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Osteoporosis International : a Journal... Dec 2022Osteosarcopenia is a common condition among elderly and postmenopausal female patients. Site-specific bone mineral density is more predictive of bone-related...
The association between lumbar paraspinal muscle functional cross-sectional area on MRI and regional volumetric bone mineral density measured by quantitative computed tomography.
UNLABELLED
Osteosarcopenia is a common condition among elderly and postmenopausal female patients. Site-specific bone mineral density is more predictive of bone-related complications. Few studies have investigated muscle-bone associations. Our results demonstrated that in women, significant positive associations between paraspinal muscles FCSA and vBMD exist at different lumbosacral levels. These regional differences should be considered when interpreting bone-muscle associations in the lumbar spine.
INTRODUCTION
There is increasing evidence between bone and muscle volume associations. Previous studies have demonstrated comorbidity between osteoporosis and sarcopenia. Recent studies showed that sarcopenic subjects had a fourfold higher risk of concomitant osteoporosis compared to non-sarcopenic individuals. Although site-specific bone mineral density (BMD) assessments were reported to be more predictive of bone-related complications after spinal fusions than BMD assessments in general, there are few studies that have investigated level-specific bone-muscle interactions. The aim of this study is to investigate the associations between muscle functional cross-sectional area (FCSA) on magnetic resonance imaging (MRI) and site-specific quantitative computed tomography (QCT) volumetric bone mineral density (vBMD) in the lumbosacral region among spine surgery patients.
METHODS
We retrospectively reviewed a prospective institutional database of posterior lumbar fusion patients. Patients with available MRI undergoing posterior lumbar fusion were included. Muscle measurements and FCSA were conducted and calculated utilizing a manual segmentation and custom-written program at the superior endplate of the L3-L5 vertebrae level. vBMD measurements were performed and calculated utilizing a QCT pro software at L1-L2 levels and bilateral sacral ala. We stratified by sex for all analyses.
RESULTS
A total of 105 patients (mean age 61.5 years and 52.4% females) were included. We found that female patients had statistically significant lower muscle FCSA than male patients. After adjusting for age and body mass index (BMI), there were statistically significant positive associations between L1-L2 and S1 vBMD with L3 psoas FCSA as well as sacral ala vBMD with L3 posterior paraspinal and L5 psoas FCSA. These associations were not found in males.
CONCLUSIONS
Our results demonstrated that in women, significant positive associations between the psoas and posterior paraspinal muscle FCSA and vBMD exist in different lumbosacral levels, which are independent of age and BMI. These regional differences should be considered when interpreting bone and muscle associations in the lumbar spine.
Topics: Female; Humans; Male; Aged; Middle Aged; Lumbosacral Region; Bone Density; Paraspinal Muscles; Retrospective Studies; Prospective Studies; Tomography, X-Ray Computed; Lumbar Vertebrae; Magnetic Resonance Imaging; Osteoporosis
PubMed: 35933479
DOI: 10.1007/s00198-022-06430-x -
Studies in Health Technology and... 2006Posterior lumbar spinal fusion is a common surgery of spine. The parapsinal muscular dysfunction was postulated to be due to injured paraspinal muscle inflicted by the... (Comparative Study)
Comparative Study
Posterior lumbar spinal fusion is a common surgery of spine. The parapsinal muscular dysfunction was postulated to be due to injured paraspinal muscle inflicted by the surgery. To better understand the muscle dysfunction after spinal fusion, this descriptive study evaluated electrophysiology and histology changes in paraspinal muscle of rabbits with and without fusion. Three New Zealand white rabbits underwent 2-level posterior spinal fusion with instrumentation. Anothor 3 rabbits underwent surgical exposure alone and served as sham control. Pre-operative and follow-up electromyography (EMG) and histological assessment were performed in a 6-month interval. All fusion achieved solid union judged by post-mortem examination. Root mean square (RMS) of EMG showed decrease in both fusion and control group immediately after surgery, but the control group recovered to pre-operative value at 6 months follow-up. At 6 months after operation, the fusion group showed lower RMS in fused region than adjacent region. In term of median frequency (MF) changes, the control group did not show obvious difference between pre- and post-operative period. However, fusion group showed obvious decrease of MF in fusion region, but increase in lower adjacent region. Histology reviewed fatty infiltration in fusion region at 6 months after spinal fusion. In addition, the muscle fiber size presented smaller in fusion region than that of pre-operative status. These results would demonstrate the lower activities and muscle disuse atrophy of paraspinal muscles in the fusion region. While, higher muscular activities were found in the lower adjacent region, which may indicate muscle hypertrophy.
