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Abdominal aortic calcification is independently associated with increased atrophy and fatty infiltration of the lumbar paraspinal muscles: a retrospective cross-sectional study

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Abstract

Background

Aortic abdominal calcification (AAC) is associated with spine-related conditions, such as lower back pain and reduced bone mineral density. Similar to peripheral vascular disease, AAC possibly reduces blood flow to the lumbar posterior paraspinal muscles (PPM) which may lead to atrophy and increased fatty infiltration.

Methods

Imaging of patients with lower back pain was analyzed. AAC was assessed on lateral lumbar radiographs according to the Kauppila classification. The cross-sectional area of the PPM was measured on a T2-weighted axial MRI sequence and the functional cross-sectional area (fCSA) and fatty infiltration (FI) were calculated with custom software. The association of AAC and FI as well as AAC and fCSA was assessed by multivariable linear regression, adjusted for age, sex, body mass index (BMI), diabetes, and smoking.

Results

Two hundred and thirty patients (47.8% female) with a median age of 60 years (IQR 48–68) were analyzed. In patients, without AAC the median FI of the PPM was 33.3% (IQR 29.1–37.6%), compared to 44.6% (IQR 38.5–54.3%) in patients with AAC (p < 0.001). In the multivariable linear regression, both fCSA and FI of the PPM were significantly and independently associated with the degree of AAC (p = 0.037 and p = 0.015, respectively).

Conclusions

This is the first study to demonstrate a significant and independent association between AAC and PPM morphology. The results of this study improve our understanding of the interaction between AAC and spinal musculature, with AAC being a reason for atrophy of the PPM.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA

    Lukas Schönnagel, Maximilian Muellner, Thomas Caffard, Soji Tani, Gaston Camino-Willhuber, Henryk Haffer, Artine Arzani, Erika Chiapparelli, Krizia Amoroso, Manuel Moser, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Lukas Schönnagel, Maximilian Muellner & Henryk Haffer

  3. Klinik Für Orthopädie, Universitätsklinikum Ulm, Ulm, Germany

    Thomas Caffard

  4. Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan

    Soji Tani

  5. Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA

    Jiaqi Zhu

  6. Medical Heart Center of Charité CBF - Charité – Universitätsmedizin Berlin, Berlin, Germany

    Phillip Suwalski

  7. Department of Cardiovascular Imaging, Johns Hopkins University, Baltimore, MD, 21287, USA

    Phillip Suwalski

  8. Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland

    Manuel Moser

  9. Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA

    Ek Tsoon Tan & John A. Carrino

Authors
  1. Lukas Schönnagel
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  2. Maximilian Muellner
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  5. Gaston Camino-Willhuber
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  8. Phillip Suwalski
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  9. Artine Arzani
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  11. Krizia Amoroso
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  12. Manuel Moser
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  13. Jennifer Shue
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  14. Ek Tsoon Tan
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  15. John A. Carrino
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  16. Andrew A. Sama
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  18. Federico P. Girardi
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  19. Alexander P. Hughes
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Contributions

LS: conceptualization, methodology, statistical analysis, investigation, writing-original draft, visualization, MM: conceptualization, methodology, writing—review& editing, TC: investigation, writing—review & editing, ST: writing—review & editing, GCW: writing—review & editing, JZ: formal analysis, investigation, validation, writing—review& editing, HH: writing—review & editing, PS: investigation, writing—review, AA: investigation, data curation, writing—review& editing, EC: investigation, data curation, writing—review& editing, KA: investigation, data curation, writing—review& editing, M.M.: investigation, data curation, writing—review & editing, JS: data curation, writing—review& editing, project administration, ET: methodology; writing—review& editing, JAC: methodology, project administration, writing—review& editing, AAS: project administration, writing—review& editing, FPC: project administration, writing—review& editing, APH: project administration, writing—review& editing; supervision, conceptualization, methodology.

Corresponding author

Correspondence to Alexander P. Hughes.

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Conflict of interest

The authors declare that there is no conflict of interest concerning materials or methods used in this study or the findings specified in this paper.

Disclosure

Dr. Sama reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, ISPH II, LLC, ISPH 3, LLC, and VBros Venture Partners X Centinel Spine; consulting fee from Clariance, Inc., Kuros Biosciences AG, and Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of the scientific advisory board of Clariance, Inc., and Kuros Biosciences AG; and trips/travel of Medical Device Business research support from Spinal Kinetics, Inc., outside the submitted work. Dr. Cammisa reports royalties from NuVasive, Inc.; private investments for 4WEB Medical/4WEB, Inc., Bonovo Orthopedics, Inc., Healthpoint Capital Partners, LP, ISPH II, LLC, ISPH 3 Holdings, LLC, Ivy Healthcare Capital Partners, LLC, Medical Device Partners II, LLC, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, Tissue Differentiation Intelligence, LLC, VBVP VI, LLC, VBVP X, LLC (Centinel) and Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., DePuy Synthes Spine, NuVasive, Inc., Spine Biopharma, LLC, and Synexis, LLC; membership of scientific advisory board/other offices of Healthpoint Capital Partners, LP, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine, outside the submitted work. Dr. Girardi reports royalties from Lanx, Inc., and Ortho Development Corp.; private investments for Centinel Spine, and BCMID; stock ownership of Healthpoint Capital Partners, LP; and consulting fees from NuVasive, Inc., and DePuy Synthes Spine, outside the submitted work. Dr. Hughes reports research support from NuVasive, Inc. and Kuros Biosciences AG; and fellowship support from NuVasive, Inc. and Kuros Biosciences AG, outside the submitted work.

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The work was performed at Hospital for Special Surgery, New York City, NY, USA. The institutional review board of Hospital for Special Surgery approved this study.

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Schönnagel, L., Muellner, M., Caffard, T. et al. Abdominal aortic calcification is independently associated with increased atrophy and fatty infiltration of the lumbar paraspinal muscles: a retrospective cross-sectional study. Eur Spine J 32, 3002–3008 (2023). https://doi.org/10.1007/s00586-023-07783-5

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