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Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal stenosis

European Spine Journal volume 26, pages 2543–2551 (2017)Cite this article

Abstract

Purpose

Lumbar spinal stenosis (LSS) is a disabling condition associated with narrowing of the spinal canal or vertebral foramina. Paraspinal muscle atrophy and fatty infiltration have been reported in patients with chronic LBP and disc herniation. However, very few imaging studies have examined paraspinal muscle morphology and composition in patients with LSS. The purpose of this study was to investigate the association of paraspinal muscle size, composition and asymmetry with functional status in patients with LSS.

Methods

Thirty-six patients diagnosed with LSS at L4–L5 with neurogenic claudication were included. Paraspinal muscle measurements were obtained from axial T2-weighted MR images, bilaterally, at the level of the superior and inferior vertebral endplates of L5. Muscle measurements of interest included: total cross-sectional area (CSA), functional CSA (FCSA), the ratio of FCSA to CSA (FCSA/CSA) as an indicator of muscle composition, and relative % asymmetry in muscle CSA. The association between muscle parameters and other patient characteristics with function as indicated from Oswestry Disability Index (ODI) scores and pain interference status was investigated.

Results

Greater multifidus muscle fatty infiltration (e.g., lower FCSA/CSA) and lower psoas relative CSA were associated with lower function (higher ODI and pain interference scores) in univariable and multivariable analyses. There was no association between the different muscle parameters and stenosis severity or back or leg pain duration or severity.

Conclusions

Our findings suggest an association of multifidus muscle fatty infiltration and psoas muscle size with functional status in patients diagnosed with LSS. Future prospective studies are needed to evaluate whether such muscle parameters are associated with prognosis and functional recovery following surgical treatment.

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Acknowledgements

We thank Laura Gibbons for her help with data requests. Support was received from the Seventh Framework Programme (Health-2007-2013, Grant agreement no: 201626; GENODISC) and the Canada Research Chairs Program.

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Authors and Affiliations

  1. PERFORM Centre, Concordia University, 7200 Sherbrooke West Street, PC 2.209, Montreal, QC, H4B 1R6, Canada

    Maryse Fortin

  2. National Centre for Spinal Disorders, Királyhágó u. 1, Budapest, 1126, Hungary

    Àron Lazáry & Peter Paul Varga

  3. Common Spinal Disorders Research Group, Faculty of Rehabilitation Medicine, University of Alberta, 8205-114 Street, Edmonton, AB, T6G 2G4, Canada

    Michele C. Battié

Authors
  1. Maryse Fortin
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  2. Àron Lazáry
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  4. Michele C. Battié
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Correspondence to Maryse Fortin.

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Fortin, M., Lazáry, À., Varga, P.P. et al. Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal stenosis. Eur Spine J 26, 2543–2551 (2017). https://doi.org/10.1007/s00586-017-5228-y

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  • DOI: https://doi.org/10.1007/s00586-017-5228-y

Keywords

  • Multifidus
  • Erector spinae
  • Psoas
  • Fatty infiltration
  • Cross-sectional area
  • Magnetic resonance imaging
  • Rehabilitation