Liu Yang, Liu Yuzeng, Hai Yong, Liu Tie, Guan Li, Chen Xiaolong, Wang Yunsheng
Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, The Third Clinical Medical College of Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing 100020, China; Department of Orthopedics, Capital Medical University Teaching Hospital, Beijing Electric Power Hospital of State Grade, TaiPingQiaoXiLi Jia 1#, Fengtai District, Beijing 100073, China.
Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, The Third Clinical Medical College of Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing 100020, China.
J Clin Neurosci. 2020 May;75:139-148. doi: 10.1016/j.jocn.2020.03.001. Epub 2020 Mar 10.
The multifidus muscle morphology and its relation to the function of patients with degenerative lumbar spinal stenosis (DLSS) remains unclear. This study aimed to investigate the multifidus muscle morphology in patients with DLSS and to determine its relations to the patients function. Sixty-two patients with single-segment DLSS at L4-5 and sixty control patients with non-spinal-derived low back pain were retrospectively enrolled and further matched based on propensity scores. The Oswestry Disability Index (ODI) and bodily pain using the Short-Form Health Survey were evaluated. The cross-sectional area (CSA), CSA of fatty free (CSAF), and fatty infiltration rate [FIR; i.e., (1- CSAF/CSA) × 100%] of the multifidus muscle were measured on magnetic resonance images using ImageJ software. Adjustment for confounders was performed using generalized linear models. The FIR at L5-S1 in controls was statistically significant but slightly less than the DLSS group. The between-groups difference was 5% (p < 0.001), and 2.8% (p = 0.036) in the complete and matching cohorts, respectively, after adjustment. Statistically significant differences were not observed in other multifidus muscle parameters between the groups. FIR > 20% at L5-S1 was independently associated with ODI ≥ 41 in patients with DLSS [Retaining demography as control block or not, Odds ratio (OR) = 8.4, p = 0.023; OR = 12.3, p = 0.030]. The multifidus muscle at L5-S1 demonstrated slightly greater fatty infiltration in patients with L4-5 single-segment DLSS than controls. Significant fatty infiltration in the multifidus muscle at L5-S1 may be correlated with poor function in patients with L4-5 single-segment DLSS.
多裂肌形态及其与退变性腰椎管狭窄症（DLSS）患者功能的关系尚不清楚。本研究旨在调查DLSS患者的多裂肌形态，并确定其与患者功能的关系。回顾性纳入62例L4-5单节段DLSS患者和60例非脊柱源性腰痛的对照患者，并根据倾向评分进一步匹配。评估了Oswestry功能障碍指数（ODI）和采用简短健康调查问卷的身体疼痛情况。使用ImageJ软件在磁共振图像上测量多裂肌的横截面积（CSA）、无脂肪横截面积（CSAF）和脂肪浸润率[FIR；即(1 - CSAF/CSA)×100%]。使用广义线性模型对混杂因素进行校正。对照组L5-S1节段的FIR有统计学意义，但略低于DLSS组。调整后，完整队列和匹配队列中组间差异分别为5%（p < 0.001）和2.8%（p = 0.036）。两组间其他多裂肌参数未观察到统计学显著差异。DLSS患者中，L5-S1节段FIR > 20%与ODI≥41独立相关[无论是否保留人口统计学作为对照块，比值比（OR）= 8.4，p = 0.023；OR = 12.3，p = 0.030]。L4-5单节段DLSS患者L5-S1节段的多裂肌脂肪浸润略高于对照组。L5-S1节段多裂肌的显著脂肪浸润可能与L4-5单节段DLSS患者的功能不良相关。
