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Impact of paravertebral muscle in thoracolumbar and lower lumbar regions on outcomes following osteoporotic vertebral fracture: a multicenter cohort study

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Abstract

Summary

We investigated the effect of paravertebral muscle (PVM) on poor prognosis in osteoporotic vertebral fracture (OVF) and remaining lower back pain (LBP) in the thoracolumbar and lower lumbar regions. Additional OVF occurrence in the thoracolumbar and remaining LBP in the lumbar region was significantly related to PVM fat infiltration percentage.

Purpose

Paravertebral muscle (PVM) is an important component of the spinal column. However, its role in the healing process after osteoporotic vertebral fracture (OVF) is unclear. This study aimed to clarify the effect of PVM in thoracolumbar and lower lumbar regions on OVF clinical and radiological outcomes.

Methods

This was a multicenter prospective cohort study from 2012 to 2015. Patients ≥ 65 years old who presented within 2 weeks after fracture onset were followed up for 6 months. PVM was measured at the upper edge of the L1 and L5 vertebral body in the magnetic resonance imaging (MRI) T2-axial position at registration. The cross-sectional area (CSA), relative CSA (rCSA), and fat infiltration percentage (FI%) were measured. Severe vertebral compression, delayed union, new OVF, and remaining low back pain (LBP) were analyzed.

Results

Among 153 patients who were followed up for 6 months, 117 with measurable PVM were analyzed. Their average age was 79.1 ± 7.2 years, and 94 were women (80.3%). There were 48 cases of severe vertebral compression, 21 delayed unions, 11 new OVF, and 27 remaining LBP. Among all poor prognoses, only the FI% of the PVM was significantly associated with new OVF (p = 0.047) in the thoracolumbar region and remaining LBP (p = 0.042) in the lumbar region.

Conclusion

The occurrence of additional OVF in the thoracolumbar region and remaining LBP in the lumbar region was significantly related to the FI% of the PVM. Physicians should be aware that patients with such fatty degeneration shown in acute MRI may require stronger treatment.

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References

  1. Hebert JJ, Kjaer P, Fritz JM, Walker BF (2014) The relationship of lumbar multifidus muscle morphology to previous, current, and future low back pain: a 9-year population-based prospective cohort study. Spine (Phila Pa 1976) 39:1417–1425. https://doi.org/10.1097/BRS.0000000000000424

    Article  Google Scholar 

  2. Yagi M, Hosogane N, Watanabe K, Asazuma T, Matsumoto M, Keio Spine Research Group (2016) The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis. Spine J 16:451–458. https://doi.org/10.1016/j.spinee.2015.07.001

    Article  PubMed  Google Scholar 

  3. Digirolamo DJ, Kiel DP, Esser KA (2013) Bone and skeletal muscle: neighbors with close ties. J Bone Miner Res 28:1509–1518. https://doi.org/10.1002/jbmr.1969

    Article  PubMed  Google Scholar 

  4. Kim JY, Chae SU, Kim GD, Cha MS (2013) Changes of paraspinal muscles in postmenopausal osteoporotic spinal compression fractures: magnetic resonance imaging study. 75–81

  5. Choi MK, Kim SB, Park CK, Malla HP, Kim SM (2017) Cross-sectional area of the lumbar spine trunk muscle and posterior lumbar interbody fusion rate: a retrospective study. Clin Spine Surg 30:E798–E803. https://doi.org/10.1097/BSD.0000000000000424

    Article  PubMed  Google Scholar 

  6. Larsson L, Degens H, Li M, Salviati L, Lee Y, Thompson W, Kirkland JL, Sandri M (2019) Sarcopenia: aging-related loss of muscle mass and function. Physiol Rev 99:427–511. https://doi.org/10.1152/physrev.00061.2017

    Article  PubMed  Google Scholar 

  7. Hori Y, Hoshino M, Inage K, Miyagi M, Takahashi S, Ohyama S, Suzuki A, Tsujio T, Terai H, Dohzono S, Sasaoka R, Toyoda H, Kato M, Matsumura A, Namikawa T, Seki M, Yamada K, Habibi H, Salimi H, Yamashita M, Yamauchi T, Furuya T, Orita S, Maki S, Shiga Y, Inoue M, Inoue G, Fujimaki H, Murata K, Kawakubo A, Kabata D, Shintani A, Ohtori S, Takaso M, Nakamura H (2019) ISSLS PRIZE IN CLINICAL SCIENCE 2019: clinical importance of trunk muscle mass for low back pain, spinal balance, and quality of life—a multicenter cross-sectional study. Eur Spine J 28:914–921. https://doi.org/10.1007/s00586-019-05904-7

    Article  PubMed  Google Scholar 

  8. Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O'Sullivan R, Cicuttini FM (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 

  9. Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. In: Osteoporosis International. Springer, pp S3–S7