Topics: Animals; Electromyography; Hong Kong; Models, Animal; Muscle Fibers, Skeletal; Muscle, Skeletal; Muscular Atrophy; Rabbits; Spinal Fusion
PubMed: 17108469
DOI: No ID Found -
Acta Neurochirurgica Mar 2015Paraspinal neurogenic tumors usually expand into the mediastinum and retroperitoneum and can reach a considerable size before they become symptomatic. Such large tumors...
BACKGROUND
Paraspinal neurogenic tumors usually expand into the mediastinum and retroperitoneum and can reach a considerable size before they become symptomatic. Such large tumors are rare. We describe 14 cases of large schwannomas (>2.5 cm ø) with mild and late onset of symptoms, which were treated with total surgical resection through a single-approach surgery.
METHODS
In 2013 14 patients with paraspinal large schwannomas were treated in our institutions. Data were analyzed retrospectively. Magnetic resonance imaging (MRI) showed lesions suspicious for a paraspinal schwannoma with partial intraforaminal growth. In case of ambiguity regarding tumor dignity, a needle biopsy was performed before final treatment. Three different approaches and their indications were discussed.
RESULTS
Fourteen patients (7 female and 7 male, ages 18-58 years, mean: 39.8 years) requiring surgical exploration because of a thoracic (6) or lumbar/lumbosacral (8) lesion were treated in our institutions. Two patients received CT-guided needle biopsy preoperatively. Complete resection of the schwannoma was possible through a mini-thoracotomy in 1 case (7 %), a retroperitoneal approach in 2 cases (14 %), and dorsal interlaminar and intercostal fenestration in 11 cases (79 %). Histological examination revealed the diagnosis of schwannoma (WHO grade I) in all cases except one with neurofibroma (WHO grade I). There were no major complications in any case.
CONCLUSION
Large benign schwannomas are rare. They need a tailored treatment, which in most cases works through one surgical approach. Usually it is possible to perform a complete resection with a good postoperative prognosis.
Topics: Adolescent; Adult; Female; Humans; Lumbosacral Region; Male; Middle Aged; Neurilemmoma; Neurofibroma; Spinal Cord Neoplasms
PubMed: 25577451
DOI: 10.1007/s00701-014-2320-5 -
Neuroradiology 1994Arteriovenous shunts within the spinal canal and in the paraspinal region are unusual. Spinal cord and dural arteriovenous communications have been the subject of...
Arteriovenous shunts within the spinal canal and in the paraspinal region are unusual. Spinal cord and dural arteriovenous communications have been the subject of numerous reports but paraspinal shunts causing venous congestion in the spinal canal are rarer and may present special problems in diagnosis and management. We describe three children with paraspinal arteriovenous malformations, associated with overt or potential venous congestion in the spinal canal. In each case, the lesion was successfully obliterated by endovascular therapy. Embolisation with permanent occlusive agents is an effective treatment for these rare but potentially debilitating lesions.
Topics: Arteriovenous Malformations; Child; Embolization, Therapeutic; Female; Humans; Infant; Male; Spinal Cord; Spine
PubMed: 8108004
DOI: 10.1007/BF00599202 -
JBJS Case Connector Feb 2021A 54-year-old man presented with low back pain and low-grade fever. Palpation revealed a focal mass of the lumbar region. Radiographs were normal, but magnetic resonance...
CASE
A 54-year-old man presented with low back pain and low-grade fever. Palpation revealed a focal mass of the lumbar region. Radiographs were normal, but magnetic resonance imaging demonstrated a multicystic mass at the level of L2-L4. The initial diagnosis of a hydatid cyst was confirmed after surgical excision.
CONCLUSION
Although primary paraspinal hydatidosis is rare, physicians should be aware of it when dealing with patients suffering from low back pain combined with red-flag symptoms. Especially in rural regions or areas where populations live in close proximity to host animals, primary paraspinal hydatidosis should be included in the differential diagnosis.
Topics: Animals; Echinococcosis; Humans; Low Back Pain; Lumbosacral Region; Magnetic Resonance Imaging; Radiography
PubMed: 33577189
DOI: 10.2106/JBJS.CC.20.00581 -
Scientific Reports Aug 2022The size, shape, and composition of paraspinal muscles have been widely reported in disorders of the cervical and lumbar spine. Measures of size, shape, and composition...
