Relationship Between L4/5 Lumbar Multifidus Cross-Sectional Area Ratio and Fall Risk in Older Adults with Lumbar Spinal Stenosis: A Retrospective Study

Abstract

Various factors, including spinal deformities and trunk muscle atrophy, greatly affect the fall risk among older adults with lumbar spinal stenosis (LSS). However, the etiology of falls in older adults with degenerative LSS and trunk muscle atrophy is poorly understood. We investigated the association between trunk muscle atrophy and falls in older LSS patients. This retrospective study included 99 hospitalized older adults with LSS. Participants completed self-reported fall score questionnaires and were divided into the fall risk (n = 30) and non-fall risk (n = 69) groups. The patients’ low back pain visual analog scale score, Geriatric Depression Scale score, sagittal vertical axis, L4/5 lumbar multifidus cross-sectional area ratio (LMCSAR), and center of pressure (COP) values during quiet standing were evaluated. The fall risk group had a lower L4/5 LMCSAR (p = 0.002) and increased COP excursion (p = 0.034) than the non-fall risk group. No significant differences were observed in the other measured variables between the two groups. The L4/5 LMCSAR (p < 0.001) and COP (p = 0.024) were related to fall risk and may be useful in fall risk assessment in such populations. Strategies aimed at enhancing controlled lumbar segmental motion and improving trunk muscle stability or mass may decrease the fall risk in this cohort.

Comparison Between Percutaneous Transforaminal Endoscopic Discectomy and Fenestration in the Treatment of Degenerative Lumbar Spinal Stenosis

“…Pathologically, degenerative changes in the vertebra, intervertebral disc or facet joints diminish available space for the neural and vascular elements in the lumbar spinal canal. Neurologic symptoms emerge when the narrowing finally impinges on the spinal cord or nerve roots [ 6 ].…”

Association between Trunk Muscle Strength and Fall Risk in Older Men and Women with Lumbar Spondylosis

“…MRI was used to evaluate the cross-sectional areas of the erector spinae and lumbar multifidus muscles at the L4/5 level, and MRI scans were assessed by a radiologist [ 9 ]. Data extraction was performed using SYNAPSE (Fujifilm Medical Co., Ltd., Tokyo, Japan).…”

“…Data extraction was performed using SYNAPSE (Fujifilm Medical Co., Ltd., Tokyo, Japan). The lumbar erector spinae and multifidus cross-sectional areas were calculated as cross-sectional area/weight (mm 2 /kg) [ 9 ].…”

“…Previous studies have reported a relation between spine angle and fall among community-dwelling older adults [ 7 , 8 ]. A decreased L4/5 lumbar multifidus cross-sectional area and increased postural sway excursion may equally increase the risk of falling in older adults with lumbar spinal stenosis [ 9 ].…”

“…Kato et al reported that abdominal muscle weakness was associated with falling in older women [ 16 ]; however, there are only a few reports on the relationship between falls and trunk muscle strength in older men. Moreover, few studies have focused on the association of fall risk with trunk muscle function in older men and women with lumbar spondylosis [ 9 ]. Theoretically, factors such as trunk muscle weakness or trunk muscle atrophy deterioration may also greatly affect the risk of falls in older adults with lumbar spondylosis.…”