The quantity and quality of lumbar muscles and lumbopelvic parameters in patients with degenerative spondylolisthesis — The International Society for the Study of the Lumbar Spine
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The quantity and quality of lumbar muscles and lumbopelvic parameters in patients with degenerative spondylolisthesis (#ZSP3)

Shuhei Ohyama 1 , Yasuchika Aoki 1 2 , Masahiro Inoue 1 2 , Takayuki Nakajima 1 2 , Yusuke Sato 1 2 , Hiroyuki Fukuchi 3 , Takayuki Sakai 3 , Shigehiro Ochi 3 , Noriyuki Yanagawa 3 , Seiji Ohtori 4
  1. Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
  2. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
  3. Department of Radiology, Eastern Chiba Medical Center, Togane, CHiba, Japan
  4. Department of Orthopaedics, Chiba University Hospital, Chiba, Japan

Introduction

Lumbar degenerative spondylolisthesis (DS) is one of the most common causes of low back pain. The lumbar muscles, such as the psoas major (PM), erector spinae (ES), and multifidus (MF) muscles, play an important role in the stability and functional movement of the lumbar spine. The quantities and qualities of these muscles may be related to the occurrence of DS and lumbopelvic parameters, such as lumbar lordosis (LL) and sacral slope (SS). However, the influence of lumbar muscles on DS and lumbopelvic alignment is not well understood.

Methods

Consecutive patients who underwent CT scans of the abdominal or lumbar regions for reasons other than low back disorders were included. Patients with prevalent vertebral fractures, previous lumbar spinal fusion surgery, and bilateral and unilateral spondylolysis were excluded. The patients were divided into two groups. The first group (DS group) consisted of patients with L4 DS. For the second group (non-DS group) patients were extracted from patients without vertebral slip who were matched for age and sex with the DS group.

Using sagittal reconstructed CT images, LL, upper lumbar lordosis ([ULL] L1-L4), lower lumbar lordosis ([LLL] L4-S1), and SS were examined. To evaluate the quantity and quality of lumbar muscles, the gross cross-sectional area (GCSA), functional cross-sectional area (FCSA), and fat infiltration (FI) of the PM, ES, and MF muscles were measured by axial reconstructed CT images. The lumbopelvic parameters, FCSA, GCSA, and FI of lumbar muscles were compared between the two groups. Then, each lumbar muscle parameter was analyzed for correlation with DS and lumbopelvic parameters.

Results

This study included 708 consecutive patients. After exclusion, a total of 545 patients were enrolled. Of the patients, 25 (mean age: 74.7±9.3 years; 13 males/12 females) had L4 DS. Another 25 patients (mean age: 74.7±9.3 years old; 13 males/12 females) without DS were extracted. The degree of vertebral slip in all patients in the DS group was classified as grade I. DS patients displayed significantly greater ULL and lower FI of the PM and ES muscles than non-DS patients (p=0.0078, 0.031, and 0.010, respectively). The FI of the ES muscle was significantly correlated with the presence of DS (p=0.010). The FCSA of the ES and MF muscles and the GCSA of the MF muscle showed a significant correlation with LL and SS in the non-DS group (p<0.05), but not in the DS group.

Discussion

ULL was greater in L4 DS patients, possibly related to the better quality of the ES muscle. All DS patients showed mild (grade I) spondylolisthesis, suggesting the possibility that lumbar muscle quality is better in patients with mild DS than in those without DS. The ES and MF muscles may play an important role in maintaining the lumbar lordotic angle in non-DS patients but not in DS patients.

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