Department of Physical Medicine and Rehabilitation, School of Medicine, Marmara University, Fevzi Çakmak Mh., Muhsin Yazıcıoğlu Cd., No:10, Pendik, 34899, Istanbul, Turkey.
Rheumatol Int. 2021 Mar;41(3):595-603. doi: 10.1007/s00296-020-04781-4. Epub 2021 Jan 27.
Paravertebral muscles are affected in spondyloarthritis. Decreased mobility of spine may lead to atrophy and fatty degeneration of these muscles. The objective of this study was to compare the sonographic, electrophysiological and magnetic resonance imaging (MRI) features of paraspinal muscles between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). The patients who were diagnosed as AS with modified New York criteria and those as nr-axSpA with ASAS 2009 criteria were enrolled. Clinical evaluation, electrophysiological examination including nerve conduction studies and needle electromyography (EMG) for lower extremities and paraspinal mapping (PSM) were performed by the first examiner. The second examiner measured lumbar multifidus areas, graded the fatty degeneration of the muscle at different levels in T2 weighted axial MRI and also performed the ultrasonographic evaluation. A total of 19 patients with AS and 14 patients with nr-axSpA were evaluated. MRI of 2 patients with AS could not be obtained. Right lumbar multifidus area/vertebra area (MV ratio) was smaller in AS patients at L3 level (p 0,029); there were no significant differences in other levels. Fatty degeneration was also higher in AS patients in left multifidus at L5-S1 disc level (p 0,015). PSM scores that demonstrate the extent of denervation in paraspinal muscles were significantly higher in AS patients than in nr-axSpA patients (p < 0,001). Patients with AS have more fatty degeneration and denervation in paraspinal muscles. These processes may also contribute the severity of pain and disability. The relationship between paraspinal muscle denervation and progression of fatty degeneration should further be revealed.
脊柱旁肌肉在强直性脊柱炎中受到影响。脊柱活动度降低可能导致这些肌肉萎缩和脂肪变性。本研究的目的是比较强直性脊柱炎（AS）和非放射学中轴型脊柱关节炎（nr-axSpA）患者的脊柱旁肌肉的超声、电生理和磁共振成像（MRI）特征。符合改良纽约标准的 AS 患者和符合 ASAS 2009 标准的 nr-axSpA 患者被纳入研究。首先由一位检查者进行临床评估、电生理检查（包括下肢神经传导研究和针电极肌电图（EMG））和脊柱旁肌映射（PSM）。第二位检查者测量腰椎多裂肌面积，在 T2 加权轴向 MRI 上对不同水平的肌肉脂肪变性进行分级，并进行超声评估。共评估了 19 例 AS 患者和 14 例 nr-axSpA 患者。2 例 AS 患者的 MRI 无法获得。AS 患者在 L3 水平的右侧腰椎多裂肌面积/椎体面积（MV 比）更小（p 0.029）；在其他水平没有显著差异。在 L5-S1 椎间盘水平，左侧多裂肌的脂肪变性在 AS 患者中也更高（p 0.015）。PSM 评分（显示脊柱旁肌肉失神经程度的指标）在 AS 患者中明显高于 nr-axSpA 患者（p<0.001）。AS 患者的脊柱旁肌肉脂肪变性和失神经程度更高。这些过程也可能导致疼痛和残疾的严重程度增加。脊柱旁肌肉失神经与脂肪变性进展之间的关系需要进一步揭示。
