Gao Yuan, Ying Jia, Lai Bowen, Gao Rui, Jiang Heng, Zhou Xuhui
Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's republic of China.
Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's republic of China.
World Neurosurg. 2025 Jun;198:124025. doi: 10.1016/j.wneu.2025.124025. Epub 2025 Apr 29.
While the etiology of adolescent idiopathic scoliosis remains unclear, it is assumed that paraspinal muscle imbalance contributes to curve progression. Previous studies have found the paraspinal muscles imbalance, but no study comprehensively analyzed the roles of different paraspinal muscle layers. Our study distinguished the thoracic paraspinal muscle into superficial, intermediate, and deep layers, and analyzed the imbalance of the 3 layers.
We retrospectively included adolescent idiopathic scoliosis patients with thoracic curve. The paraspinal muscle parameters including relative muscle cross-sectional area (rmCSA) and fatty infiltration in upper end vertebra, apical vertebra, and lower end vertebra regions and in superficial, intermediate, and deep layers were calculated. The parameters between convex and concave sides were compared by paired t-test. The correlation between paraspinal muscle parameters and radiographic parameters was tested by Spearman correlation analysis.
A total of 46 patients were included. In apical vertebra region, the rmCSA in superficial (P = 0.038), intermediate (P = 0.001), and deep (P = 0.001) layers on convex side was greater than that on concave side, while the fatty infiltration in intermediate (P = 0.023) and deep layers (P = 0.000) on concave side was greater than that on convex side. Radiographic parameters were associated with both intermediate ΔrmCSA (P = 0.002) and deep ΔrmCSA (P = 0.000).
Our research indicates that the severity of paraspinal muscle imbalance is different in three layers, with the deep layer most severe, followed by the intermediate layer, and the superficial layer least severe. The imbalance of deep muscle correlates strongly with radiographic parameters, suggesting its role as a compensatory adaptation to curve magnitude.
虽然青少年特发性脊柱侧凸的病因尚不清楚，但推测椎旁肌失衡会导致侧弯进展。以往研究发现了椎旁肌失衡，但没有研究全面分析不同椎旁肌层的作用。我们的研究将胸段椎旁肌分为浅层、中层和深层，并分析了这三层的失衡情况。
我们回顾性纳入了患有胸段侧弯的青少年特发性脊柱侧凸患者。计算上终椎、顶椎和下终椎区域以及浅层、中层和深层的椎旁肌参数，包括相对肌肉横截面积（rmCSA）和脂肪浸润情况。通过配对t检验比较凸侧和凹侧之间的参数。通过Spearman相关性分析检验椎旁肌参数与影像学参数之间的相关性。
共纳入46例患者。在顶椎区域，凸侧浅层（P = 0.038）、中层（P = 0.001）和深层（P = 0.001）的rmCSA大于凹侧，而凹侧中层（P = 0.023）和深层（P = 0.000）的脂肪浸润大于凸侧。影像学参数与中层ΔrmCSA（P = 0.002）和深层ΔrmCSA（P = 0.000）均相关。
我们的研究表明，椎旁肌失衡的严重程度在三层中有所不同，深层最严重，其次是中层，浅层最不严重。深层肌肉的失衡与影像学参数密切相关，表明其作为对侧弯程度的一种代偿性适应的作用。
