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A new radiological index for the assessment of higher body fat status and lumbar spine degeneration

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Abstract

Objective

Obesity has been proposed as a risk factor for low back pain (LBP) and intervertebral disc degeneration (IVDD). Even though body mass index (BMI) is used as a parameter for obesity, it could not represent percentage and distribution of the body fat. Subcutaneous fat tissue thickness (SFTT) was proposed as one of the magnetic resonance imaging (MRI) parameters to evaluate the percentage of the body fat. In this study, we aimed to find out whether SFTT at lower back correlated with LBP and spine degeneration.

Materials and methods

We retrospectively reviewed a database of the patients with LBP. Concomitantly, asymptomatic control subjects were retrieved. Patients and control subjects were evaluated in terms of IVDD and Modic changes at all lumbar levels on MRI. SFTT was measured both on MRI and computed tomography (CT) scans, where applicable.

Results

SFTT at the lumbar spine had moderate-to-strong correlations with BMI. SFTT at L1-L2 level was significantly associated with severe IVDD at L5-S1 level, and Modic changes at L4-L5 and L5-S1 levels. BMI had no significant association with severe IVDD and Modic changes at lumbar spine. BMI and mean SFTT of all lumbar levels had ORs of 0.735 (95% CI: 0.631–0.857, p < 0.001) and 1.389 (95% CI: 1.266–1.524, p < 0.001) in predicting symptomatic subjects with LBP.

Conclusion

SFTT at upper lumbar levels could predict severe IVDD and Modic changes better than BMI, specifically in men. SFTT was better than BMI in predicting a symptomatic patient with LBP.

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References

  1. Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA, American Society of Interventional Pain P. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician. 2009;12:E35-70.

    Article  PubMed  Google Scholar 

  2. Ozcan-Eksi EE, Eksi MS, Akcal MA. Severe lumbar intervertebral disc degeneration is associated with modic changes and fatty infiltration in the paraspinal muscles at all lumbar levels, Except for L1–L2: a cross-sectional analysis of 50 symptomatic women and 50 age-matched symptomatic men. World Neurosurg. 2019;122:e1069–77.

    Article  PubMed  Google Scholar 

  3. Leino-Arjas P, Kaila-Kangas L, Solovieva S, Riihimaki H, Kirjonen J, Reunanen A. Serum lipids and low back pain: an association? A follow-up study of a working population sample. Spine (Phila Pa 1976). 2006;31:1032–7.

    Article  Google Scholar 

  4. Kauppila LI. Atherosclerosis and disc degeneration/low-back pain–a systematic review. Eur J Vasc Endovasc Surg. 2009;37:661–70.

    Article  CAS  PubMed  Google Scholar 

  5. Takatalo J, Karppinen J, Taimela S, Niinimaki J, Laitinen J, Sequeiros RB, et al. Association of abdominal obesity with lumbar disc degeneration–a magnetic resonance imaging study. PLoS One. 2013;8:e56244.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. J Bone Joint Surg Am. 2011;93:662–70.

    Article  PubMed  Google Scholar 

  7. Samartzis D, Karppinen J, Chan D, Luk KD, Cheung KM. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: a population-based study. Arthritis Rheum. 2012;64:1488–96.

    Article  PubMed  Google Scholar 

  8. Liuke M, Solovieva S, Lamminen A, Luoma K, Leino-Arjas P, Luukkonen R, et al. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond). 2005;29:903–8.

    Article  CAS  Google Scholar 

  9. Gurunathan U, Myles PS. Limitations of body mass index as an obesity measure of perioperative risk. Br J Anaesth. 2016;116:319–21.

    Article  CAS  PubMed  Google Scholar 

  10. Cornier MA, Despres JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, et al. Assessing adiposity: a scientific statement from the American Heart Association. Circulation. 2011;124:1996–2019.

    Article  PubMed  Google Scholar 

  11. Roubenoff R. Applications of bioelectrical impedance analysis for body composition to epidemiologic studies. Am J Clin Nutr. 1996;64:459S-S462.

    Article  CAS  PubMed  Google Scholar 

  12. Coutinho T, Goel K, Correa de Sa D, Kragelund C, Kanaya AM, Zeller M, et al. Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol. 2011;57:1877–86.

    Article  PubMed  Google Scholar 

  13. Dutton DJ, McLaren L. The usefulness of “corrected” body mass index vs. self-reported body mass index: comparing the population distributions, sensitivity, specificity, and predictive utility of three correction equations using Canadian population-based data. BMC Public Health. 2014;14:430.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Smith SR, Lovejoy JC, Greenway F, Ryan D, deJonge L, de la Bretonne J, et al. Contributions of total body fat, abdominal subcutaneous adipose tissue compartments, and visceral adipose tissue to the metabolic complications of obesity. Metabolism. 2001;50:425–35.

