Skeletal Radiology

, Volume 47, Issue 7, pp 955–961 | Cite as

Lumbar paraspinal muscle fat infiltration is independently associated with sex, age, and inter-vertebral disc degeneration in symptomatic patients

  • Julio UrrutiaEmail author
  • Pablo Besa
  • Daniel Lobos
  • Mauricio Campos
  • Cristobal Arrieta
  • Marcelo Andia
  • Sergio Uribe
Scientific Article



To determine the association of paraspinal muscles and psoas relative cross-sectional area (RCSA) and fat signal fraction (FSF) with sex, age, and intervertebral disc degeneration (IDD) in symptomatic patients.


We retrospectively evaluated 80 adult patients with spinal symptoms using T2-weighted magnetic resonance images. We determined RCSA and FSF of the paraspinal muscles (erector spinae and multifidus) and psoas from L1–L2 to L5–S1; we determined IDD using the Pfirrmann classification. We compared differences in muscle RCSA and FSF based on sex and IDD, and we correlated age and IDD with RCSA and FSF. Using multivariate linear regression analyses, we determined the impact of sex, age, and IDD on RCSA and FSF.


Men exhibited larger psoas RCSA but not larger paraspinal muscles RCSA than women. Women had larger FSF in the paraspinal muscles and psoas. Increasing IDD was associated with larger FSF if ≥2 Pfirrmann grades were observed. IDD correlated with FSF of the paraspinal muscles, and age correlated with FSF of the paraspinal muscles and psoas. IDD was less consistently correlated with RCSA, but age correlated negatively with RCSA of all three muscles. Linear regression analyses demonstrated that sex, age, and IDD were each independently associated with FSF of the paraspinal muscles; additionally, sex and age, but not IDD, were associated with psoas FSF. RCSA was less consistently influenced by these three variables.


Sex, age, and IDD are independently associated with paraspinal muscles FSF; only sex and age influence psoas FSF.


Paraspinal muscles Aging spine Fat infiltration, cross-sectional area Intervertebral disc degeneration 



CONICYT FONDEF/I Concurso IDeA en dos etapas ID15I10284.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest


