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The influence of 3D curve severity on paraspinal muscle fatty infiltration in patients with adolescent idiopathic scoliosis

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Abstract

Purpose

In a sex-inclusive cohort of patients with adolescent idiopathic scoliosis (AIS): (1) assess the relationship between 3D curve severity, curve flexibility, and paraspinal muscle fatty infiltration, and (2) describe three-dimensional (3D) fatty infiltration of the paraspinal muscles.

Methods

Fat signal fraction of the paravertebral muscles was measured in pre-operative magnetic resonance images (MRIs) of males and females with AIS at the apex, ± 1, and ± 2 levels from the apex of the curve (n = 62). In a subset of patients with biplanar erect radiographic imaging (n = 35), 3D measures of deformity (axial rotation of the apical vertebrae, thoracic kyphosis, and coronal Cobb angle) were measured.

Results

Contrary to previous studies, no relationship between coronal Cobb angle and fatty infiltration was found. However, axial apical rotation and sagittal Cobb angle were found to be significant predictors of paravertebral fatty infiltration (R2 = 0.196–0.222). Curve concavity, female sex, and proximity to the curve apex were found to be the strongest predictors of fatty infiltration. Greater fatty infiltration of the paravertebral muscles was found on the concave side of the curve (15–24% vs. 11–13%), with increasing fatty infiltration toward the apex of the curve. Fatty infiltration was protected on the convex side of the curve, with no differences in the amount of fatty infiltration across levels.

Conclusion

These findings highlight that coronal curve severity and flexibility are not the primary influencing factors for the degree of paraspinal fatty infiltration in patients with AIS. This may have implications for nonsurgical rehabilitation strategies such as bracing and physical therapy.

Level of evidence

II.

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Data availability

All data are available upon reasonable request to the corresponding author.

Code availability

All code is available upon reasonable request to the corresponding author.

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Acknowledgements

None.

Funding

The study was not funded.

Author information

Authors and Affiliations

Authors

Contributions

Conceptualization: DBB, CLF, PON, and BS; methodology: DBB, CDG, CLF, and EKE; formal analysis and investigation: DBB, CDG; writing—original draft preparation: DBB; writing—review and editing: DBB, CDG, CLF, EKE, PON, and BS; supervision: PON, BS.

Corresponding author

Correspondence to Bahar Shahidi.

Ethics declarations

Conflict of interest

PON: DePuy Synthes Spine via Setting Scoliosis Straight Foundation: research support. DePuy Synthes Spine, A Johnson & Johnson Company: IP royalties, ElectroCore: stock or stock Options. EOS Imaging via Setting Scoliosis Straight Foundation: research support. Globus Medical: paid consultant. Harms Study Group: board or committee member. International Pediatric Orthopedic Think Tank: board or committee member. Medtronic via Setting Scoliosis Straight: research support. Nuvasive via Setting Scoliosis Straight Foundation: research support. Pacira Pharmaceuticals Inc: paid consultant. Scoliosis Research Society: board or committee member. Setting Scoliosis Straight Foundation: board or committee member. Stryker K2M via Setting Scoliosis Straight Foundation: research support. Stryker K2M: IP royalties; Paid consultant. Theime Publishing: publishing royalties, and financial or material support. Zimmer Biomet via Setting Scoliosis Straight Foundation: research support. DBB, CDG, CLF, EKE, and BS: None.

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This study was approved by the local Institutional Review Board and approved by the hospital research administration.

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All participants or their representatives provided informed consent to provide the data used in this study.

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Berry, D.B., Grant, C.D., Farnsworth, C.L. et al. The influence of 3D curve severity on paraspinal muscle fatty infiltration in patients with adolescent idiopathic scoliosis. Spine Deform 9, 987–995 (2021). https://doi.org/10.1007/s43390-021-00318-2

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  • DOI: https://doi.org/10.1007/s43390-021-00318-2

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