Asymmetric degeneration of paravertebral muscles in patients with degenerative lumbar scoliosis.
METHODS
A prospective observational study.


OBJECTIVE
To evaluate the paravertebral muscle (PVM) degeneration in patients with degenerative lumbar scoliosis (DLS), using magnetic resonance imaging.


BACKGROUND
Several studies have described the histological and morphological changes to the PVM in patients with chronic low back pain and lumbar radiculopathy. However, there is little knowledge about the PVM changes in patients with DLS.


METHODS
Fifty-seven patients with lumbar spinal stenosis (LSS) with DLS (DLS group) and 50 control patients with LSS without DLS (LSS group) were examined. The cross-sectional area (CSA) and percentage of fat infiltration area (%FIA) of the bilateral multifidus and longissimus muscles at the L1-S1 levels were measured using T2-weighted axial magnetic resonance imaging and computer software. A multifidus muscle biopsy and histological evaluation were performed in some patients.


RESULTS
In the DLS group, the CSA of the multifidus muscle was significantly smaller and the %FIA of both muscles was significantly higher on the concave side than on the convex side at all levels (P < 0.0001 for each). These differences were also found in the longissimus muscles at the L4-L5 and L5-S1 levels (P < 0.0001 for each). Histologically, the multifidus muscle exhibited reductions in the muscle fiber size and number of nuclei on the concave side. In the LSS group, the total CSA and %FIA did not differ significantly between the left and right sides. However, in patients with unilateral radiculopathy, the CSA of the multifidus muscle was significantly smaller (P < 0.05) and the %FIA of both muscles was significantly higher (P < 0.05) on the symptomatic side, especially at 1 level below.


CONCLUSIONS
This observational study with magnetic resonance imaging and histology showed that muscle degeneration was more common on the concave side in patients with DLS. Radiculopathy and spinal deformity may contribute to the PVM degeneration.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Najibullah
N
Shafaq
Akinobu
A
Suzuki
Akira
A
Matsumura
Hidetomi
H
Terai
Hiromitsu
H
Toyoda
Hiroyuki
H
Yasuda
Mohammad
M
Ibrahim
Hiroaki
H
Nakamura
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007564:Japan; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology*; D009133:Muscular Atrophy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012600:Scoliosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology