Enhanced Grading Methods for Lumbar Paraspinal Fat Infiltration and Its Prognostic Value in Predicting Lumbar Disc Herniation

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2023 Oct 4

PMID 37794405

Authors

Gang Wen

Wanmei Hou

Guangwei Xu

Affiliations

Soon will be listed here.

Abstract

Background: The simplified 3-grade system for measuring fat infiltration in the paraspinal muscles is widely utilized. In comparing our proposed 4-grade system to the existing 3-grade system, we evaluated its impact on results and particularly its ability to predict disc herniation, ultimately highlighting deficiencies in the latter. The objective of this investigation was to validate the efficacy of our newly proposed semi-quantitative simplified 4-grade system for assessing fat infiltration, as compared to the existing literature-based simplified 3-grade system, in terms of their predictive value for lumbar disc herniation.

Methods: Infiltration of the right and left lumbar multifidus and erector spinae muscles were assessed using a semi-quantitative 3- and 4-grade fat infiltration system on axial magnetic resonance imaging sections at the L3-S1 level in all subjects, with comparison of results between groups. The correlation between these grading systems and lumbar disc herniation was investigated.

Results: The simplified 3-degree system for measuring fat infiltration was not effective in predicting lumbar disc herniation (p > 0.05), while the 4-degree system proved to be useful in predicting it (p < 0.05). In both grading systems, females were found to have a higher risk of lumbar disc herniation than males (p < 0.05), and the risk increased with age and body mass index (BMI) (p < 0.001).

Conclusions: It was observed that using the 4-grade fat infiltration system to determine the level of fat infiltration in the paraspinal muscles is more effective in predicting lumbar disc herniation compared to the 3-grade system. The 4-grade fat infiltration grading system proves to be an efficient semi-quantitative method that can replace the simplified 3-grade system.

Citing Articles

The effect of lumbar multifidus muscle degeneration on upper lumbar disc herniation.

Wang B, Xu L, Teng P, Nie L, Yue H Front Surg. 2024; 11:1323939.

PMID: 39600535 PMC: 11588698. DOI: 10.3389/fsurg.2024.1323939.

References

Hu Z, He J, Zhao F, Fang X, Zhou L, Fan S . An assessment of the intra- and inter-reliability of the lumbar paraspinal muscle parameters using CT scan and magnetic resonance imaging. Spine (Phila Pa 1976). 2011; 36(13):E868-74. DOI: 10.1097/BRS.0b013e3181ef6b51. View

Kalichman L, Klindukhov A, Li L, Linov L . Indices of Paraspinal Muscles Degeneration: Reliability and Association With Facet Joint Osteoarthritis: Feasibility Study. Clin Spine Surg. 2016; 29(9):465-470. DOI: 10.1097/BSD.0b013e31828be943. View

Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C . The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73(6):968-74. DOI: 10.1136/annrheumdis-2013-204428. View

Min J, Choi H, Rhee W, Lee J . Association between radiculopathy and lumbar multifidus atrophy in magnetic resonance imaging. J Back Musculoskelet Rehabil. 2013; 26(2):175-81. DOI: 10.3233/BMR-130365. View

Fortin M, Videman T, Gibbons L, Battie M . Paraspinal muscle morphology and composition: a 15-yr longitudinal magnetic resonance imaging study. Med Sci Sports Exerc. 2013; 46(5):893-901. DOI: 10.1249/MSS.0000000000000179. View

Kreiner D, Hwang S, Easa J, Resnick D, Baisden J, Bess S . An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2013; 14(1):180-91. DOI: 10.1016/j.spinee.2013.08.003. View

Kuligowski T . Prevalence of Lumbar Segmental Instability in Young Individuals with the Different Types of Lumbar Disc Herniation-Preliminary Report. Int J Environ Res Public Health. 2022; 19(15). PMC: 9368739. DOI: 10.3390/ijerph19159378. View

Zhao X, Liang H, Hua Z, Li W, Li J, Wang L . The morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation. BMC Musculoskelet Disord. 2022; 23(1):994. PMC: 9673353. DOI: 10.1186/s12891-022-05968-5. View

Niemelainen R, Briand M, Battie M . Substantial asymmetry in paraspinal muscle cross-sectional area in healthy adults questions its value as a marker of low back pain and pathology. Spine (Phila Pa 1976). 2011; 36(25):2152-7. DOI: 10.1097/BRS.0b013e318204b05a. View

10.

Hides J, Gilmore C, Stanton W, Bohlscheid E . Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2006; 13(1):43-9. DOI: 10.1016/j.math.2006.07.017. View

11.

Kong W, Goel V, Gilbertson L, Weinstein J . Effects of muscle dysfunction on lumbar spine mechanics. A finite element study based on a two motion segments model. Spine (Phila Pa 1976). 1996; 21(19):2197-206; discussion 2206-7. DOI: 10.1097/00007632-199610010-00004. View

12.

Suri P, Fry A, Gellhorn A . Do Muscle Characteristics on Lumbar Spine Magnetic Resonance Imaging or Computed Tomography Predict Future Low Back Pain, Physical Function, or Performance? A Systematic Review. PM R. 2015; 7(12):1269-1281. DOI: 10.1016/j.pmrj.2015.04.016. View

13.

DAprile P, Tarantino A, Jinkins J, Brindicci D . The value of fat saturation sequences and contrast medium administration in MRI of degenerative disease of the posterior/perispinal elements of the lumbosacral spine. Eur Radiol. 2006; 17(2):523-31. DOI: 10.1007/s00330-006-0324-0. View

14.

Battaglia P, Maeda Y, Welk A, Hough B, Kettner N . Reliability of the Goutallier classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging. J Manipulative Physiol Ther. 2014; 37(3):190-7. DOI: 10.1016/j.jmpt.2013.12.010. View

15.

Kumar Y, Hayashi D . Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC Musculoskelet Disord. 2016; 17:310. PMC: 4957861. DOI: 10.1186/s12891-016-1169-6. View

16.

Chen W, Wang K, Yuan W, Zhan H . [Relationship between lumbosacral multifidus muscle and lumbar disc herniation]. Zhongguo Gu Shang. 2016; 29(6):581-4. View

17.

Parkkola R, Rytokoski U, Kormano M . Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976). 1993; 18(7):830-6. DOI: 10.1097/00007632-199306000-00004. View

18.

Fortin M, Macedo L . Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Phys Ther. 2013; 93(7):873-88. PMC: 3704232. DOI: 10.2522/ptj.20120457. View

19.

Takayama K, Kita T, Nakamura H, Kanematsu F, Yasunami T, Sakanaka H . New Predictive Index for Lumbar Paraspinal Muscle Degeneration Associated With Aging. Spine (Phila Pa 1976). 2015; 41(2):E84-90. DOI: 10.1097/BRS.0000000000001154. View

20.

Faur C, Patrascu J, Haragus H, Anglitoiu B . Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain. BMC Musculoskelet Disord. 2019; 20(1):414. PMC: 6729014. DOI: 10.1186/s12891-019-2786-7. View