Mallio Carlo A, Russo Fabrizio, Vadalà Gianluca, Papalia Rocco, Pileri Matteo, Mancuso Valeria, Bernetti Caterina, Volpecina Manuel, Di Gennaro Gianfranco, Beomonte Zobel Bruno, Denaro Vincenzo
Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
N Am Spine Soc J. 2024 May 1;18:100326. doi: 10.1016/j.xnsj.2024.100326. eCollection 2024 Jun.
Low back pain (LBP) is the most frequent indication to magnetic resonance imaging (MRI) examinations of the lumbosacral spine. The individual role of soft tissues, including muscles, on LBP is not fully understood and the contribution of each MRI-derived parameter of soft tissues status on the intensity of LBP has not been investigated in detail.
The study design was observational retrospective, single center carried out at a University Hospital. Images were acquired using a using a 1.5 Tesla scanner. Patients completed a symptom questionnaire and rated their pain intensity using the Visual Analogue Scale (VAS). The VAS scores were categorized as mild, moderate, and severe using cutoff values of 3.8 and 5.7, based on the literature. Biometric data, including weight and height, were also recorded to calculate the body mass index (BMI). The ratios between intramuscular fat infiltration and net muscle area were also calculated. Patient sample included 94 patients with LBP underwent MRI of the lumbosacral spine.
The stepwise analysis revealed that increasing psoas net area was associated with lower VAS levels (odds ratio [OR]: 0.94: 95% confidence interval [CI]: 0.90-0.98; p=.005), and an increase of one square centimeter of total psoas area resulted in a greater probability of reporting a mild (+1.21%; 95% CI: 0.37, 2.05%) or a moderate VAS (+0.40%; 95% CI: -0.02, 0.82%), Furthermore, a more severe VAS was associated with a higher BMI (OR: 1.13; 95% CI: 1.00-1.27).
Our study demonstrates a relationship between LBP and MRI parameters of paravertebral and psoas muscles status. The psoas muscle is extremely important for spine stabilization and is linked to clinical symptoms of patients affected by LBP. These findings could contribute to future studies and improve treatment options in patients with LBP, possibly reducing the impact on disability, quality of life and socioeconomical burden.
下腰痛（LBP）是腰骶椎磁共振成像（MRI）检查最常见的指征。包括肌肉在内的软组织在LBP中的个体作用尚未完全明确，且软组织状态的每个MRI衍生参数对LBP强度的贡献尚未得到详细研究。
本研究设计为观察性回顾性单中心研究，在一家大学医院进行。使用1.5特斯拉扫描仪采集图像。患者完成症状问卷，并使用视觉模拟量表（VAS）对疼痛强度进行评分。根据文献，使用3.8和5.7的临界值将VAS评分分为轻度、中度和重度。还记录了包括体重和身高在内的生物特征数据，以计算体重指数（BMI）。还计算了肌内脂肪浸润与净肌肉面积的比率。患者样本包括94例接受腰骶椎MRI检查的LBP患者。
逐步分析显示，腰大肌净面积增加与较低的VAS水平相关（优势比[OR]：0.94；95%置信区间[CI]：0.90 - 0.98；p = 0.005），腰大肌总面积每增加1平方厘米，报告轻度（+1.21%；95% CI：0.37，2.05%）或中度VAS（+0.40%；95% CI： - 0.02，0.82%）的可能性就更大。此外，更严重的VAS与更高的BMI相关（OR：1.13；95% CI：1.00 - 1.27）。
我们的研究表明LBP与椎旁肌和腰大肌状态的MRI参数之间存在关联。腰大肌对脊柱稳定极为重要，且与LBP患者的临床症状相关。这些发现可能有助于未来的研究，并改善LBP患者的治疗选择，可能减少对残疾、生活质量和社会经济负担的影响。
