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


Study design

A multicenter cross-sectional study.


To clarify the relationship of trunk muscle mass with low back pain, spinal sagittal balance, and quality of life.

Summary of background data

Few reports have investigated the relationship of trunk muscle mass with lumbar spine function and spinal balance, and the clinical significance of trunk muscle mass remains unclear.


Patients attending spinal outpatient clinics at 10 different medical institutions were enrolled in this study. Patient demographics, trunk muscle mass and appendicular skeletal muscle mass (ASM) measured by bioelectrical impedance analysis (BIA), body mass index (BMI), Charlson Comorbidity Index (CCI), the Oswestry Disability Index (ODI), visual analog scale (VAS) for low back pain, sagittal vertical axis (SVA), and EuroQol 5 Dimension (EQ5D) score were investigated. Multivariate nonlinear regression analysis was used to investigate the association of trunk muscle mass with the ODI, VAS score, SVA, and EQ5D score.


Of 2551 eligible patients, 1738 (mean age 70.2 ± 11.0 years; 781 men and 957 women) were enrolled. Trunk muscle mass was significantly correlated with the ODI, VAS score, SVA, and EQ5D score (P < 0.001) when adjusted for age, sex, BMI, ASM, CCI, and history of lumbar surgery. Patient deterioration was associated with a decrease in trunk muscle mass, and the deterioration accelerated from approximately 23 kg.


Trunk muscle mass was significantly associated with the ODI, VAS score, SVA, and EQ5D score. Trunk muscle mass may assume an important role to elucidate and treat lumbar spinal dysfunction and spinal imbalance.

Graphical abstract

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The authors thank Satomi Kawabata, Yoshika Notani, Yuka Tatsumi, and Aiko Nakashima for their help in collecting the data and conducting interviews with the patients.


This work was financially supported by the Japanese Orthopaedic Association Research Grant.

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Corresponding author

Correspondence to Masatoshi Hoshino.

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All authors declare that they have no competing interests; each author certifies that no commercial relationships exist that might pose a conflict of interest in connection with this article.

Ethical approval

This study was approved by the local ethics committee of the Faculty of Medicine, Osaka City University (number 3806).

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Hori, Y., Hoshino, M., Inage, K. et al. 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 (2019).

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  • Lumbar spine
  • Low back pain
  • Trunk muscles
  • Kyphosis
  • Sarcopenia