  10. Statistics Bureau Home Page. http://www.stat.go.jp/english/. Accessed 6 Apr 2020

  11. Pfirrmann CWA, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878. https://doi.org/10.1097/00007632-200109010-00011

    Article  CAS  Google Scholar 

  12. Chen P, Krege JH, Adachi JD, Prior JC, Tenenhouse A, Brown JP, Papadimitropoulos E, Kreiger N, Olszynski WP, Josse RG, Goltzman D, the CaMOS Research Group (2009) Vertebral fracture status and the World Health Organization risk factors for predicting osteoporotic fracture risk. J Bone Miner Res 24:495–502. https://doi.org/10.1359/jbmr.081103

    Article  PubMed  Google Scholar 

  13. Huang C (1996) Vertebral fracture and other predictors of physical impairment and health care utilization. Arch Intern Med 156:2469–2475. https://doi.org/10.1001/archinte.1996.00440200087011

    Article  CAS  PubMed  Google Scholar 

  14. Kado DM (1999) Vertebral fractures and mortality in older women. Arch Intern Med 159:1215–1220

    Article  CAS  Google Scholar 

  15. Tsai AG, Bessesen DH (2019) Annals of internal medicine. Ann Intern Med 170:ITC33–ITC48. https://doi.org/10.7326/AITC201903050

    Article  PubMed  Google Scholar 

  16. Oner FC, Van Gils APG, Dhert WJA, Verbout AJ (1999) MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures. Skeletal Radiol 28:433–443. https://doi.org/10.1007/s002560050542

    Article  CAS  PubMed  Google Scholar 

  17. Cho T, Matsuda M, Sakurai M (1996) MRI findings on healing process of vertebral fracture in osteoporosis. J Orthop Sci 1:16–33. https://doi.org/10.1007/bf01234112

    Article  Google Scholar 

  18. Katsu M, Ohba T, Ebata S, Haro H (2018) Comparative study of the paraspinal muscles after OVF between the insufficient union and sufficient union using MRI. BMC Musculoskelet Disord 19:143. https://doi.org/10.1186/s12891-018-2064-0

    Article  PubMed  PubMed Central  Google Scholar 

  19. Huang CWC, Tseng IJ, Yang SW, Lin YK, Chan WP (2019) Lumbar muscle volume in postmenopausal women with osteoporotic compression fractures: quantitative measurement using MRI. Eur Radiol 29:4999–5006. https://doi.org/10.1007/s00330-019-06034-w

    Article  PubMed  Google Scholar 

  20. Briggs AM, Greig AM, Bennell KL, Hodges PW (2007) Paraspinal muscle control in people with osteoporotic vertebral fracture. Eur Spine J 16:1137–1144. https://doi.org/10.1007/s00586-006-0276-8

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cunha-Henriques S (2011) Postmenopausal women with osteoporosis and musculoskeletal status: a comparative cross-sectional study. J Clin Med Res. https://doi.org/10.4021/jocmr537w

  22. Sinaki M, Khosla S, Limburg PJ, Rogers JW, Murtaugh PA (1993) Muscle strength in osteoporotic versus normal women. Osteoporos Int 3:8–12. https://doi.org/10.1007/BF01623170

    Article  CAS  PubMed  Google Scholar 

  23. Takahashi S, Hoshino M, Takayama K, Sasaoka R, Tsujio T, Yasuda H, Kanematsu F, Kono H, Toyoda H, Ohyama S, Hori Y, Nakamura H (2020) The natural course of the paravertebral muscles after the onset of osteoporotic vertebral fracture. Osteoporos Int 31:1089–1095. https://doi.org/10.1007/s00198-020-05338-8

    Article  CAS  PubMed  Google Scholar 

  24. Takahashi S, Hoshino M, Takayama K, Iseki K, Sasaoka R, Tsujio T, Yasuda H, Sasaki T, Kanematsu F, Kono H, Toyoda H, Nakamura H (2017) Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study. Osteoporos Int 28:473–482. https://doi.org/10.1007/s00198-016-3737-x

    Article  CAS  PubMed  Google Scholar 

  25. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148. https://doi.org/10.1002/jbmr.5650080915

    Article  CAS  Google Scholar 

  26. Engelke K, Museyko O, Wang L, Laredo JD (2018) Quantitative analysis of skeletal muscle by computed tomography imaging—state of the art. J Orthop Transl 15:91–103. https://doi.org/10.1016/j.jot.2018.10.004

    Article  Google Scholar 

  27. Hu ZJ, He J, Zhao FD, Fang XQ, Zhou LN, Fan SW (2011) An assessment of the intra- and inter-reliability of the lumbar paraspinal muscle parameters using CT scan and magnetic resonance imaging. Spine (Phila Pa 1976) 36:868–874. https://doi.org/10.1097/BRS.0b013e3181ef6b51

