Lee Donggyu, Kang Minsoo
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Korea.
Healthcare (Basel). 2021 Sep 9;9(9):1189. doi: 10.3390/healthcare9091189.
Sarcopenia is characterized by a decline in systemic muscle mass and physical performance. Disc degeneration also causes back muscle atrophy. Therefore, we aimed to evaluate the influence of systemic muscle mass decline on back muscle atrophy and fatty infiltration compared to disc degeneration. We included 127 patients (65.54 ± 14.93 years) with back pain who underwent lumbar spine magnetic resonance imaging (MRI). Axial T2-weighted MRI data of the L4-5 and L5-S1 levels were used to measure the cross-sectional area (CSA) of the psoas and spinal muscles. The psoas index (cm/m) was used as a surrogate for systemic muscle mass. The Pfirrmann grading system was used to evaluate intervertebral disc degeneration. The functional area of the back muscles was calculated by subtracting the fat infiltration area from the CSA; the functional CSA ratio was calculated by dividing the functional CSA by the CSA. Image-processing software (ImageJ; National Institutes of Health, Bethesda, MD, USA) was used for analysis. Psoas index and aging significantly affected CSA and the ratio of functional CSA of the back muscles and multifidi. Disc degeneration did not significantly affect the back muscles beyond aging in patients with back pain. Males showed substantially higher CSA of the back muscles and multifidi than females; however, sex did not affect the functional CSA ratio of these muscles. Systemic muscle mass decline showed a more powerful influence on back muscle atrophy and fatty infiltration than disc degeneration. Therefore, proper evaluation of sarcopenia is needed for patients with chronic back pain and back muscle degeneration.
肌肉减少症的特征是全身肌肉量和身体机能下降。椎间盘退变也会导致背部肌肉萎缩。因此，我们旨在评估全身肌肉量下降与椎间盘退变相比，对背部肌肉萎缩和脂肪浸润的影响。我们纳入了127例（65.54±14.93岁）有背痛症状且接受了腰椎磁共振成像（MRI）检查的患者。使用L4-5和L5-S1水平的轴向T2加权MRI数据来测量腰大肌和脊柱旁肌肉的横截面积（CSA）。腰大肌指数（cm/m）用作全身肌肉量的替代指标。采用Pfirrmann分级系统评估椎间盘退变情况。通过从CSA中减去脂肪浸润面积来计算背部肌肉的功能面积；功能CSA比率通过将功能CSA除以CSA来计算。使用图像处理软件（ImageJ；美国国立卫生研究院，马里兰州贝塞斯达）进行分析。腰大肌指数和年龄显著影响背部肌肉和多裂肌的CSA以及功能CSA比率。在有背痛的患者中，除了年龄因素外，椎间盘退变对背部肌肉没有显著影响。男性的背部肌肉和多裂肌CSA显著高于女性；然而，性别并不影响这些肌肉的功能CSA比率。与椎间盘退变相比，全身肌肉量下降对背部肌肉萎缩和脂肪浸润的影响更大。因此，对于慢性背痛和背部肌肉退变的患者，需要对肌肉减少症进行适当评估。
