Sagital Denge ile Multifidus Kas Dejenerasyonu Arası İlişki

Yıl 2023, Cilt: 49 Sayı: 2, 193 - 197, 08.09.2023

Zafer Soydan , Emru Bayramoğlu

https://doi.org/10.32708/uutfd.1298352

Öz

Bu çalışmada alt bel ağrılı hastalarda multifidus yağ dejenerasyonu (MFYD) ile spinopelvik parametreler arasındaki ilişki araştırıldı. Çalışmaya toplam 244 hasta (172 kadın ve 72 erkek) dahil edildi. Gruptaki ortalama yaş 46.9±12.2 idi. Spinopelvik parametreler ayakta lateral lumbar grafi kullanılarak ölçüldü. L4-5 ve L5-S1 seviyelerinde MFYD aksiyel T2W MRG kesitleri kullanılarak derecelendirildi. Hastalar dejenerasyon derecesine göre üç gruba ayrıldı ve gruplar arasında spinopelvik parametreler yönünden istatistiksel anlamlı fark olup olmadığı incelendi. MFYD ile yaş ve cinsiyet arasında anlamlı pozitif korelasyon vardı (p<0.001). Pelvik İnsidans (PI), Pelvik Tilt (PT) ve Sakral Tabla Açısı (STA) ile MFYD arasında ilişki saptanmadı. Lomber Lordoz (LL), Sakral Slop (SS)ve MFYD arasında istatistiksel olarak anlamlı zayıf negatif korelasyon bulundu (p<0.001). MFYD ile dinamik sagittal spinopelvik parametreler olan SS ve LL arasında zayıf bir negatif korelasyon gözlenmesine rağmen, MFYD ile kompansatuar parametre PT arasında herhangi bir korelasyon gözlenmemiştir. Ek olarak, MFYD ile sabit spinopelvik parametreler olan PI ve STA arasında korelasyon bulunmadı.

Anahtar Kelimeler

sagital denge, spinopelvik parametreler, multifidus kas dejenerasyonu, korelasyon analizleri

Association of Sagittal Balance and Multifidus Fatty Degeneration

Öz

We investigated the relationship between multifidus fatty degeneration (MFFI) and spinopelvic parameters in patients with low back pain (LBP). The study included a total of 244 patients (172 females and 72 males). Spinopelvic parameters were measured using lateral standing x-rays, and L4-5 and L5-S1 levels of multifidus muscle fatty degeneration were graded using axial T2W MRI slices. Patients were divided into three groups based on degeneration grade, and the statistical significance of differences in spinopelvic parameters between the groups was examined. The mean age in the group was 46.9±12.2 years. There was a significant positive correlation between MFFI and age and gender (p<0.001). Pelvic Incidence (PI), Pelvic Tilt (PT), and Sacral Table Angle (STA) were not associated with MFFI. A statistically significant weak negative correlation was found between Lumbar Lordosis (LL), Sacral Slope (SS), and MFFI (p<0.001). Although a weak negative correlation was observed between MFFI and the dynamic sagittal spinopelvic parameters SS and LL, no correlation was observed between MFFI and the compensatory parameter PT. Additionally, there is no correlation between the MFFI and the fixed spinopelvic parameters PI and STA.

Anahtar Kelimeler

sagittal balance, spinopelvic parameters, mutifidus fatty degeneration, correlation analyses

