. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis. Age Ageing 39:412–423. https://doi.org/10.1093/ageing/afq034

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hirschfeld HP, Kinsella R, Duque G (2017) Osteosarcopenia: where bone, muscle, and fat collide. Osteoporos Int 28:2781–2790. https://doi.org/10.1007/s00198-017-4151-8

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was not funded.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery – Spine Unit, Inselspital, Bern University Hospital, 3010, Freiburgstrasse, Bern, Switzerland

    Sven Hoppe, Daniela Maurer, Lorin M. Benneker, Sebastian F. Bigdon, Sonja Häckel, Sebastian Wangler & Christoph E. Albers

  2. Spine Medicine Bern, Hirslanden Salem-Spital, Bern, Switzerland

    Sven Hoppe

  3. INSEL Data Science Center, Inselspital, Bern University Hospital, Bern, Switzerland

    Waldo Valenzuela

Authors
  1. Sven Hoppe
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  2. Daniela Maurer
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  3. Waldo Valenzuela
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  4. Lorin M. Benneker
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  5. Sebastian F. Bigdon
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  6. Sonja Häckel
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  7. Sebastian Wangler
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  8. Christoph E. Albers
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Correspondence to Sven Hoppe.

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Hoppe, S., Maurer, D., Valenzuela, W. et al. 3D analysis of fatty infiltration of the paravertebral lumbar muscles using T2 images—a new approach. Eur Spine J 30, 2570–2576 (2021). https://doi.org/10.1007/s00586-021-06810-7

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  • DOI: https://doi.org/10.1007/s00586-021-06810-7

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