Baysal Begumhan, Dogan Mahmut Bilal, Hindioglu Dogan Nurbanu
Istanbul Medeniyet University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey.
Marmara University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation , Istanbul, Turkey.
Eur Spine J. 2025 Sep 2. doi: 10.1007/s00586-025-09317-7.
The aim of this study is to investigate the role of the cross-sectional area (CSA) of the lumbar paraspinal muscles in the development of degenerative and isthmic spondylolisthesis and its effect on the percentage of slip (PoS).
This retrospective single-center study included 171 patients, 100 of whom were isthmic and 71 patients with degenerative lumbar spondylolisthesis. First, CSAs of bilateral psoas major (PM), erector spinae (ES), and multifidus (MF) muscles were measured using MRI, and then the ratio of muscle areas to L5 vertebral body (VB) area was calculated. PoS was found by dividing the displacement distance of the superior vertebra to the corpus AP diameter of the inferior vertebra on sagittal T2-weighted images. Group comparisons were performed for muscle CSAs, VB ratios, PoS, disc height, and Modic changes, with additional analyses adjusted for age using ANCOVA.
The PoS rate of the degenerative group cases was found to be statistically significantly lower than the isthmic group cases (p = 0.002). The CSA of bilateral PM, bilateral MF, and right ES muscles of the patients with degenerative spondylolisthesis was found to be statistically significantly lower than the group with isthmic spondylolisthesis (p < 0.05). The MF/VB ratio was found to be significantly lower in the degenerative group (p < 0.01). After age adjustment, only the MF CSA difference persisted.
MF atrophy in degenerative spondylolisthesis appears to be associated with the underlying pathology rather than aging alone. These findings support incorporating targeted multifidus-strengthening and paraspinal muscle-preserving strategies into rehabilitation programs for spondylolisthesis.
本研究旨在探讨腰椎旁肌肉横截面积（CSA）在退行性和峡部裂性腰椎滑脱发展中的作用及其对滑脱百分比（PoS）的影响。
这项回顾性单中心研究纳入了171例患者，其中100例为峡部裂性腰椎滑脱患者，71例为退行性腰椎滑脱患者。首先，使用MRI测量双侧腰大肌（PM）、竖脊肌（ES）和多裂肌（MF）的CSA，然后计算肌肉面积与L5椎体（VB）面积的比值。通过在矢状面T2加权图像上除以上位椎体的位移距离与下位椎体的前后径来计算PoS。对肌肉CSA、VB比值、PoS、椎间盘高度和Modic改变进行组间比较，并使用协方差分析对年龄进行调整后的额外分析。
发现退行性组病例的PoS率在统计学上显著低于峡部裂性组病例（p = 0.002）。发现退行性腰椎滑脱患者双侧PM、双侧MF和右侧ES肌肉的CSA在统计学上显著低于峡部裂性腰椎滑脱组（p < 0.05）。发现退行性组的MF/VB比值显著更低（p < 0.01）。在年龄调整后，仅MF CSA差异仍然存在。
退行性腰椎滑脱中的MF萎缩似乎与潜在病理相关，而非仅与衰老有关。这些发现支持将有针对性的多裂肌强化和保留脊柱旁肌肉的策略纳入腰椎滑脱康复计划。
