Study Design: Feasibility study.Purpose: To investigate the feasibility of using fat degeneration of lumbar extensor muscle (LEM) as an alternative diagnostic criterion for sarcopenia in patients with osteoporotic vertebral fractures.Overview of Literature: Although sarcopenia has been gaining increased attention among researchers and healthcare practitioners, there is uncertainty about the association between sarcopenia and fat degeneration of LEM.Methods: In this study, 33 patients with osteoporotic vertebral fractures (group 1) and 29 patients without such fractures (group 2) were enrolled. Sarcopenia was diagnosed in accordance with the Asian Working Group for Sarcopenia (AWGS) criteria, including assessment of extremity muscle mass using dual-energy X-ray absorptiometry, grip strength, and gait speed. The bone mineral density and fat degeneration of LEM were investigated using magnetic resonance imaging.Results: The mean rates of fat degeneration of LEM and the skeletal muscle index were 38.3% and 5.5 kg/m<sup>2</sup> in group 1 and 28.9% and 6.3 kg/m<sup>2</sup> in group 2, respectively. The fat degeneration of LEM was negatively correlated with gait speed (<i>r</i>=−0.44, <i>p</i>=0.01) and handgrip strength (<i>r</i>=−0.37, <i>p</i>=0.01). The fat degeneration of LEM also demonstrated a significant relationship with osteoporotic vertebral fractures (<i>p</i>=0.01). Receiver operating characteristic curve analysis between fat degeneration of LEM and osteoporotic vertebral fractures showed that the cut-off value of fat degeneration was 31.9% (sensitivity=0.67, specificity=0.66). There was a positive correlation between sarcopenia defined by the AWGS and that defined by the 31.90% cut-off value of fat degeneration of LEM instead of extremity muscle mass (<i>r</i>=0.46, <i>p</i>=0.01).Conclusions: These results suggest the feasibility of using fat degeneration of LEM as an alternative diagnostic criterion for sarcopenia in patients with osteoporotic vertebral fractures. A cut-off value of fat degeneration of LEM of 31.9% was shown to be useful for diagnosing osteoporotic vertebral fractures.
BackgroundThe role of ultrasound in the thoracic spine has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and the limitation of imaging through the narrow acoustic windows produced by the bony framework of thoracic spine. The aim of this study was to make a comparison between the 12th rib and the spinous process of C7 as a landmark for effective ultrasound-guided target segment identification in the thoracic spine.MethodsUltrasonography of 44 thoracic spines was performed and the same procedure was carried out 1 week later again. The target segments (T3–4, T7–8, and T10–11) were identified using the 12th rib (group 1) or the spinous process of C7 (group 2) as a starting landmark. Ultrasound scanning was done proximally (group 1) or distally (group 2) toward the target transverse process and further medially and slightly superior to the target thoracic facet. Then, a metal marker was placed on the T3–4, T7–8, and T10–11 and the location of each marker was confirmed by fluoroscopy.ResultsIn the total 132 segments, sonographic identification was confirmed to be successful with fluoroscopy in 84.1% in group 1 and 56.8% in group 2. Group 1 had a greater success rate in ultrasound-guided target segment identification than group 2 (p = 0.001), especially in T10–11 (group 1, 93.2%; group 2, 43.2%; p = 0.001) and T7–8 (group 1, 86.4%; group 2, 56.8%; p = 0.002). The intrarater reliability of ultrasound-guided target segment identification was good (group 1, r = 0.76; group 2, r = 0.82), showing no difference between right and left sides. Ultrasound-guided target segment identification was more effective in the non-obese subjects (p = 0.001), especially in group 1.ConclusionsUltrasound-guided detection using the 12th rib as a starting landmark for scanning could be a promising technique for successful target segment identification in the thoracic spine.
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