    Article  Google Scholar 

  28. Takahashi S, Hoshino M, Takayama K, Iseki K, Sasaoka R, Tsujio T, Yasuda H, Sasaki T, Kanematsu F, Kono H, Toyoda H, Nakamura H (2016) Predicting delayed union in osteoporotic vertebral fractures with consecutive magnetic resonance imaging in the acute phase: a multicenter cohort study. Osteoporos Int 27:3567–3575. https://doi.org/10.1007/s00198-016-3687-3

    Article  CAS  PubMed  Google Scholar 

  29. Shahidi B, Parra CL, Berry DB, Hubbard JC, Gombatto S, Zlomislic V, Allen RT, Hughes-Austin J, Garfin S, Ward SR (2017) Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976) 42:616–623. https://doi.org/10.1097/BRS.0000000000001848

    Article  Google Scholar 

  30. Muratore M, Ferrera A, Masse A, Bistolfi A (2018) Osteoporotic vertebral fractures: predictive factors for conservative treatment failure. A systematic review. Eur Spine J 27:2565–2576

    Article  Google Scholar 

  31. Kim HJ, Yi JM, Cho HG, Chang BS, Lee CK, Kim JH, Yeom JS (2014) Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial. J Bone Jt Surg - Am Vol 96:1959–1966. https://doi.org/10.2106/JBJS.N.00187

    Article  Google Scholar 

  32. Hoshino M, Tsujio T, Terai H, Namikawa T, Kato M, Matsumura A, Suzuki A, Takayama K, Takaoka K, Nakamura H (2013) Impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures. Spine (Phila Pa 1976) 38:E641–E648. https://doi.org/10.1097/BRS.0b013e31828ced9d

    Article  Google Scholar 

  33. Rathore M, Sinha MB, Trivedi S, Sharma DK (2014) A focused review – thoracolumbar spine : Anatomy , Biomechanics and Clinical Significance. Indian J Clin Anat Physiol 1:41–46

    Google Scholar 

  34. Harrison DE, Colloca CJ, Harrison DD, Janik TJ, Haas JW, Keller TS (2005) Anterior thoracic posture increases thoracolumbar disc loading. Eur Spine J 14:234–242. https://doi.org/10.1007/s00586-004-0734-0

    Article  PubMed  Google Scholar 

  35. Paalanne N, Niinimäki J, Karppinen J, Taimela S, Mutanen P, Takatalo J, Korpelainen R, Tervonen O (2011) Assessment of association between low back pain and paraspinal muscle atrophy using opposed-phase magnetic resonance imaging: a population-based study among young adults. Spine (Phila Pa 1976) 36:1961–1968. https://doi.org/10.1097/BRS.0b013e3181fef890

    Article  Google Scholar 

  36. Cutts A, Alexander RM, Ker RF (1991) Ratios of cross-sectional areas of muscles and their tendons in a healthy human forearm. J Anat 176:133–137

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Hansen L, de Zee M, Rasmussen J, Andersen TB, Wong C, Simonsen EB (2006) Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling. Spine (Phila Pa 1976) 31:1888–1899. https://doi.org/10.1097/01.brs.0000229232.66090.58

    Article  Google Scholar 

  38. Kalimo H, Rantanen J, Viljanen T, Einola S (1989) Lumbar muscles: structure and function. Ann Med 21:353–359. https://doi.org/10.3109/07853898909149220

    Article  CAS  PubMed  Google Scholar 

  39. Pogrund H, Bloom RA, Weinberg H, et al (2009) Relationship of psoas width to osteoporosis. 6470:8–11. https://doi.org/10.3109/17453678608994377

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Funding

This study was funded by the Grant of Japan Orthopedics and Traumatology Research Foundation (grant no. 270).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Hasibullah Habibi, Shinji Takahashi, Masatoshi Hoshino, Hiromitsu Toyoda, Shoichiro Ohyama, Yusuke Hori & Hiroaki Nakamura

  2. Department of Orthopaedic Surgery, Seikeikai Hospital, Osaka, Japan

    Kazushi Takayama

  3. Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan

    Ryuichi Sasaoka

  4. Department of Orthopaedic Surgery, Shiraniwa Hospital, Ikoma, Japan

    Tadao Tsujio

  5. Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan

    Hiroyuki Yasuda

  6. Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan

    Fumiaki Kanematsu

  7. Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan

    Hiroshi Kono

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  1. Hasibullah Habibi
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Corresponding author

Correspondence to Shinji Takahashi.

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This study was approved by the Ethical Committee of Osaka City University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Habibi, H., Takahashi, S., Hoshino, M. et al. Impact of paravertebral muscle in thoracolumbar and lower lumbar regions on outcomes following osteoporotic vertebral fracture: a multicenter cohort study. Arch Osteoporos 16, 2 (2021). https://doi.org/10.1007/s11657-020-00866-6

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