title: Paraspinal muscles density: a marker for degenerative lumbar spinal stenosis?
abstract: The condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain. It is generally agreed that these muscles play an important role in the stability and functional movements of the lumbar vertebral column. Although spinal instability has been shown to play an essential role in degenerative lumbar spinal stenosis (DLSS), the role of paraspinal muscles remains elusive. The main purpose of this study was to shed light on the relationship between the condition of paraspinal muscles and symptomatic DLSS.
  
  
  
  Two sample populations were studied. The first included 165 individuals with DLSS (age range: 40-88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40-99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS.
  
  
  
  Individuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS.
  
  
  
  Our results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.
authors.affiliation: Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. janan1705@gmail.com.|Department of Physical Therapy, Zefat Academic College, Zefat, Israel. janan1705@gmail.com.
authors.forename: Janan
authors.initials: J
authors.lastname: Abbas
authors.affiliation: Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Viviane
authors.initials: V
authors.lastname: Slon
authors.affiliation: Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: May
authors.affiliation: Department of Radiology, Carmel Medical Center, Haifa, Israel.
authors.forename: Nathan
authors.initials: N
authors.lastname: Peled
authors.affiliation: Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Hershkovitz
authors.affiliation: Department of Physical Therapy, Zefat Academic College, Zefat, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.|Department of Orthopaedic Surgery, The Baruch Padeh Poriya Medical Center, Tiberias, Israel.
authors.forename: Kamal
authors.initials: K
authors.lastname: Hamoud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064170:Paraspinal Muscles / Q000000981:diagnostic imaging*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers
keywords: Computerized tomography (CT); Degenerative lumbar spinal stenosis; Muscle cross-sectional area size; Paraspinal muscles density