Vitale Jacopo A, Mannion Anne F, Haschtmann Daniel, Ropelato Mario, Fekete Tamás F, Kleinstück Frank S, Loibl Markus, Haltiner Tina, Galbusera Fabio
Spine Group, Schulthess Klinik, Zürich, Switzerland.
Zürich University of Applied Sciences ZHAW, Zürich, Switzerland.
Brain Spine. 2024 Oct 16;4:103916. doi: 10.1016/j.bas.2024.103916. eCollection 2024.
Epimuscular fat (EF) has rarely been studied in the context of low back pain (LBP).
This study aims to assess the presence and extent of EF in the lumbar muscles and its association with vertebral level in patients with low back disorders and to explore correlations between EF, demographics, BMI, and LBP.
T2 axial MRIs from L1 to L5 were manually segmented to analyze the cross-sectional area (CSA) of EF (mm), and fat infiltration (FI,%) of 40 patients (23 females, 17 males; mean age:65.9 years) with lumbar degenerative pathologies awaiting a surgical procedure. COMI, LBP, demographic, and clinical data were extracted from the institutional registry. Statistical analyses included Wilcoxon and Mann-Whitney tests for differences in EF between sides and sexes, the Friedman test for EF size differences among lumbar levels, and Spearman's correlation for associations, adjusted for BMI, age, and sex.
EF was found in 77.5% of subjects at L1, 92.5% at L2, 100% at L3 and L4, and 95.0% at L5. EF was significantly larger at L4 (253.1 ± 183.6 mm) and L5 (220.2 ± 194.9 mm) than at L1 (36.1 ± 37.8 mm) and L2 (72.2 ± 84.4 mm). No significant EF differences were found between sides and sexes. EF correlated strongly with BMI (r = 0.65,p < 0.001) and moderately with FI (r = 0.31,p = 0.04), though its correlation with FI was not significant after adjustment. EF did not correlate with COMI scores but correlated with LBP in the adjusted analysis (r:0.31,p = 0.04).
EF is present across all lumbar levels, with higher concentrations at L4 and L5, and a significant correlation between EF and LBP intensity was observed. The present findings are limited to a specific subset of patients with lumbar degenerative disorders who are awaiting surgical procedures.
在腰痛（LBP）的背景下，肌外脂肪（EF）很少被研究。
本研究旨在评估腰椎疾病患者腰椎肌肉中EF的存在情况和范围及其与椎体水平的关联，并探讨EF、人口统计学、体重指数（BMI）和LBP之间的相关性。
对40例（23例女性，17例男性；平均年龄：65.9岁）等待手术的腰椎退行性病变患者从L1至L5的T2轴位磁共振成像（MRI）进行手动分割，以分析EF的横截面积（CSA，mm）和脂肪浸润（FI，%）。从机构登记处提取COMI、LBP、人口统计学和临床数据。统计分析包括Wilcoxon检验和Mann-Whitney检验，用于比较两侧和两性之间EF的差异；Friedman检验用于比较腰椎各水平之间EF大小的差异；Spearman相关性分析用于评估相关性，并对BMI、年龄和性别进行校正。
在L1水平，77.5%的受试者发现有EF；L2水平为92.5%；L3和L4水平为100%；L5水平为95.0%。L4（253.1±183.6mm）和L5（220.2±194.9mm）的EF明显大于L1（36.1±37.8mm）和L2（72.2±84.4mm）。两侧和两性之间未发现EF有显著差异。EF与BMI密切相关（r = 0.65，p < 0.001），与FI中度相关（r = 0.31，p = 0.04），不过校正后其与FI的相关性不显著。EF与COMI评分无相关性，但在校正分析中与LBP相关（r：0.31，p = 0.04）。
EF存在于所有腰椎水平，在L4和L5浓度较高，并且观察到EF与LBP强度之间存在显著相关性。本研究结果仅限于等待手术的特定腰椎退行性疾病患者亚组。
