Zhang Cong, Sun Rui, Wu Xiaotao, Sun Xiaozhi
Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
Surgery Research Center, School of Medicine, Southeast University, Nanjing, China.
Front Med (Lausanne). 2025 Jun 11;12:1609660. doi: 10.3389/fmed.2025.1609660. eCollection 2025.
We evaluated differences in multifidus muscle atrophy (MMA) among patients with degenerative lumbar spondylolisthesis (DLS) across various segments and grades of spondylolisthesis, analysed the correlation between DLS and MMA, identified risk factors contributing to MMA, and provided a clinical reference for the prevention and treatment of MMA.
This retrospective study analysed data from 213 patients diagnosed with single-segment DLS between September 2020 and January 2022. Participants were categorised into three groups based on the affected spinal segment: L3 ( = 27), L4 ( = 140), and L5 ( = 46). The LCSA/GCSA ratio was calculated to assess the extent of MMA. Differences in MMA and its correlation with DLS severity were analysed across different spondylolisthesis grades. Furthermore, based on the Kjaer classification, patients were stratified into Mild and Severe MMA groups. A multivariate logistic regression analysis was performed to identify risk factors influencing the degree of MMA in DLS patients.
The LCSA/GCSA ratio at the spondylolisthesis segment was significantly lower than that at the non-spondylolisthesis segment ( < 0.001). When comparing LCSA/GCSA ratios between different grades of lumbar spondylolisthesis (Grade I and II), no statistically significant differences were observed ( > 0.05). In the general population, a strong positive correlation was identified between the degree of MMA and the VAS and ODI scores for low back pain, whereas no significant correlation was found with the VAS score for leg pain. Age, BMI, and osteoporosis demonstrated statistically significant differences between the two groups ( < 0.05). Multivariate logistic regression analysis identified age, BMI, and osteoporosis as significant risk factors for MMA progression in DLS patients ( < 0.05).
DLS patients exhibit MMA, with more pronounced atrophy at the spondylolisthesis-affected segment. Age, BMI, and osteoporosis are independent risk factors for MMA progression in DLS patients. Clinically, it is crucial to identify and monitor high-risk patients with these factors and implement early preventive and therapeutic interventions to mitigate disease progression.
我们评估了退行性腰椎滑脱（DLS）患者在不同腰椎滑脱节段和分级中多裂肌萎缩（MMA）的差异，分析了DLS与MMA之间的相关性，确定了导致MMA的危险因素，并为MMA的防治提供临床参考。
这项回顾性研究分析了2020年9月至2022年1月期间诊断为单节段DLS的213例患者的数据。根据受影响的脊柱节段将参与者分为三组：L3组（n = 27）、L4组（n = 140）和L5组（n = 46）。计算腰大肌横截面积（LCSA）与竖脊肌横截面积（GCSA）的比值以评估MMA的程度。分析不同腰椎滑脱分级中MMA的差异及其与DLS严重程度的相关性。此外，根据凯尔分类法，将患者分为轻度和重度MMA组。进行多因素逻辑回归分析以确定影响DLS患者MMA程度的危险因素。
腰椎滑脱节段的LCSA/GCSA比值显著低于非腰椎滑脱节段（P < 0.001）。比较不同程度腰椎滑脱（I级和II级）之间的LCSA/GCSA比值时，未观察到统计学上的显著差异（P > 0.05）。在总体人群中，MMA程度与下腰痛的视觉模拟评分（VAS）和功能障碍指数（ODI）评分之间存在强烈的正相关，而与腿痛的VAS评分未发现显著相关性。两组之间的年龄、体重指数（BMI）和骨质疏松症存在统计学上的显著差异（P < 0.05）。多因素逻辑回归分析确定年龄、BMI和骨质疏松症是DLS患者MMA进展的显著危险因素（P < 0.05）。
DLS患者存在MMA，在受腰椎滑脱影响的节段萎缩更为明显。年龄、BMI和骨质疏松症是DLS患者MMA进展的独立危险因素。临床上，识别和监测具有这些因素的高危患者并实施早期预防和治疗干预以减轻疾病进展至关重要。
