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Multiple univariate analysis of radiologic and clinical features on 168 patients with lumbar spinal stenosis: what is the role of the erector spinae in the development of a patient’s disability?

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Abstract

Background

The weakening of paraspinal muscles in the paravertebral area may play a role in developing central lumbar spinal stenosis, resulting in lower back discomfort.

Objective

The study thoroughly examined the correlation between the Oswestry Disability Index, Dural Sac cross-sectional area, Schizas grading Scale, Body Mass Index, and the cross-sectional areas of Erector Spinae, Multifidus, and Psoas muscles. The findings were also compared between patients with central Lumbar Spinal Stenosis and healthy individuals.

Study design

Retrospective monocentric observational study.

Methods

The study recruited 168 consecutive patients aged 60 or older diagnosed with central Lumbar Spinal Stenosis between January 2020 and July 2022. The patients’ condition was evaluated by administering a preoperative Oswestry Disability Index questionnaire, measuring their Body Mass Index, and performing preoperative Magnetic Resonance Imaging. The analyzed parameters were the cross-sectional area of paraspinal muscles at the L4-L5 level, dural sac cross-sectional area, and Schizas grading Scale at the most stenotic level, using multiple linear univariate analyses. Two groups of healthy individuals were recruited: Group A (under 60 years old) and Group B (over 60 years old). The same data extrapolated from these groups were compared with those of patients with central lumbar stenosis using a two-tailed Mann-Whitney test.

Results

As the Erector Spinae degenerates, the Oswestry Disability Index tends to increase. Similarly, an increase in Body Mass Index is often accompanied by a decrease in the cross-sectional area of the Erector Spinae. Low dural sac cross-sectional area is statistically linked to a reduced Multifidus cross-sectional area. Interestingly, the Schizas grading scale does not appear to correlate with changes in the cross-sectional area of the paraspinal muscles. Additionally, there is no significant difference in the cross-sectional area of the Psoas muscle between individuals with central lumbar spinal stenosis and healthy individuals.

Conclusions

Our study found that degeneration of the Erector Spinae plays a crucial role in the progression of perceived disability in Lumbar Spinal Stenosis. Prospective studies should investigate the long-term evolution of paraspinal muscles in decompressed patients.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy

    Giuseppe Corazzelli & Vincenzo Meglio

  2. Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy

    Mara Capece

  3. Department of Neurosurgery, IRCCS Neuromed, (IS), Pozzilli, Italy

    Settimio Leonetti, Valentina Pizzuti, Francesco Ricciardi, Alessandro D’Elia & Gualtiero Innocenzi

  4. Department of Neurology, IRCCS Neuromed, (IS), Pozzilli, Italy

    Marco Santilli

Authors
  1. Giuseppe Corazzelli
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  2. Mara Capece
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  3. Vincenzo Meglio
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  4. Settimio Leonetti
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  5. Valentina Pizzuti
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  6. Francesco Ricciardi
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  7. Alessandro D’Elia
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  8. Marco Santilli
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  9. Gualtiero Innocenzi
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Corresponding author

Correspondence to Giuseppe Corazzelli.

Ethics declarations

Ethics approval

The ethical review process and approval by our ethics committee were not required for the present study because it is a retrospective study. Furthermore, the research data analysis has no effect on the participants and their medical care.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Comments

The authors have chosen to include paraspinal - cross section area as a whole. If we consider carefully there may be different ratio of muscle fibres and fat, in the axial images of stenotic lumbar segment, in each patient. This aspect may influence the results of this study. Further sutdies should consider this aspect. In my opinion, hypotrophy of the erector spine muscle and the intermuscluar fat are factors that contribute to the instability and consequently progressive stenosis of that segment of vertebral column.

Ridvan Alimehmeti

Tirana, Albania

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Corazzelli, G., Capece, M., Meglio, V. et al. Multiple univariate analysis of radiologic and clinical features on 168 patients with lumbar spinal stenosis: what is the role of the erector spinae in the development of a patient’s disability?. Acta Neurochir 165, 3947–3957 (2023). https://doi.org/10.1007/s00701-023-05863-5

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  • DOI: https://doi.org/10.1007/s00701-023-05863-5

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