    Article  CAS  PubMed  Google Scholar 

  15. Kim J, Lim H, Lee SI, Kim YJ. Thickness of rectus abdominis muscle and abdominal subcutaneous fat tissue in adult women: correlation with age, pregnancy, laparotomy, and body mass index. Arch Plast Surg. 2012;39:528–33.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hernandez R, Younan Y, Mulligan M, Singer AD, Sharma GB, Umpierrez M, et al. Correlation between subcutaneous fat measurements in knee MRI and BMI: relationship to obesity and related co-morbidities. Acta Radiol Open. 2019;8:2058460119853541.

    PubMed  PubMed Central  Google Scholar 

  17. Seidell JC, Bakker CJ, van der Kooy K. Imaging techniques for measuring adipose-tissue distribution–a comparison between computed tomography and 1.5-T magnetic resonance. Am J Clin Nutr. 1990;51:953–7.

    Article  CAS  PubMed  Google Scholar 

  18. Yang L, Mu L, Huang K, Zhang T, Mei Z, Zeng W, et al. Abdominal adipose tissue thickness measured using magnetic resonance imaging is associated with lumbar disc degeneration in a Chinese patient population. Oncotarget. 2016;7:82055–62.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  CAS  Google Scholar 

  20. Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of degenerative disk disease. Radiology. 1988;168:177–86.

    Article  CAS  PubMed  Google Scholar 

  21. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166:193–9.

    Article  CAS  PubMed  Google Scholar 

  22. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  PubMed  Google Scholar 

  23. Lee JJ, Odeh KI, Holcombe SA, Patel RD, Wang SC, Goulet JA, et al. Fat thickness as a risk factor for infection in lumbar spine surgery. Orthopedics. 2016;39:e1124–8.

    PubMed  Google Scholar 

  24. Nadeem B, Bacha R, Gilani SA. Correlation of subcutaneous fat measured on ultrasound with body mass index. J Med Ultrasound. 2018;26:205–9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Özcan-Ekşi EE, Turgut VU, Küçüksüleymanoğlu D, Ekşi MŞ. Obesity could be associated with poor paraspinal muscle quality at upper lumbar levels and degenerated spine at lower lumbar levels: Is this a domino effect? J Clin Neurosci. 2021;94:120–7.

    Article  PubMed  Google Scholar 

  26. Kvist H, Chowdhury B, Grangard U, Tylen U, Sjostrom L. Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr. 1988;48:1351–61.

    Article  CAS  PubMed  Google Scholar 

  27. Zore T, Palafox M, Reue K. Sex differences in obesity, lipid metabolism, and inflammation-A role for the sex chromosomes? Mol Metab. 2018;15:35–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Stevens J, Katz EG, Huxley RR. Associations between gender, age and waist circumference. Eur J Clin Nutr. 2010;64:6–15.

    Article  CAS  PubMed  Google Scholar 

  29. Eksi MS, Kara M, Ozcan-Eksi EE, Aytar MH, Gungor A, Ozgen S, et al. Is diabetes mellitus a risk factor for modic changes?: a novel model to understand the association between intervertebral disc degeneration and end-plate changes. J Orthop Sci. 2020;25:571–5.

    Article  PubMed  Google Scholar 

  30. Cao J, Kong L, Meng F, Zhang Y, Shen Y. Impact of obesity on lumbar spinal surgery outcomes. J Clin Neurosci. 2016;28:1–6.

  31. Sang C, Chen X, Ren H, Meng Z, Jiang J, Qin Y. Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case-control study. BMC Surg. 2020;20:35.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Peng W, Liang Y, Lu T, Li M, Li DS, Du KH, et al. Multivariate analysis of incision infection after posterior lumbar surgery in diabetic patients: a single-center retrospective analysis. Medicine. 2019;98:e15935.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank to Göksu Bozdereli Berikol, M.D. for her contributions to the statistical analyses.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, İstanbul, Turkey

    Emel Ece Özcan-Ekşi

  2. Department of Internal Medicine, Division of Endocrinology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey

    Müjdat Kara

  3. Taksim Education and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey

    Gürkan Berikol

  4. School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey

    Ömer Orhun

  5. Antalya Atatürk State Hospital, Neurosurgery Clinic, Antalya, Turkey

    Veli Umut Turgut

  6. Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey

    Murat Şakir Ekşi

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  1. Emel Ece Özcan-Ekşi
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  2. Müjdat Kara
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  3. Gürkan Berikol
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Correspondence to Murat Şakir Ekşi.

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Özcan-Ekşi, E.E., Kara, M., Berikol, G. et al. A new radiological index for the assessment of higher body fat status and lumbar spine degeneration. Skeletal Radiol 51, 1261–1271 (2022). https://doi.org/10.1007/s00256-021-03957-8

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  • DOI: https://doi.org/10.1007/s00256-021-03957-8

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