  1. 1.
    Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol. 2011;84:709–13. Scholar
  2. 2.
    Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976). 1993;18:830–6.CrossRefGoogle Scholar
  3. 3.
    Fortin M, Lazary A, Varga PP, Battie MC. Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal stenosis. Eur Spine J. 2017;26:2543–51. Scholar
  4. 4.
    Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5:2. Scholar
  5. 5.
    Mengiardi B, Schmid MR, Boos N, Pfirrmann CW, Brunner F, Elfering A, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240:786–92. Scholar
  6. 6.
    Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2008;13:43–9. Scholar
  7. 7.
    Barry JJ, Lansdown DA, Cheung S, Feeley BT, Ma CB. The relationship between tear severity, fatty infiltration, and muscle atrophy in the supraspinatus. J Shoulder Elb Surg. 2013;22:18–25. Scholar
  8. 8.
    Hodges P, Holm AK, Hansson T, Holm S. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine (Phila Pa 1976). 2006;31:2926–33. Scholar
  9. 9.
    Hodges PW, James G, Blomster L, Hall L, Schmid A, Shu C, et al. Multifidus muscle changes after back injury are characterized by structural remodeling of muscle, adipose and connective tissue, but not muscle atrophy: molecular and morphological evidence. Spine (Phila Pa 1976). 2015;40:1057–71. Scholar
  10. 10.
    Kalichman L, Hodges P, Li L, Guermazi A, Hunter DJ. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J. 2010;19:1136–44. Scholar
  11. 11.
    Kalichman L, Klindukhov A, Li L, Linov L. Indices of Paraspinal muscles degeneration: reliability and association with facet joint osteoarthritis: feasibility study. Clin Spine Surg. 2016;29:465–70. Scholar
  12. 12.
    Sebro R, O'Brien L, Torriani M, Bredella MA. Assessment of trunk muscle density using CT and its association with degenerative disc and facet joint disease of the lumbar spine. Skelet Radiol. 2016;45:1221–6. Scholar
  13. 13.
    Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O'Sullivan R, et al. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J. 2015;15:1593–601. Scholar
  14. 14.
    Shahidi B, Parra CL, Berry DB, Hubbard JC, Gombatto S, Zlomislic V, et al. Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976). 2017;42:616–23. Scholar
  15. 15.
    Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26:1873–8.CrossRefGoogle Scholar
  16. 16.
    Urrutia J, Besa P, Campos M, Cikutovic P, Cabezon M, Molina M, et al. The Pfirrmann classification of lumbar intervertebral disc degeneration: an independent inter- and intra-observer agreement assessment. Eur Spine J. 2016;25:2728–33. Scholar
  17. 17.
    Crawford RJ, Filli L, Elliott JM, Nanz D, Fischer MA, Marcon M, et al. Age- and level-dependence of fatty infiltration in lumbar paravertebral muscles of healthy volunteers. AJNR Am J Neuroradiol. 2016;37:742–8. Scholar
  18. 18.
    Lee SH, Park SW, Kim YB, Nam TK, Lee YS. The fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level. Spine J. 2017;17:81–7. Scholar
  19. 19.
    Fortin M, Battie MC. Quantitative paraspinal muscle measurements: inter-software reliability and agreement using OsiriX and ImageJ. Phys Ther. 2012;92:853–64. Scholar
  20. 20.
    Crawford RJ, Cornwall J, Abbott R, Elliott JM. Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging: a proposed method for the lumbar spine with anatomical cross-reference. BMC Musculoskelet Disord. 2017;18:25. Scholar
  21. 21.
    Hyun SJ, Bae CW, Lee SH, Rhim SC. Fatty degeneration of the paraspinal muscle in patients with degenerative lumbar kyphosis: a new evaluation method of quantitative digital analysis using MRI and CT scan. Clin Spine Surg. 2016;29:441–7. Scholar
  22. 22.
    Otsu N. A threshold selection method from gray-level histograms. IEEE Trans Syst, Man, Cybernet: Syst. 1979;9:62–6.CrossRefGoogle Scholar
  23. 23.
    Song Y, Zhu LA, Wang SL, Leng L, Bucala R, Lu LJ. Multi-dimensional health assessment questionnaire in China: reliability, validity and clinical value in patients with rheumatoid arthritis. PLoS One. 2014;9:e97952. Scholar
  24. 24.
    Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55:145–9. Scholar
  25. 25.
    Fortin M, Videman T, Gibbons LE, Battie MC. Paraspinal muscle morphology and composition: a 15-yr longitudinal magnetic resonance imaging study. Med Sci Sports Exerc. 2014;46:893–901. Scholar
  26. 26.
    Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine (Phila Pa 1976). 2004;29:E515–9.CrossRefGoogle Scholar
  27. 27.
    Stokes MJ, Cooper RG, Morris G, Jayson MI. Selective changes in multifidus dimensions in patients with chronic low back pain. Eur Spine J. 1992;1:38–42.CrossRefPubMedGoogle Scholar
  28. 28.
    Ranson CA, Burnett AF, Kerslake R, Batt ME, O'Sullivan PB. An investigation into the use of MR imaging to determine the functional cross-sectional area of lumbar paraspinal muscles. Eur Spine J. 2006;15:764–73. Scholar
  29. 29.
    Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, et al. Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2005;60:882–7.CrossRefPubMedGoogle Scholar
  30. 30.
    D'Hooge R, Cagnie B, Crombez G, Vanderstraeten G, Dolphens M, Danneels L. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther. 2012;17:584–8. Scholar
  31. 31.
    Fortin M, Lazary A, Varga PP, McCall I, Battie MC. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. Eur Spine J. 2016;25:1452–9. Scholar
  32. 32.
    Crawford RJ, Elliott JM, 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. 2017;
  33. 33.
    Fischer MA, Nanz D, Shimakawa A, Schirmer T, Guggenberger R, Chhabra A, et al. Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology. 2013;266:555–63. Scholar

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© ISS 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, School of MedicinePontificia Universidad Catolica de ChileSantiagoChile
  2. 2.Biomedical Imaging CenterPontificia Universidad Catolica de ChileSantiagoChile
  3. 3.Department of Radiology, School of MedicinePontificia Universidad Catolica de ChileSantiagoChile

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