The size, shape, and composition of paraspinal muscles have been widely reported in disorders of the cervical and lumbar spine. Measures of size, shape, and composition have required time-consuming and rater-dependent manual segmentation techniques. Convolutional neural networks (CNNs) provide alternate timesaving, state-of-the-art performance measures, which could realise clinical translation. Here we trained a CNN for the automatic segmentation of lumbar paraspinal muscles and determined the impact of CNN architecture and training choices on segmentation performance. T-weighted MRI axial images from 76 participants (46 female; age (SD): 45.6 (12.8) years) with low back pain were used to train CNN models to segment the multifidus, erector spinae, and psoas major muscles (left and right segmented separately). Using cross-validation, we compared 2D and 3D CNNs with and without data augmentation. Segmentation accuracy was compared between the models using the Sørensen-Dice index as the primary outcome measure. The effect of increasing network depth on segmentation accuracy was also investigated. Each model showed high segmentation accuracy (Sørensen-Dice index ≥ 0.885) and excellent reliability (ICC ≥ 0.941). Overall, across all muscles, 2D models performed better than 3D models (p = 0.012), and training without data augmentation outperformed training with data augmentation (p < 0.001). The 2D model trained without data augmentation demonstrated the highest average segmentation accuracy. Increasing network depth did not improve accuracy (p = 0.771). All trained CNN models demonstrated high accuracy and excellent reliability for segmenting lumbar paraspinal muscles. CNNs can be used to efficiently and accurately extract measures of paraspinal muscle health from MRI.
Topics: Adult; Female; Humans; Image Processing, Computer-Assisted; Low Back Pain; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Neural Networks, Computer; Paraspinal Muscles; Reproducibility of Results
PubMed: 35931772
DOI: 10.1038/s41598-022-16710-5 -
European Spine Journal : Official... Oct 2018Growing evidence suggests an association between lumbar paraspinal muscle degeneration and low back pain (LBP). Currently, time-consuming and laborious manual...
PURPOSE
Growing evidence suggests an association between lumbar paraspinal muscle degeneration and low back pain (LBP). Currently, time-consuming and laborious manual segmentations of paraspinal muscles are commonly performed on magnetic resonance imaging (MRI) axial scans. Automated image analysis algorithms can mitigate these drawbacks, but they often require individual MRIs to be aligned to a standard "reference" atlas. Such atlases are well established in automated neuroimaging analysis. Our aim was to create atlases of similar nature for automated paraspinal muscle measurements.
METHODS
Lumbosacral T2-weighted MRIs were acquired from 117 patients who experienced LBP, stratified by gender and age group (30-39, 40-49, and 50-59 years old). Axial MRI slices of the L4-L5 and L5-S1 levels at mid-disc were obtained and aligned using group-wise linear and nonlinear image registration to produce a set of unbiased population-averaged atlases for lumbar paraspinal muscles.
RESULTS
The resulting atlases represent the averaged morphology and MRI intensity features of the corresponding cohorts. Differences in paraspinal muscle shapes and fat infiltration levels with respect to gender and age can be visually identified from the population-averaged data from both linear and nonlinear registrations.
CONCLUSION
We constructed a set of population-averaged atlases for developing automated algorithms to help analyze paraspinal muscle morphometry from axial MRI scans. Such an advancement could greatly benefit the fields of paraspinal muscle and LBP research. These slides can be retrieved under Electronic Supplementary Material.
Topics: Adult; Age Factors; Algorithms; Atlases as Topic; Female; Humans; Image Processing, Computer-Assisted; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Muscular Atrophy; Paraspinal Muscles; Retrospective Studies; Sex Factors
PubMed: 30051147
DOI: 10.1007/s00586-018-5704-z -
PM & R : the Journal of Injury,... Feb 2018Lumbar spondylolysis is a defect in the pars interarticularis that is common in young athletes; the stress distribution at the pars interarticularis is the highest in...
BACKGROUND
Lumbar spondylolysis is a defect in the pars interarticularis that is common in young athletes; the stress distribution at the pars interarticularis is the highest in extension and rotation movements. The paraspinal muscles play an important role in stabilization of the lumbar spine; however, no study has assessed the properties of paraspinal muscles in athletes with lumbar spondylolysis.
OBJECTIVE
To evaluate the properties of paraspinal muscles in athletes with lumbar spondylolysis.
DESIGN
Cross-sectional study.
SETTING
Laboratory.
PARTICIPANTS
Six high school baseball players with terminal-stage lumbar spondylolysis and 11 high school baseball players without organic lumbar lesions of similar anthropometric characteristics.
METHODS
All subjects performed the unsupported trunk holding test combined with surface electromyographic (EMG) power spectral analysis until exhaustion. The results of EMG power spectral analysis were compared between the spondylolysis and control groups.
