Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY.
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Spine (Phila Pa 1976). 2023 Dec 1;48(23):1627-1634. doi: 10.1097/BRS.0000000000004826. Epub 2023 Sep 12.
Retrospective analysis of longitudinal data.
To assess the association between the paraspinal musculature (PM) and lumbar endplate degeneration.
The PM is essential for spinal stability, while the vertebral endplate is pivotal for nutrient transport and force distribution. The clinical importance of both has been highlighted in recent literature, though little is known about their interaction.
We identified patients with lumbar MRI scans due to low back pain, with a 3-year interval between MRI scans. Endplate damage was assessed by the total endplate score (TEPS) at each lumbar level. The PM was evaluated for its functional cross-sectional area and fatty infiltration (FI) at the L4 level. We used a generalized mixed model to analyze the association between PM parameters and TEPS at timepoint one, adjusting for age, sex, BMI, diabetes, hypertension, and smoking status. The association with the progression of endplate damage was analyzed through an ordinal regression model, additionally adjusted for TEPS at baseline.
In all, 329 patients were included, with a median follow-up time of 3.4 years. Participants had a median age of 59 and a BMI of 25.8 kg/m 2 . In the univariate analysis, FI of the posterior PM was significantly associated with TEPS at baseline (β: 0.08, P <0.001) and progression of TEPS [Odds Ratio (OR): 1.03, P =0.020] after adjustment for confounders. The β and OR in this analysis are per percent of FI. In a binary analysis, patients with FI≥40% had an OR of 1.92 ( P =0.006) for the progression of TEPS.
This is the first longitudinal study assessing the relationship between PM and endplate degeneration, demonstrating the association between PM atrophy and the progression of endplate degeneration. This insight may aid in identifying patients at risk for degenerative lumbar conditions and guide research into preventive measures.
回顾性纵向数据分析。
评估脊柱旁肌肉（PM）与腰椎终板退变之间的关联。
PM 是脊柱稳定性的关键，而椎骨终板对于营养物质运输和力分布至关重要。最近的文献强调了两者的临床重要性，但对它们之间的相互作用知之甚少。
我们确定了因腰痛而接受腰椎 MRI 扫描的患者，两次 MRI 扫描之间的间隔为 3 年。通过每个腰椎水平的总终板评分（TEPS）评估终板损伤。在 L4 水平评估 PM 的功能横截面积和脂肪浸润（FI）。我们使用广义混合模型分析 PM 参数与时间点 1 的 TEPS 之间的关联，同时调整年龄、性别、BMI、糖尿病、高血压和吸烟状况。通过有序回归模型分析与终板损伤进展的关联，另外还调整了基线时的 TEPS。
共纳入 329 例患者，中位随访时间为 3.4 年。参与者的中位年龄为 59 岁，BMI 为 25.8kg/m2。在单变量分析中，PM 后外侧的 FI 与基线时的 TEPS（β：0.08，P<0.001）和 TEPS 的进展显著相关[优势比（OR）：1.03，P=0.020]，调整混杂因素后。该分析中β和 OR 是每百分比 FI 的值。在二元分析中，FI≥40%的患者 TEPS 进展的 OR 为 1.92（P=0.006）。
这是第一项评估 PM 与终板退变之间关系的纵向研究，证明了 PM 萎缩与终板退变进展之间的关联。这一发现可能有助于识别患有退行性腰椎疾病风险的患者，并指导预防措施的研究。
