Guven Ali E, Schönnagel Lukas, Chiapparelli Erika, Camino-Willhuber Gaston, Zhu Jiaqi, Caffard Thomas, Arzani Artine, Finos Kyle, Nathoo Isaac, Amoroso Krizia, Shue Jennifer, Sama Andrew A, Cammisa Frank P, Girardi Federico P, Hughes Alexander P
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). 2025 May 15;50(10):702-706. doi: 10.1097/BRS.0000000000005113. Epub 2024 Aug 1.
A retrospective cross-sectional study.
To evaluate the relationship between lumbar foraminal stenosis (LFS) and multifidus muscle atrophy.
The multifidus muscle is an important stabilizer of the lumbar spine. In LFS, the compression of the segmental nerve can give rise to radicular symptoms and back pain. LFS can impede function and induce atrophy of the segmentally innervated multifidus muscle.
Patients with degenerative lumbar spinal conditions who underwent posterior spinal fusion for degenerative lumbar disease from December 2014 to February 2024 were analyzed. Multifidus fatty infiltration (FI) and functional cross-sectional area (fCSA) were determined at the L4 upper endplate axial level on T2-weighted MRI scans using dedicated software. The severity of LFS was assessed at all lumbar levels and sides using the Lee classification (grade: 0-3). For each level, Pfirrmann and Weishaupt gradings were used to assess intervertebral disc disease (IVDD) and facet joint osteoarthritis (FJOA), respectively. Multivariable linear mixed models were run for the LFS grade of each level and side separately as the independent predictor of multifidus FI and fCSA. Each analysis was adjusted for age, sex, BMI, as well as FJOA and IVDD of the level corresponding to the LFS.
A total of 216 patients (50.5% female) with a median age of 61.6 years (interquartile range=52.0-69.0) and a median BMI of 28.1 kg/m 2 (interquartile range=24.8-33.0) were included. Linear mixed model analysis revealed that higher multifidus FI [estimate (CI)=1.7% (0.1-3.3), P =0.043] and lower fCSA [-18.6 mm 2 (-34.3 to -2.6), P =0.022] were both significantly predicted by L2-L3 level LFS severity.
The observed positive correlation between upper segment LFS and multifidus muscle atrophy points toward compromised innervation. This necessitates further research to establish the causal relationship and guide prevention efforts.
一项回顾性横断面研究。
评估腰椎管狭窄症（LFS）与多裂肌萎缩之间的关系。
多裂肌是腰椎的重要稳定肌。在腰椎管狭窄症中，节段性神经受压可引起神经根症状和背痛。腰椎管狭窄症会妨碍功能并导致节段性支配的多裂肌萎缩。
分析2014年12月至2024年2月因退变性腰椎疾病接受后路脊柱融合术的退变性腰椎疾病患者。使用专用软件在T2加权MRI扫描的L4上终板轴向层面确定多裂肌脂肪浸润（FI）和功能横截面积（fCSA）。使用Lee分类法（分级：0 - 3级）评估所有腰椎节段和双侧的腰椎管狭窄症严重程度。对于每个节段，分别使用Pfirrmann分级和Weishaupt分级评估椎间盘疾病（IVDD）和小关节骨关节炎（FJOA）。分别以每个节段和双侧的腰椎管狭窄症分级作为多裂肌脂肪浸润和功能横截面积的独立预测因素，运行多变量线性混合模型。每次分析均对年龄、性别、BMI以及与腰椎管狭窄症相应节段的小关节骨关节炎和椎间盘疾病进行了校正。
共纳入216例患者（女性占50.5%），中位年龄为61.6岁（四分位间距 = 52.0 - 69.0），中位BMI为28.1kg/m²（四分位间距 = 24.8 - 33.0）。线性混合模型分析显示，L2 - L3节段腰椎管狭窄症严重程度显著预测了更高的多裂肌脂肪浸润[估计值（可信区间）= 1.7%（0.1 - 3.3），P = 0.043]和更低的功能横截面积[-18.6mm²（-34.3至 - 2.6），P = 0.022]。
观察到的上段腰椎管狭窄症与多裂肌萎缩之间的正相关表明神经支配受损。这需要进一步研究以确定因果关系并指导预防工作。
