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Change in fatty infiltration of lumbar multifidus, erector spinae, and psoas muscles in asymptomatic adults of Asian or Caucasian ethnicities

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Abstract

Purpose

Fatty infiltration (FI) is a feature of degenerating muscle that predominates in the low lumbar spine, associates with pain, and is confounded by age, spinal degeneration, and curvature. We determined rates for decline of lumbar muscle quality according to ethnicity, muscle, and spinal level in asymptomatic subjects.

Methods

Cross-sectional simulation study assessing aggregated data; 650 Asians aged 20–89 years versus 80 Caucasians aged 20–62 years. Change in lumbar multifidus, erector spinae (ES), and psoas fat content were computed using synthetic data and Monte Carlo simulations. General linear regression models and multivariate adaptive regression splines enabled estimation of yearly decline rates [with 95% confidence intervals (CI)].

Results

ES at L1–5 (total) shows steeply reduced density (rate; CI) for Asians in older (>53.3 years) adulthood (−0.32; −0.27 to −0.36/year). For Asians, multifidus (−0.18; −0.15 to −0.20/year) and psoas (−0.04; −0.03 to −0.06/year) also decline, while ES in younger ≤53.3 years) adults does not (0.06; 0.01–0.12/year). Caucasian multifidus declines (increasing FI % rate; CI) insignificantly faster (L1–5; 0.23; 0.10–0.36%/year) than ES (0.13; 0.04–0.22%/year). Multifidus decline does not differ between ethnicities. ES in older Asians generally declines fastest across ethnicities and muscles, and particularly in the low lumbar levels. Low lumbar levels show higher rates of decline in Asians, with mixed level-dependencies apparent in Caucasians.

Conclusions

Decline in lumbar muscle composition may differ between ethnicities and muscles. ES and low lumbar levels appear increasingly susceptible in Asians. Longitudinal studies examining rate of change to muscle composition may provide distinction between spinal conditions.

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Abbreviations

APCT:

Abdomen and pelvis computer tomography

CI:

95% confidence intervals

ES:

Erector spinae

FI:

Fatty infiltration

LBP:

Low back pain

MRI:

Magnetic resonance imaging

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Acknowledgements

We would like to thank Dr. Seung Won Park as corresponding author for the Lee et al. [11] study for his helpful communications in providing sample sizes for each of their three age cohorts.

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Authors and Affiliations

  1. Institute for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, 8401, Winterthur, Switzerland

    Rebecca J. Crawford, James M. Elliott & Thomas Volken

  2. Faculty of Health Sciences, Curtin University, Perth, Australia

    Rebecca J. Crawford

  3. Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    James M. Elliott

  4. School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia

    James M. Elliott

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  1. Rebecca J. Crawford
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Correspondence to Rebecca J. Crawford.

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Authors RC and TV declare they have no conflicts of interest. Author JE is in receipt of an NIH research Grant (2014-19) for a cervical spine investigation, and provides consultation outside the submitted work as part-owner/investor in a medical consulting startup.

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No funding was received for or in relation to this study.

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Crawford, R.J., Elliott, J.M. & Volken, T. Change in fatty infiltration of lumbar multifidus, erector spinae, and psoas muscles in asymptomatic adults of Asian or Caucasian ethnicities. Eur Spine J 26, 3059–3067 (2017). https://doi.org/10.1007/s00586-017-5212-6

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