Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Eur Spine J. 2023 Nov;32(11):3979-3986. doi: 10.1007/s00586-023-07921-z. Epub 2023 Sep 12.
While the etiopathogenesis of adolescent idiopathic scoliosis (AIS) remains unclear, it is assumed that muscular asymmetries contribute to curve progression. As previous studies have found asymmetries of the thoracic paraspinal muscles in AIS patients, our study's aim was to analyze differences in the erector spinae, multifidus, quadratus lumborum, and psoas muscles of the lumbar spine depending on the curve's radiographic characteristics.
We retrospectively included all patients who received posterior reposition spondylodesis for AIS treatment at our institution. Patients were classified according to the Lenke classification. Muscle cross-sectional areas were obtained from magnetic resonance imaging of the lumbar spine. Data were analyzed with the Wilcoxon rank sum test, the Kruskal-Wallis test with post hoc testing, or the Spearman's correlation coefficient.
Seventy-four (14 males and 60 females) AIS patients with a median age of 16 (IQR ± 4) years and a mean Cobb angle of 56.0° (± 18.0°) were included. In curve types Lenke 1 and 2 (n = 45), the erector spinae (p < 0.001) and multifidus (p < 0.001) muscles had a significantly larger cross-sectional area on the convex side, whereas the quadratus lumborum (p = 0.034) and psoas (p < 0.001) muscles each had a significantly larger cross-sectional area on the lumbar contralateral side.
Our results show an asymmetry of the lumbar spine's muscles which depends on both the convexity and the extent of the scoliotic curve. While our results cannot prove whether these differences are the deformity's cause or effect, they may contribute to a better understanding of AIS pathogenesis and may allow for more specific preoperative physiotherapy.
尽管青少年特发性脊柱侧凸（AIS）的病因仍然不清楚，但人们认为肌肉不对称会导致曲线进展。由于先前的研究已经发现 AIS 患者的胸段脊柱旁肌存在不对称，因此我们的研究旨在分析腰椎脊柱旁肌的竖脊肌、多裂肌、腰方肌和腰大肌在不同曲度的影像学特征下的差异。
我们回顾性地纳入了所有在我院接受后路复位脊柱融合术治疗 AIS 的患者。患者根据 Lenke 分类进行分类。从腰椎的磁共振成像中获得肌肉横截面积。使用 Wilcoxon 秩和检验、Kruskal-Wallis 检验（带事后检验）或 Spearman 相关系数分析数据。
共纳入 74 例 AIS 患者（14 名男性和 60 名女性），中位年龄为 16 岁（IQR ± 4 岁），平均 Cobb 角为 56.0°（± 18.0°）。在 Lenke 1 型和 2 型（n = 45）曲线类型中，凸侧的竖脊肌（p < 0.001）和多裂肌（p < 0.001）肌肉的横截面积明显更大，而腰方肌（p = 0.034）和腰大肌（p < 0.001）肌肉的横截面积在腰椎对侧明显更大。
我们的结果显示腰椎肌肉的不对称性取决于凸侧和脊柱侧凸的程度。虽然我们的结果不能证明这些差异是畸形的原因还是结果，但它们可能有助于更好地理解 AIS 的发病机制，并可能允许更具体的术前物理治疗。