MAIN OUTCOME MEASUREMENTS
The median frequency (MF) was computed from the raw EMG signal of the erector spinae and multifidus during trunk holding test using fast Fourier transform spectrum analysis. The initial MF and MF slope were calculated.
RESULTS
No significant differences in endurance time were found between the spondylolysis and control groups. The initial MF and the MF slopes of the erector spinae and multifidus were significantly lower in the spondylolysis group than in the control group.
CONCLUSIONS
The results suggest lower fast-twitch motor unit recruitment in the erector spinae and multifidus of high school baseball players with terminal-stage lumbar spondylolysis compared with the control.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Baseball; Cross-Sectional Studies; Electromyography; Exercise Test; Female; Humans; Japan; Lumbar Vertebrae; Male; Muscle Fatigue; Muscle Strength Dynamometer; Paraspinal Muscles; Schools; Spondylolysis; Students
PubMed: 28673735
DOI: 10.1016/j.pmrj.2017.06.018 -
BMC Musculoskeletal Disorders Dec 2021The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases.
BACKGROUND
The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases.
METHODS
This study retrospectively collected 52 patients who underwent lumbar surgery with the K-rod group or PLIF. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative exercise time were compared in the two groups. The visual analog scale (VAS) score and the oswestry dysfunction index (ODI) were employed to evaluate the clinical outcomes. The functional cross-sectional area (FCSA) of the paraspinal muscles and paraspinal muscles fat infiltration were measured to assess on the paraspinal muscles.
RESULTS
As compared with the PLIF group, the operation time, the postoperative time in the field, and the average postoperative hospital stay in the K-rod internal fixation group were significantly shortened. At the last follow-up, both the groups showed significant improvement in the VAS score and ODI. The FCSA atrophy of the upper and lower adjacent segments (UAS and LAS) of the K-rod internal group was significantly less than that of the PLIF group. The extent of increase in the fatty infiltration of the paraspinal muscles in the K-rod group was significantly lesser than that in the PLIF group. The postoperative low back pain of the two groups of patients was significantly positively correlated with the FCSA atrophy.
CONCLUSIONS
As compared to PLIF, the posterior lumbar unilateral K-rod dynamic internal fixation showed significantly lesser paraspinal muscle atrophy and fatty infiltration, which were significantly positively correlated with postoperative low back pain.
Topics: Fracture Fixation, Internal; Humans; Lumbosacral Region; Paraspinal Muscles; Postoperative Period; Retrospective Studies
PubMed: 34930199
DOI: 10.1186/s12891-021-04943-w -
BMC Musculoskeletal Disorders Nov 2023There is an increasing interest in assessing paraspinal morphology and composition in relation to low back pain (LBP). However, variations in methods and segmentation...
BACKGROUND
There is an increasing interest in assessing paraspinal morphology and composition in relation to low back pain (LBP). However, variations in methods and segmentation protocols contribute to the inconsistent findings in the literature. We present an on-line resource, the ParaspInaL muscLe segmentAtion pRoject (PILLAR, https://projectpillar.github.io/ ), to provide a detailed description and visual guide of a segmentation protocol by using the publicly available ITK-SNAP software and discuss related challenges when performing paraspinal lumbar muscles segmentations from magnetic resonance imaging (MRI).
METHODS
T2-weighted and corresponding fat-water IDEAL axial MRI from 3 males and 3 females (2 chronic LBP and 1 control for each sex) were used to demonstrate our segmentation protocol for each lumbar paraspinal muscle (erector spinae, lumbar multifidus, quadratus lumborum and psoas) and lumbar spinal level (L1-L5).
RESULTS
Proper segmentation requires an understanding of the anatomy of paraspinal lumbar muscles and the variations in paraspinal muscle morphology and composition due to age, sex, and the presence of LBP or related spinal pathologies. Other challenges in segmentation includes the presence and variations of intramuscular and epimuscular fat, and side-to-side asymmetry.
CONCLUSION
The growing interest to assess the lumbar musculature and its role in the development and recurrence of LBP prompted the need for comprehensive and easy-to-follow resources, such as the PILLAR project to reduce inconsistencies in segmentation protocols. Standardizing manual muscle measurements from MRI will facilitate comparisons between studies while the field is progressively moving towards the automatization of paraspinal muscle measurements for large cohort studies.
Topics: Male; Female; Humans; Paraspinal Muscles; Lumbar Vertebrae; Low Back Pain; Lumbosacral Region; Magnetic Resonance Imaging
PubMed: 37996857
DOI: 10.1186/s12891-023-07029-x