Ohyama Shuhei, Aoki Yasuchika, Inoue Masahiro, Nakajima Takayuki, Sato Yusuke, Fukuchi Hiroyuki, Sakai Takayuki, Ochi Shigehiro, Yanagawa Noriyuki, Ohtori Seiji
Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, JPN.
Department of Radiology, Eastern Chiba Medical Center, Togane, JPN.
Cureus. 2021 Oct 1;13(10):e18428. doi: 10.7759/cureus.18428. eCollection 2021 Oct.
Introduction Lumbar degenerative spondylolisthesis (DS) is one of the most common causes of low back pain. The lumbar muscles, such as the psoas major (PM), erector spinae (ES), and multifidus (MF) muscles, play an important role in the stability and functional movement of the lumbar spine. The quantities and qualities of these muscles may be related to the occurrence of DS and lumbopelvic parameters, such as lumbar lordosis (LL) and sacral slope (SS). However,the influence of lumbar muscles on DS and lumbopelvic alignment is not well understood. Methods Patients with L4 DS (DS group, n=25) and without DS (non-DS group, n=25) were included. Using sagittal reconstructed CT images of patients who visited our hospital for reasons other than low back disorders, LL, upper lumbar lordosis ([ULL] L1-L4), lower lumbar lordosis ([LLL] L4-S1), and SS were examined. To evaluate the quantity and quality of lumbar muscles, the gross cross-sectional area (GCSA), functional cross-sectional area (FCSA), and fat infiltration (FI) of the PM, ES, and MF muscles were measured by CT images. The lumbopelvic parameters, FCSA, GCSA, and FI of lumbar muscles were compared between the two groups. Then, each lumbar muscle parameter was analyzed for correlation with DS and lumbopelvic parameters. Results DS patients displayed significantly greater ULL and lower FI of the PM and ES muscles than non-DS patients (p=0.0078, 0.031, and 0.010, respectively). The FI of the ES muscle was significantly correlated with the presence of DS (p=0.010). The FCSA of the ES and MF muscles and the GCSA of the MF muscle showed a significant correlation with LL and SS in the non-DS group (p<0.05), but not in the DS group.. Conclusion ULL was greater in L4 DS patients, possibly related to the better quality of the ES muscle. All DS patients showed mild (grade I) spondylolisthesis, suggesting the possibility that lumbar muscle quality is better in patients with mild DS than in those without DS. The ES and MF muscles may play an important role in maintaining the lumbar lordotic angle in non-DS patients but not in DS patients.
引言 腰椎退行性椎体滑脱（DS）是下腰痛最常见的病因之一。腰大肌（PM）、竖脊肌（ES）和多裂肌（MF）等腰部肌肉在腰椎的稳定性和功能运动中起重要作用。这些肌肉的数量和质量可能与DS的发生以及腰骨盆参数有关，如腰椎前凸（LL）和骶骨倾斜度（SS）。然而，腰部肌肉对DS和腰骨盆排列的影响尚不清楚。方法 纳入L4椎体滑脱患者（DS组，n = 25）和无椎体滑脱患者（非DS组，n = 25）。利用因非下腰部疾病来我院就诊患者的矢状位重建CT图像，检查LL、上腰椎前凸（[ULL] L1-L4）、下腰椎前凸（[LLL] L4-S1）和SS。为评估腰部肌肉的数量和质量，通过CT图像测量PM、ES和MF肌肉的总横截面积（GCSA）、功能横截面积（FCSA）和脂肪浸润（FI）。比较两组患者的腰骨盆参数、腰部肌肉的FCSA、GCSA和FI。然后，分析每个腰部肌肉参数与DS和腰骨盆参数的相关性。结果 与非DS患者相比，DS患者的ULL显著更大，PM和ES肌肉的FI更低（分别为p = 0.0078、0.031和0.010）。ES肌肉的FI与DS的存在显著相关（p = 0.010）。在非DS组中，ES和MF肌肉的FCSA以及MF肌肉的GCSA与LL和SS显著相关（p < 0.05），但在DS组中无相关性。结论 L4椎体滑脱患者的ULL更大，可能与ES肌肉质量较好有关。所有DS患者均表现为轻度（I级）椎体滑脱，提示轻度DS患者的腰部肌肉质量可能优于无DS患者。ES和MF肌肉在非DS患者维持腰椎前凸角度方面可能起重要作用，但在DS患者中并非如此。
