Radiological Changes of Paraspinal Muscles: A Comparative Study of Patients with Isthmic Spondylolisthesis, Patients with Degenerative Lumbar Spondylolisthesis, and Healthy Subjects

Abstract

Objective To investigate the differences, correlations, and clinical significance of the paraspinal muscles among patients with isthmic spondylolisthesis (IS), degenerative lumbar spondylolisthesis (DLS), and age-matched healthy subjects. Methods This study involved 159 age-matched patients with L4 anterior spondylolisthesis. The patients were divided into the IS group (n = 81) and DLS group (n = 78). Eighty-four age-matched healthy adults were enrolled as the control group. The cross-sectional area (CSA) of paraspinal muscles (multifidus [MF], erector spinae [ES], and psoas [PS]) and the relative CSA of the paraspinal muscles (paraspinal muscle CSA/vertebral CSA) were measured in the IS group, DLS group, and control group. The degree of fat infiltration was simultaneously observed. Results There was no significant difference in age or sex among the three groups. The relative CSA of the MF and PS was higher in control group than in IS and DLS groups (p < 0.05). The relative CSA of ES was higher in IS and control groups than in DLS group (p < 0.05). The relative CSA of total paraspinal muscles decreased in the order of control group > IS group > DLS group (p < 0.05). Logistic regression analysis showed that the relative CSA of MF, and the degree of fat infiltration of ES were independent protective factors for IS (odds ratio < 1, p < 0.05). The relative CSA of MF was an independent protective factor for DLS (odds ratio < 1, p < 0.05), whereas BMI and the degree of fat infiltration of MF were independent risk factor for DLS (odds ratio > 1, p < 0.05). Conclusion Compared with the control group, patients with IS and DLS showed varying degrees of degeneration, and the degree of degeneration in patients with DLS was more severe at the same age. Lower fat infiltration and higher paraspinal muscle CSA are protective factors for IS and DLS, whereas the higher BMI is risk factor for DLS.

The association between morphological characteristics of paraspinal muscle and spinal disorders

“…Although the paraspinal muscles in patients with isthmic spondylolisthesis (IS) and DLS showed varying degrees of degeneration [ 114 ], they might play an important role in maintaining the structure and function of the spine in patients with DLS and IS. Some retrospective research has provided support for this viewpoint.…”

“…Some retrospective research has provided support for this viewpoint. Low FI and high CSA of the paraspinal muscles might have a protective effect against the development of DLS and IS [ 114 ]. In addition, larger CSAs of MF and PS might be protective factors to prevent lumbar stability in patients with isthmic spondylolisthesis [ 115 ].…”

Erector spinae could be the game changer in surgical decision-making in patients with lumbar spondylolisthesis: a cross-sectional analysis of an age-, sex-, subtype-, level-matched patients with similar spinopelvic parameters received surgical or conservative management

“…Even patients with different type of spondylolisthesis (IS vs. DS) had different CSA and fatty infiltration patterns in their paraspinal muscles. Li et al [16] depicted that patient with IS and control subjects had bigger erector spinae muscles than those with DS. Cao et al [17] suggested that fatty infiltration in the psoas was an independent factor related to DS in asymptomatic adults.…”

“…Cao et al [17] suggested that fatty infiltration in the psoas was an independent factor related to DS in asymptomatic adults. However, they evaluated paraspinal muscles at only L4-L5 level [15][16][17]. A recent study showed multifidus degeneration was more significant in patients with lumbar DS compared to those with degenerative lumbar kyphosis [18].…”