Department of Orthopaedic Surgery, Georges Pompidou European Hospital, APHP, Paris V University, 20 rue Leblanc, 75015, Paris, France.
Laboratoire de Biomécanique Georges Charpak, Ecole Nationale Supérieure des Arts et Métiers, 75013, Paris, France.
Spine Deform. 2021 Nov;9(6):1617-1624. doi: 10.1007/s43390-021-00357-9. Epub 2021 Apr 28.
Spinal muscles are a major component of posture in spinal pathologies and changes to the spine with aging. Specifically, spinopelvic muscles may compensate for underlying anomalies such as pelvic retroversion, knee flexion, and cervical or thoracic spinal balance abnormalities. To increase understanding between muscular characteristics and compensatory mechanisms, this study aimed to compare the volume of spinopelvic muscles in adults with a spinal deformity (ASD) to a control group of well-aligned adult subjects.
Twenty-eight lumbar ASD patients [Cobb angle > 20°, > 40 years old (yo)] were prospectively included and compared to 35 normal subjects divided into 2 different groups: one group of young (Y) subjects (n = 23, < 20 yo) and one group of old (O) subjects (n = 12, > 40 yo). All subjects had a fat/water separation MRI (from C7 to the knees). Volumetric 3D reconstructions of 30 spinopelvic muscles were performed and muscles volumes were compared.
Mean age was 60 ± 16 yo, without significant differences between the ASD and O groups (57 ± 11 yo). Age and BMI were smaller in the young group. Mean Cobb angle of the ASD group was 45 ± 11°. Comparing the ASD and O groups, total muscular volume was similar; however, erector spinae (0.24 ± 0.06 vs 0.68 ± 0.08 dm, p = 0.001), iliopsoas (0.49 ± 0.09 vs 0.60 ± 0.09 dm, p = 0.001) and obliquus (0.42 ± 0.08 vs 0.50 ± 0.08 dm, p = 0.02) were significantly smaller in the ASD group. Comparing the Y and the ASD groups, total muscular volume was higher in the Y group than the ASD group (+ 3.3 dm, p = 0.003) and erector spinae (0.24 ± 0.06 vs 0.74 ± 0.08, p = 0.0001), gluteus medius (0.51 ± 0.07 vs 0.62 ± 0.13, p = 0.01) and vastus lateralis (1.33 ± 0.21 vs 2.08 ± 0.29, p = 0.001) were significantly bigger in the Y group.
This is the first study to compare volume of spinopelvic muscles between ASD patients and a control group without spinal deformity. Our results demonstrate that muscular degeneration has a double origin: aging and deformity. Erector spinae, iliopsoas, and obliquus are the muscles most affected by degeneration.
脊柱肌肉是脊柱病变和脊柱老化过程中姿势的主要组成部分。具体来说，脊柱骨盆肌肉可能会代偿骨盆后倾、膝关节屈曲以及颈椎或胸椎脊柱平衡异常等潜在异常。为了增加对肌肉特征和代偿机制的理解，本研究旨在比较脊柱畸形（ASD）成人与脊柱排列良好的成人对照组之间的脊柱骨盆肌肉体积。
前瞻性纳入 28 例腰椎 ASD 患者（Cobb 角>20°，>40 岁），并与 35 名正常受试者进行比较，正常受试者分为两组：一组为年轻（Y）受试者（n=23，<20 岁），另一组为年老（O）受试者（n=12，>40 岁）。所有受试者均进行了脂肪/水分离 MRI（从 C7 到膝关节）。对 30 个脊柱骨盆肌肉进行三维容积重建，并比较肌肉体积。
平均年龄为 60±16 岁，ASD 组和 O 组之间无显著差异（57±11 岁）。年轻组的年龄和 BMI 较小。ASD 组的平均 Cobb 角为 45±11°。与 ASD 组和 O 组相比，总肌肉体积相似；然而，竖脊肌（0.24±0.06 与 0.68±0.08 dm，p=0.001）、髂腰肌（0.49±0.09 与 0.60±0.09 dm，p=0.001）和斜肌（0.42±0.08 与 0.50±0.08 dm，p=0.02）在 ASD 组中明显较小。与 Y 组和 ASD 组相比，Y 组的总肌肉体积高于 ASD 组（+3.3 dm，p=0.003），竖脊肌（0.24±0.06 与 0.74±0.08，p=0.0001）、臀中肌（0.51±0.07 与 0.62±0.13，p=0.01）和股外侧肌（1.33±0.21 与 2.08±0.29，p=0.001）也较大。
这是第一项比较 ASD 患者与无脊柱畸形对照组之间脊柱骨盆肌肉体积的研究。我们的结果表明，肌肉退化有双重起源：衰老和畸形。竖脊肌、髂腰肌和斜肌是退化最严重的肌肉。
