Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine
Abstract Background The function of the paraspinal muscles and especially the psoas muscle in maintaining an upright posture is not fully understood. While usually considered solely as a hip flexor, the psoas muscle and its complex anatomy suggest that the muscle has other functions involved in stab...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-023-06967-w |
| _version_ | 1797647584237453312 |
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| author | Maximilian Muellner Henryk Haffer Erika Chiapparelli Yusuke Dodo Jennifer Shue Ek T. Tan Jiaqi Zhu Matthias Pumberger Andrew A. Sama Frank P. Cammisa Federico P. Girardi Alexander P. Hughes |
| author_facet | Maximilian Muellner Henryk Haffer Erika Chiapparelli Yusuke Dodo Jennifer Shue Ek T. Tan Jiaqi Zhu Matthias Pumberger Andrew A. Sama Frank P. Cammisa Federico P. Girardi Alexander P. Hughes |
| author_sort | Maximilian Muellner |
| collection | DOAJ |
| description | Abstract Background The function of the paraspinal muscles and especially the psoas muscle in maintaining an upright posture is not fully understood. While usually considered solely as a hip flexor, the psoas muscle and its complex anatomy suggest that the muscle has other functions involved in stabilizing the lumbar spine. The aim of this study is to determine how the psoas muscle and the posterior paraspinal muscles (PPM; erector spinae and multifidus) interact with each other. Methods A retrospective review including patients undergoing posterior lumbar fusion surgery between 2014 and 2021 at a tertiary care center was conducted. Patients with a preoperative lumbar magnetic resonance imaging (MRI) scan performed within 12 months prior to surgery were considered eligible. Exclusion criteria included previous spinal surgery at any level, lumbar scoliosis with a Cobb Angle > 20° and patients with incompatible MRIs. MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA) and the fat area (FAT) at L4 was conducted. The degree of fat infiltration (FI) was further calculated. FI thresholds for FIPPM were defined according to literature and patients were divided into two groups (< or ≥ 50% FIPPM). Results One hundred ninetypatients (57.9% female) with a median age of 64.7 years and median BMI of 28.3 kg/m2 met the inclusion criteria and were analyzed. Patients with a FIPPM ≥ 50% had a significantly lower FI in the psoas muscle in both sexes. Furthermore, a significant inverse correlation was evident between FIPPM and FIPsoas for both sexes. A significant positive correlation between FATPPM and fCSAPsoas was also found for both sexes. No significant differences were found for both sexes in both FIPPM groups. Conclusion As the FIPPM increases, the FIPsoas decreases. Increased FI is a surrogate marker for a decrease in muscular strength. Since the psoas and the PPM both segmentally stabilize the lumbar spine, these results may be indicative of a potential compensatory mechanism. Due to the weakened PPM, the psoas may compensate for a loss in strength in order to stabilize the spine segmentally. |
| first_indexed | 2024-03-11T15:18:39Z |
| format | Article |
| id | doaj.art-e4f6a5330a53452697410456ee473bf7 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-11T15:18:39Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-e4f6a5330a53452697410456ee473bf72023-10-29T12:05:09ZengBMCBMC Musculoskeletal Disorders1471-24742023-10-012411910.1186/s12891-023-06967-wFat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spineMaximilian Muellner0Henryk Haffer1Erika Chiapparelli2Yusuke Dodo3Jennifer Shue4Ek T. Tan5Jiaqi Zhu6Matthias Pumberger7Andrew A. Sama8Frank P. Cammisa9Federico P. Girardi10Alexander P. Hughes11Spine Care Institute, Hospital for Special SurgerySpine Care Institute, Hospital for Special SurgerySpine Care Institute, Hospital for Special SurgerySpine Care Institute, Hospital for Special SurgerySpine Care Institute, Hospital for Special SurgeryDepartment of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell MedicineBiostatistics Core, Hospital for Special SurgeryCenter for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu BerlinSpine Care Institute, Hospital for Special SurgerySpine Care Institute, Hospital for Special SurgerySpine Care Institute, Hospital for Special SurgerySpine Care Institute, Hospital for Special SurgeryAbstract Background The function of the paraspinal muscles and especially the psoas muscle in maintaining an upright posture is not fully understood. While usually considered solely as a hip flexor, the psoas muscle and its complex anatomy suggest that the muscle has other functions involved in stabilizing the lumbar spine. The aim of this study is to determine how the psoas muscle and the posterior paraspinal muscles (PPM; erector spinae and multifidus) interact with each other. Methods A retrospective review including patients undergoing posterior lumbar fusion surgery between 2014 and 2021 at a tertiary care center was conducted. Patients with a preoperative lumbar magnetic resonance imaging (MRI) scan performed within 12 months prior to surgery were considered eligible. Exclusion criteria included previous spinal surgery at any level, lumbar scoliosis with a Cobb Angle > 20° and patients with incompatible MRIs. MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA) and the fat area (FAT) at L4 was conducted. The degree of fat infiltration (FI) was further calculated. FI thresholds for FIPPM were defined according to literature and patients were divided into two groups (< or ≥ 50% FIPPM). Results One hundred ninetypatients (57.9% female) with a median age of 64.7 years and median BMI of 28.3 kg/m2 met the inclusion criteria and were analyzed. Patients with a FIPPM ≥ 50% had a significantly lower FI in the psoas muscle in both sexes. Furthermore, a significant inverse correlation was evident between FIPPM and FIPsoas for both sexes. A significant positive correlation between FATPPM and fCSAPsoas was also found for both sexes. No significant differences were found for both sexes in both FIPPM groups. Conclusion As the FIPPM increases, the FIPsoas decreases. Increased FI is a surrogate marker for a decrease in muscular strength. Since the psoas and the PPM both segmentally stabilize the lumbar spine, these results may be indicative of a potential compensatory mechanism. Due to the weakened PPM, the psoas may compensate for a loss in strength in order to stabilize the spine segmentally.https://doi.org/10.1186/s12891-023-06967-wConnective tissueMuscle qualitySpinal fusionSpineLumbar lordosisSpinal stability |
| spellingShingle | Maximilian Muellner Henryk Haffer Erika Chiapparelli Yusuke Dodo Jennifer Shue Ek T. Tan Jiaqi Zhu Matthias Pumberger Andrew A. Sama Frank P. Cammisa Federico P. Girardi Alexander P. Hughes Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine BMC Musculoskeletal Disorders Connective tissue Muscle quality Spinal fusion Spine Lumbar lordosis Spinal stability |
| title | Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine |
| title_full | Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine |
| title_fullStr | Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine |
| title_full_unstemmed | Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine |
| title_short | Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine |
| title_sort | fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle a potential compensatory mechanism in the lumbar spine |
| topic | Connective tissue Muscle quality Spinal fusion Spine Lumbar lordosis Spinal stability |
| url | https://doi.org/10.1186/s12891-023-06967-w |
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