Kaynakça

• 1. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55:145–9.
• 2. Fortin M, Lazary A, Varga PP, McCall I, Battie MC. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. Eur Spine J. 2016;25:1452-1459.
• 3. Altinkaya N, Cekinmez M. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging. Skeletal Radiol. 2016;45(1):73-77.
• 4. Ekin, E. E., Kurtul Yıldız, H., & Mutlu, H. (2016). Age and sex-based distribution of lumbar multifidus muscle atrophy and coexistence of disc hernia: an MRI study of 2028 patients. Diagnostic and interventional radiology (Ankara, Turkey), 22(3), 273–276.
• 5. Özcan-Ekşi EE, Ekşi MŞ, Akçal MA. Severe Lumbar Intervertebral Disc Degeneration Is Associated with Modic Changes and Fatty Infiltration in the Paraspinal Muscles at all Lumbar Levels, Except for L1-L2: A Cross-Sectional Analysis of 50 Symptomatic Women and 50 Age-Matched Symptomatic Men. World Neurosurg. 2019;122:e1069-e1077.
• 6. Wang X, Liu H, Wang W, et al. Comparison of multifidus degeneration between scoliosis and lumbar disc herniation. BMC Musculoskelet Disord. 2022;23(1):891. Published 2022 Sep 30.
• 7. Liu Y, Liu Y, Hai Y, Li G, Liu T, Wang Y. Lumbar lordosis reduction and disc bulge may correlate with multifidus muscle fatty infiltration in patients with single-segment degenerative lumbar spinal stenosis. Clin Neurol Neurosurg. 2020;189:105629.
• 8. Katsu M, Ohba T, Ebata S, Oba H, Koyama K, Haro H. Potential Role of Paraspinal Musculature in the Maintenance of Spinopelvic Alignment in Patients With Adult Spinal Deformities. Clin Spine Surg. 2020;33(2):E76-E80.
• 9. Zhang Y, Mandelli F, Mündermann A, et al. Association between fatty infiltration of paraspinal muscle, sagittal spinopelvic alignment and stenosis grade in patients with degenerative lumbar spinal stenosis. N Am Spine Soc J. 2021;5:100054. Published 2021 Feb 23.
• 10. Sun D, Liu P, Cheng J, Ma Z, Liu J, Qin T. Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation. BMC Musculoskelet Disord (2017) 18(1):167.
• 11. Colakoglu B, Alis D. Evaluation of lumbar multifidus muscle in patients with lumbar disc herniation: are complex quantitative MRI measurements needed?. J Int Med Res. 2019;47(8):3590-3600.
• 12. Wang W, Sun Z, Li W, Chen Z. Relationships between Paraspinal Muscle and Spinopelvic Sagittal Balance in Patients with Lumbar Spinal Stenosis. Orthop Surg. 2022;14(6):1093-1099.
• 13. Chung N-S, Jeon C-H, Lee H-D, Won S-H. Measurement of spinopelvic parameters on standing lateral lumbar radiographs: validity and reliability. Clin Spine Surg 2017;30:E119–23.
• 14.Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine 1993; 18:830– 836.
• 15.Hodges PW, Danneels L. Changes in structure and function of the back muscles in low back pain: different time points, observations, and mechanisms. J Orthop Sports Phys Ther(2019) 49(6):464–76.
• 16.Faur C, Patrascu JM, Haragus H, Anglitoiu B. Correlation between multifidus fatty atrophy and lumbar disc degenerationin low back pain. BMC Musculoskelet Disord. 2019;20(1):414. Published 2019 Sep 5.
• 17.Yaltırık K, Güdü BO, Işık Y, Altunok Ç, Tipi U, Atalay B.Volumetric Muscle Measurements Indicate Significant Muscle Degeneration in Single-Level Disc Herniation Patients. World Neurosurg. 2018;116:e500-e504.
• 18.Özcan-Ekş􀵴 EE, Ekş􀵴 MŞ, Turgut VU, Canbolat Ç, Pam􀵴r MN. Reciprocal relationship between multifidus and psoas at L4-L5 level in women with low back pain. Br J Neurosurg (2021)35(2):220–8.
• 19.Takayama K , Kita T, Nakamura H, et al. New Predictive Indexfor Lumbar Paraspinal Muscle Degeneration Associated With Aging. Spine (Phila Pa 1976). 2016;41(2):E84-E90.
• 20.Boulay C, Bollini G, Legaye J, et al. Pelvic incidence: apredictive factor for three-dimensional acetabular orientation-a preliminary study. Anat Res Int 2014;2014:594650.
• 21.Klineberg E, Schwab F, Smith JS, Gupta MC, Lafage V, BessS.Sagittal spinal pelvic alignment. Neurosurg Clin N Am.2013; 24(2):15
• 22.Miura, K., Kadone, H., Asada, T., Koda, M., Funayama, T., Takahashi, H., Noguchi, H., Mataki, K., Shibao, Y., Sato, K., Eto, F., Kono, M., Suzuki, K., & