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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (09) : 846 -852. doi: 10.3877/cma.j.issn.1674-0785.2024.09.008

综述

腰椎椎旁肌的研究进展
王景明1, 王磊1, 许小多1, 邢文强1, 张兆岩2, 黄伟敏1,()   
  1. 1.250031 济南,中国人民解放军联勤保障部队第九六〇医院骨病科
    2.250031 济南,中国人民解放军联勤保障部队第九六〇医院干部一科
  • 收稿日期:2024-08-16 出版日期:2024-09-15
  • 通信作者: 黄伟敏
  • 基金资助:
    山东省医药卫生发展计划(202204071067)

Advances in research of paravertebral muscles of the lumbar spine

Jingming Wang1, Lei Wang1, Xiaoduo Xu1, Wenqiang Xing1, Zhaoyan Zhang2, Weimin Huang1,()   

  1. 1.Department of Osteopathy,960th Hospital, Joint Logistic Support Force, People's Liberation Army, Jinan 250031, China
    2.Staff Section 1,960th Hospital, Joint Logistic Support Force, People's Liberation Army, Jinan 250031, China
  • Received:2024-08-16 Published:2024-09-15
  • Corresponding author: Weimin Huang
引用本文:

王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.

Jingming Wang, Lei Wang, Xiaoduo Xu, Wenqiang Xing, Zhaoyan Zhang, Weimin Huang. Advances in research of paravertebral muscles of the lumbar spine[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(09): 846-852.

腰椎椎旁肌作为稳定脊柱的重要结构,其随着年龄增加及腰椎退变出现脂肪浸润增加。核磁共振作为研究椎旁肌形态及脂肪浸润程度的最佳测量方式,目前得到广泛应用。不同学者提出了包括半定量(Goutallier 分级系统)、定量(肌肉脂肪指数MFI)、功能评价(伊藤实验)等多种测量方法,用于评价椎旁肌,均具有良好的可靠性。研究发现椎旁肌肉萎缩与慢性腰痛相关,与腰椎间盘突出症、腰椎滑脱等腰椎退行性疾病显著相关,与骨质疏松以及脊柱骨折次数相关。另外,影像学研究发现,椎旁肌萎缩导致椎间盘退变、终板异常、椎间盘真空征增加,小关节突骨性关节炎增加,腰椎前凸减少和骨盆倾斜增加。椎旁肌改变影响患者手术预后,椎旁肌脂肪浸润指数与术后患者较差的ODI 评分相关,是男性椎间融合器下沉的独立危险因素,是成人脊柱畸形术后近段交界性后凸(PJK)的独立危险因素,是椎体成形术后再骨折发生,以及残余腰痛的潜在危险因素。在对椎旁肌肉的基因表达谱研究中发现,COL3A1 表达增加和椎旁肌脂肪浸润降低相关,mTOR 表达的减少与椎旁肌功能性横截面积(FCSA)增大相关。

Lumbar paravertebral muscles, which play an important role in stabilizing the spine,have been observed to exhibit an increase in fat infiltration with age and lumbar degeneration. Magnetic resonance imaging (MRI) has emerged as a valuable tool for studying the morphology of paravertebral muscles and the degree of fat infiltration. A variety of measurement methods have been proposed by scholars for evaluating paravertebral muscles, including semi-quantitative (Goutallier grading system), quantitative(muscle fat index MFI), and functional evaluations (Ito test). All of these methods have been demonstrated to have good reliability. Paravertebral muscle atrophy has been demonstrated to be associated with chronic low back pain, exhibiting a significant correlation with lumbar degenerative diseases such as lumbar disc herniation and lumbar spondylolisthesis. Additionally, it has been linked to osteoporosis and the number of spinal fractures. Furthermore, imaging studies have demonstrated that paravertebral muscle atrophy is associated with disc degeneration, endplate abnormalities, increased disc vacuum sign, increased osteoarthritis of the facet joints, decreased lumbar lordosis, and increased pelvic tilt. The surgical prognosis of patients is affected by alterations in paravertebral muscles. The fat infiltration index of paraspinal muscles correlates with poorer Oswestry Disability Index scores in postoperative patients. Furthermore, it is an independent risk factor for severe cage subsidence in men, an independent risk factor for postoperative proximal junctional kyphosis (PJK) in adult spinal deformities, and a potential risk factor for the occurrence of re-fracture after vertebroplasty and residual low back pain. A gene expression profiling study of paravertebral muscles revealed that increased COL3A1 expression was associated with a reduction in the fat infiltration in these muscles, while decreased mTOR expression was associated with an increase in the functional cross-sectional area of paravertebral muscles.

1
Cooley JR, Walker BF, M Ardakani E, et al. Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis [J]. BMC Musculoskelet Disord, 2018, 19(1): 351.
2
Fortin M, Lazáry À, Varga PP, et al. Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal stenosis [J]. Eur Spine J, 2017, 26(10):2543-2551.
3
He K, Head J, Mouchtouris N, et al. The implications of paraspinal muscle atrophy in low back pain, thoracolumbar pathology, and clinical outcomes after spine surgery: A review of the literature [J].Global Spine J, 2020, 10(5): 657-666.
4
Han G, Wang W, Yue L, et al. Age-dependent differences of paraspinal muscle endurance and morphology in Chinese community population without chronic low back pain [J]. Global Spine J, 2024, 14(1): 235-243.
5
Kızılgöz V, Aydın S, Karavaş E, et al. Are paraspinal muscle quantity,lumbar indentation value, and subcutaneous fat thickness related to disc degeneration? An MRI-based study [J]. Radiography (Lond),2023, 29(2): 428-35.
6
Naghdi N, Mohseni-Bandpei MA, Taghipour M, et al. Lumbar multifidus muscle morphology changes in patient with different degrees of lumbar disc herniation: an ultrasonographic study [J].Medicina (Kaunas), 2021, 57(7): 699.
7
Sun D, Wang Z, Mou J, et al. Characteristics of paraspinal muscle degeneration in degenerative diseases of the lumbar spine at different ages [J]. Clin Neurol Neurosurg, 2022, 223: 107484.
8
Battaglia PJ, Maeda Y, Welk A, et al. Reliability of the Goutallier classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging [J]. J Manipulative Physiol Ther, 2014, 37(3): 190-197.
9
Hasebe Y, Suzuki K, Akasaka K, et al. Inter-examiner reliability in identifying lumbar paraspinal muscle atrophy by lumbar paraspinal muscle atrophy index, a novel parameter [J]. J Phys Ther Sci, 2022,34(11): 737-740.
10
Han G, Jiang Y, Zhang B, et al. Imaging evaluation of fat infiltration in paraspinal muscles on MRI: a systematic review with a focus on methodology [J]. Orthop Surg, 2021, 13: 1141-1148.
11
Hodges PW, Bailey JF, Fortin M, et al. Paraspinal muscle imaging measurements for common spinal disorders: review and consensusbased recommendations from the ISSLS degenerative spinal phenotypes group [J]. Eur Spine J, 2021, 30: 3428-3441.
12
Mannil M, Burgstaller JM, Held U, et al. Correlation of texture analysis of paraspinal musculature on MRI with different clinical endpoints: Lumbar Stenosis Outcome Study (LSOS) [J]. Eur Radiol,2919, 29: 22-30.
13
Banitalebi H, Aaen J, Storheim K, et al. A novel MRI index for paraspinal muscle fatty infiltration: reliability and relation to pain and disability in lumbar spinal stenosis: results from a multicentre study [J].Eur Radiol Exp, 2022, 6(1): 38.
14
Han G, Fan Z, Yue L, et al. Paraspinal muscle endurance and morphology (PMEM) score: a new method for prediction of postoperative mechanical complications after lumbar fusion [J]. Spine J, 2024, 24(10): 1900-1909.
15
Ito T, Shirado O, Suzuki H, et al. Lumbar trunk muscle endurance testing: an inexpensive alternative to a machine for evaluation [J].Arch Phys Med Rehabil, 1996, 77(1): 75-79.
16
Kızılgöz V, Aydın S, Karavaş E, et al. Are paraspinal muscle quantity,lumbar indentation value, and subcutaneous fat thickness related to disc degeneration? An MRI-based study [J]. Radiography (Lond),2023, 29(2): 428-35.
17
Balagué F, Mannion AF, Pellisé F, et al. Non-specific low back pain [J].Lancet, 2012, 379(9814): 482-491.
18
Agten A, Stevens S, Verbrugghe J, et al. Biopsy samples from the erector spinae of persons with nonspecific chronic low back pain display a decrease in glycolytic muscle fibers [J]. Spine J, 2020, 20(2):199-206.
19
Huang Y, Wang L, Zeng X, et al. Association of paraspinal muscle CSA and PDFF measurements with lumbar intervertebral disk degeneration in patients with chronic low back pain [J]. Front Endocrinol (Lausanne), 2022, 13: 792819.
20
Gandham A, Mesinovic J, Jansons P, et al. Falls, fractures, and areal bone mineral density in older adults with sarcopenic obesity: a systematic review and meta-analysis [J]. Obes Rev, 2021, 22: e13187.
21
Li X, Zhang Y, Xie Y, et al. Correlation between bone mineral density(BMD) and paraspinal muscle fat infiltration based on QCT: A crosssectional study [J]. Calcif Tissue Int, 2022, 110(6): 666-673.
22
Li Z, Chen J, Yang J, et al. Relationship between paraspinal muscle properties and bone mineral density based on QCT in patients with lumbar disc herniation [J]. BMC Musculoskelet Disord, 2024, 25(1):360.
23
Cao B, Zuo Y, Xu Y, et al. Correlation between fat infiltration of paraspinal muscle and L4 degenerative lumbar spondylolisthesis in asymptomatic adults [J]. Asian J Surg, 2023, 46(2): 834-840.
24
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [J]. Age Ageing, 2019,48(4): 601
25
Schönnagel L, Chiaparelli E, Camino-Willhuber G, et al. Spinespecific sarcopenia: distinguishing paraspinal muscle atrophy from generalized sarcopenia [J]. Spine J, 2024, 24(7): 1211-1221.
26
Minetama M, Kawakami M, Nakatani T, et al. Lumbar paraspinal muscle morphology is associated with spinal degeneration in patients with lumbar spinal stenosis [J]. Spine J, 2023, 23(11): 1630-1640.
27
Camino-Willhuber G, Schönnagel L, Chiapparelli E, et al. Association between lumbar intervertebral vacuum phenomenon severity and posterior paraspinal muscle atrophy in patients undergoing spine surgery [J]. Eur Spine J, 2024, 33(3): 1013-1020.
28
Schönnagel L, Zhu J, Guven AE, et al. Understanding the interplay between paraspinal muscle atrophy and lumbar endplate degeneration:A 3-year longitudinal study [J]. Spine (Phila Pa 1976), 2023, 48(23):1627-1634.
29
Guven AE, Schönnagel L, Camino-Willhuber G, et al. Relationship between facet joint osteoarthritis and lumbar paraspinal muscle atrophy: a cross-sectional study [J]. J Neurosurg Spine, 2024, 1-9.
30
Wang W, Sun Z, Li W, et al. Relationships between paraspinal muscle and spinopelvic sagittal balance in patients with lumbar spinal stenosis[J]. Orthop Surg, 2022, 14(6): 1093-1099.
31
Haffer H, Muellner M, Chiapparelli E, et al. Georg Schmorl Prize of the German Spine Society (DWG) 2023: the influence of sarcopenia and paraspinal muscle composition on patient-reported outcomes:a prospective investigation of lumbar spinal fusion patients with 12-month follow-up [J]. Eur Spine J, 2024, 33(5): 1737-1746.
32
Moser M, Adl Amini D, Jones C, et al. The predictive value of psoas and paraspinal muscle parameters measured on MRI for severe cage subsidence after standalone lateral lumbar interbody fusion [J]. Spine J,2023, 23(1): 42-53.
33
Narayanan R, Ezeonu T, Kellish A, et al. Does paraspinal muscle mass predict lumbar lordosis before and after decompression for degenerative spinal stenosis? [J] Spine (Phila Pa 1976), 2024.
34
Han G, Wu H, Dai J, et al. Does paraspinal muscle morphometry predict functional status and re-operation after lumbar spinal surgery?A systematic review and meta-analysis [J]. Eur Radiol, 2023, 33(8):5269-5281.
35
Park JS, Cho KJ, Kim JS, et al. Sarcopenia in paraspinal muscle as a risk factor of proximal junctional kyphosis and proximal junctional failure after adult spinal deformity surgery [J]. J Neurosurg Spine,2024, 40(3): 324-330.
36
Si F, Yuan S, Zang L, et al. Paraspinal muscle degeneration: A potential risk factor for new vertebral compression fractures after percutaneous kyphoplasty [J]. Clin Interv Aging, 2022, 17: 1237-1248.
37
Tang M, Zhang G, Zeng F, et al. Paraspinal muscle parameters'predictive value for new vertebral compression fractures post-vertebral augmentation: Nomogram development and validation [J]. Front Med(Lausanne), 2024, 11: 1379078.
38
Jeon I, Kim SW, Yu D. Paraspinal muscle fatty degeneration as a predictor of progressive vertebral collapse in osteoporotic vertebral compression fractures [J]. Spine J, 2022, 22(2): 313-320.
39
Gao X, Du J, Hao D, et al. Risk factors for residual back pain following percutaneous vertebral augmentation: the importance of paraspinal muscle fatty degeneration [J]. Int Orthop, 2023, 47(7):1797-804.
40
Ordaz A, Anderson B, Zlomislic V, et al. Paraspinal muscle gene expression across different aetiologies in individuals undergoing surgery for lumbar spine pathology [J]. Eur Spine J, 2023, 32(4): 1123-1131.
41
Anderson B, Ordaz A, Zlomislic V, et al. Paraspinal muscle health is related to fibrogenic, adipogenic, and myogenic gene expression in patients with lumbar spine pathology [J]. BMC Musculoskelet Disord,2022, 23(1): 608.
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