Orthopedics, Medical Experiment Center, General Hospital of Ningxia Medical University, Yinchuan, China.
Department of Medicine, Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
BMC Musculoskelet Disord. 2021 Jun 12;22(1):536. doi: 10.1186/s12891-021-04411-5.
Degenerative lumbar spinal stenosis (DLSS) is a common degenerative condition in older adults. Muscle atrophy (MA) is a leading cause of muscle weakness and disability commonly reported in individuals with spinal stenosis. The purpose of this study was to investigate if the MA correlates with the grade of spinal stenosis in patients with DLSS.
A retrospective analysis on 48 male and 184 female DLSS patients aged around 54.04 years (54.04 ± 8.93) were involved and divided into 6 groups according to claudication-distance-based grading of spinal stenosis, which confirmed by two independent orthopedic surgeons using T2- weighted images. Using 1.5T MRI scanner, the severity of MA is assessed based on its negative correlation with the ratio of total fat-free multifidus muscle cross-sectional area (TFCSA) to total multifidus muscle cross-sectional area (TCSA). Adobe Photoshop CS6 was used for qualitative image analysis and calculate the TFCSA/TCSA ratio to assess the severity of MA, compare the grade of MA with the spinal stenosis segment, stenosis grade and symptom side.
In DLSS group, The TFCSA/TCSA ratio are 74.33 ± 2.18 in L3/4 stenosis, 75.51 ± 2.79 in L4/5 stenosis, and 75.49 ± 2.69 in L5/S1 stenosis. there were significant decreases in the TFCSA/TCSA ratio of stenotic segments compared with non-stenotic segments of the spinal canal (P < 0.05) while no significant difference between the non-stenotic segments (P > 0.05). TFCSA/TCSA ratios is significant differences in the TFCSA/TCSA ratios of the 6 DLSS groups (F = 67.832; P < 0.05). From Group 1 to Group 6, the TFCSA/TCSA ratio of stenotic segments positively correlated with the absolute claudication distance (ACD). (P < 0.001, r = 0.852). Besides, the TFCSA/TCSA ratios are smaller in the symptomatic sides of the spine than the contralateral sides (t = 4.128, P = 0.001).
The stenotic segments of the spinal canal are more atrophied than the non-stenotic segment in DLSS patients. It is shows that a strong positive correlation between the severity of multifidus atrophy and the severity of spinal stenosis.
退行性腰椎管狭窄症（DLSS）是老年人常见的退行性疾病。肌肉萎缩（MA）是椎管狭窄患者常见的肌肉无力和残疾的主要原因。本研究的目的是探讨 MA 是否与 DLSS 患者的椎管狭窄程度相关。
对 48 名男性和 184 名女性 DLSS 患者进行回顾性分析，年龄约为 54.04 岁（54.04 ± 8.93），根据跛行距离为基础的椎管狭窄分级，分为 6 组，由两位独立的骨科医生使用 T2 加权图像确认。使用 1.5T MRI 扫描仪，根据其与多裂肌总脂肪游离横截面积（TFCSA）与多裂肌总横截面积（TCSA）的比值的负相关关系，评估 MA 的严重程度。使用 Adobe Photoshop CS6 进行定性图像分析，并计算 TFCSA/TCSA 比值，以评估 MA 的严重程度，比较 MA 的程度与椎管狭窄节段、狭窄程度和症状侧。
在 DLSS 组中，L3/4 狭窄的 TFCSA/TCSA 比值为 74.33 ± 2.18，L4/5 狭窄为 75.51 ± 2.79，L5/S1 狭窄为 75.49 ± 2.69。与椎管非狭窄节段相比，狭窄节段的 TFCSA/TCSA 比值显著降低（P < 0.05），而椎管非狭窄节段之间无显著差异（P > 0.05）。在 6 个 DLSS 组中，TFCSA/TCSA 比值有显著差异（F = 67.832；P < 0.05）。从第 1 组到第 6 组，狭窄节段的 TFCSA/TCSA 比值与绝对跛行距离（ACD）呈正相关（P < 0.001，r = 0.852）。此外，脊柱症状侧的 TFCSA/TCSA 比值小于对侧（t = 4.128，P = 0.001）。
在 DLSS 患者中，椎管狭窄节段比非狭窄节段更易萎缩。这表明多裂肌萎缩的严重程度与椎管狭窄的严重程度之间存在很强的正相关关系。
