Mardulyn Tess, Delafontaine Arnaud, Jissendi Patrice, Fabeck Laurent
Orthopaedic Surgery Department, University Hospital Center Saint-Pierre, 1000 Bruxelles, Belgium.
Laboratory of Functional Anatomy, Faculty of Motor Sciences, Free University of Brussels (ULB), 1000 Brussels, Belgium.
J Clin Med. 2025 Mar 20;14(6):2125. doi: 10.3390/jcm14062125.
Low back pain (LBP) may be related to intramuscular fatty infiltration (FI), the topography of which has been the subject of only a few studies. Our goal is therefore to determine the importance and topography of FI at the lumbar level and evaluate its correlation with LBP. We conducted a retrospective study and compared 254 LBP patients who underwent a lumbosacral CT scan with a sample of 115 healthy subjects, all classified into three age groups (≤35, 36-55, and >55 years old). In CT scan images from L2 to S1, muscle density (Hounsfield unit values ranging from -29 to +150), reflecting intramuscular FI, was measured. LBP was further divided into five subgroups of pathologies. There was a significant difference in muscle density between the small and large circles at the L4/L5 and L5/S1 levels in LBP patients, which was not observed in the healthy subjects. In both LBP patients and healthy subjects, a decreasing density gradient was observed from L2 to S1, with a significant difference in density across age groups. LBP patients exhibit lower muscle densities compared to healthy subjects. In LBP patients, fatty infiltration (FI) of the paraspinal muscles is most pronounced in the lower lumbar region and appears to be localized at the level of muscle insertion. This localized muscle deficit differs from the age-related process of FI and may contribute to the development of LBP and discopathies.
下腰痛（LBP）可能与肌肉内脂肪浸润（FI）有关，而关于其分布情况的研究较少。因此，我们的目标是确定腰椎水平FI的重要性和分布情况，并评估其与LBP的相关性。我们进行了一项回顾性研究，将254例接受腰骶部CT扫描的LBP患者与115例健康受试者样本进行比较，所有受试者均分为三个年龄组（≤35岁、36 - 55岁和>55岁）。在L2至S1的CT扫描图像中，测量反映肌肉内FI的肌肉密度（亨氏单位值范围为 - 29至 + 150）。LBP进一步分为五个病理亚组。LBP患者在L4/L5和L5/S1水平的小圈和大圈之间的肌肉密度存在显著差异，而健康受试者中未观察到这种差异。在LBP患者和健康受试者中，从L2到S1均观察到密度梯度降低，且各年龄组之间的密度存在显著差异。与健康受试者相比，LBP患者的肌肉密度较低。在LBP患者中，椎旁肌的脂肪浸润（FI）在腰椎下部最为明显，且似乎局限于肌肉附着水平。这种局部肌肉缺陷不同于与年龄相关的FI过程，可能导致LBP和椎间盘疾病的发生。
