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Changes of the posterior paraspinal and psoas muscle in patients with low back pain: a 3-year longitudinal study

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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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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funds, grants, or other support was received for the submitted work.

Author information

Authors and Affiliations

  1. Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA

    Maximilian Muellner, Henryk Haffer, Manuel Moser, Krizia Amoroso, Erika Chiapparelli, Yusuke Dodo, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany

    Maximilian Muellner, Henryk Haffer & Matthias Pumberger

  3. Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland

    Manuel Moser

  4. Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA

    Zhaorui Wang & Artine Arzani

  5. Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA

    Ek T. Tan

Authors
  1. Maximilian Muellner
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  2. Henryk Haffer
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Contributions

Conception and design contributed by M. Acquisition of data contributed by M, H, M, C, D. Analysis and interpretation of data contributed by M, H, H, M. Drafting the article was contributed by M. Critically revising the article was contributed by all authors. Preparation of Graphical Content was contributed by M, H. Reviewed submitted version of manuscript was contributed by all authors. Approved the final version of the manuscript on behalf of all authors was contributed by H. Statistical analysis contributed by M, Z. Administrative/technical/material support contributed by T, S. Study Supervision contributed by H.

Corresponding author

Correspondence to Alexander P. Hughes.

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Conflict of interest

Dr. Sama reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, IVY II, LLC, ISPH 3, LLC, and VBros Venture Partners X Centinel Spine; consulting fee from Clariance, Inc., Kuros Biosciences AG, and Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of scientific advisory board of Clariance, Inc., and Kuros Biosciences AG; and trips/travel of Medical Device Business research support from Spinal Kinetics, Inc., outside the submitted work. Dr. Cammisa reports royalties from NuVasive, Inc. Accelus; private investments for 4WEB Medical/4WEB, Inc., Bonovo Orthopedics, Inc., Healthpoint Capital Partners, LP, ISPH II, LLC, ISPH 3 Holdings, LLC, Ivy Healthcare Capital Partners, LLC, Medical Device Partners II, LLC, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, Tissue Differentiation Intelligence, LLC, VBVP VI, LLC, VBVP X, LLC (Centinel) and Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., DePuy Synthes Spine, NuVasive, Inc., Spine Biopharma, LLC, and Synexis, LLC, Accelus; membership of scientific advisory board/other office of Healthpoint Capital Partners, LPIVY, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine, outside the submitted work. Dr. Girardi reports royalties from Lanx, Inc., and Ortho Development Corp.; private investments for Centinel Spine, and BCMID; stock ownership of Healthpoint Capital Partners, LP; and consulting fees from NuVasive, Inc., and DePuy Synthes Spine, outside the submitted work. Dr. Hughes reports research support from NuVasive, Inc. and Kuros Biosciences AG; and fellowship support from NuVasive, Inc. and Kuros Biosciences AG, outside the submitted work.

Ethical approval

The investigation was approved by the institutional review board. IRB approval: Hospital for Special Surgery #2019-2137.

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The work was performed at the Hospital for Special Surgery, New York City, NY, USA. The institutional review board of the Hospital for Special Surgery approved this study.

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Muellner, M., Haffer, H., Moser, M. et al. Changes of the posterior paraspinal and psoas muscle in patients with low back pain: a 3-year longitudinal study. Eur Spine J 32, 3290–3299 (2023). https://doi.org/10.1007/s00586-023-07814-1

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