Özcan Ekşi Emel Ece, Ekşi Murat Şakir
Acıbadem Bağdat Caddesi Medical Center, Istanbul, Turkey.
Sağlık Bilimleri Üniversitesi, Istanbul, Turkey.
Eur Spine J. 2025 Jul 21. doi: 10.1007/s00586-025-09165-5.
With increased life expectancy, age-related spinal disorders such as adult degenerative scoliosis (ADS) are becoming more prevalent. However, few studies have comprehensively evaluated the role of lumbar paraspinal muscles in the pathogenesis of ADS. This study aimed to (1) systematically review current literature on the association between paraspinal muscles and ADS and (2) compare lumbar paraspinal muscle fatty infiltration between age- and sex-matched individuals with and without ADS, stratified by treatment type.
For the first part of the study, a systematic literature review was conducted using PubMed/MEDLINE databases, following PRISMA guidelines, to identify studies on the role of paraspinal muscles in ADS. For the second part, a total of 145 participants were evaluated: 40% (n = 58) were controls, 32.4% (n = 47) had conservatively managed ADS, and 27.6% (n = 40) had surgically treated ADS. Fatty infiltration of the multifidus, erector spinae, and psoas muscles was assessed via lumbar spine magnetic resonance imaging at three curve locations: apex, above the apex, and below the apex.
Compared with controls, patients with ADS exhibited significantly higher fatty infiltration in the multifidus, erector spinae, and psoas muscles on the concave and convex sides of the curve. Logistic regression analysis revealed that each one-point increase in fatty infiltration score of the concave-sided multifidus and psoas at the apex was associated with a 2.3-fold and 4.1-fold increased likelihood of having ADS, respectively. Additionally, a one-point increase in fatty infiltration in the concave-sided psoas above the apex and the convex-sided psoas below the apex was associated with 6.9-fold and 2.7-fold increased odds of ADS, respectively.
Fatty infiltration in the psoas muscle may contribute to the early development of ADS, while increased fatty infiltration in the concave-sided multifidus at the apex may influence surgical decision-making. Comprehensive assessment of lumbar paraspinal muscles is essential for optimizing management strategies in patients with ADS.
随着预期寿命的增加，诸如成人退变性脊柱侧凸（ADS）等与年龄相关的脊柱疾病正变得越来越普遍。然而，很少有研究全面评估腰椎旁肌肉在ADS发病机制中的作用。本研究旨在（1）系统回顾关于旁肌肉与ADS之间关联的当前文献，以及（2）比较按治疗类型分层的年龄和性别匹配的有和没有ADS的个体之间的腰椎旁肌肉脂肪浸润情况。
对于研究的第一部分，按照PRISMA指南，使用PubMed/MEDLINE数据库进行系统的文献回顾，以识别关于旁肌肉在ADS中作用的研究。对于第二部分，总共评估了145名参与者：40%（n = 58）为对照组，32.4%（n = 47）患有经保守治疗的ADS，27.6%（n = 40）患有经手术治疗的ADS。通过腰椎磁共振成像在三个曲线位置评估多裂肌、竖脊肌和腰大肌的脂肪浸润情况：顶点、顶点上方和顶点下方。
与对照组相比，ADS患者在曲线凹侧和凸侧的多裂肌、竖脊肌和腰大肌中表现出明显更高的脂肪浸润。逻辑回归分析显示，顶点处凹侧多裂肌和腰大肌脂肪浸润评分每增加一分，患ADS的可能性分别增加2.3倍和4.1倍。此外，顶点上方凹侧腰大肌和顶点下方凸侧腰大肌脂肪浸润每增加一分，患ADS的几率分别增加6.9倍和2.7倍。
腰大肌中的脂肪浸润可能有助于ADS的早期发展，而顶点处凹侧多裂肌中脂肪浸润增加可能会影响手术决策。对腰椎旁肌肉进行全面评估对于优化ADS患者的管理策略至关重要。
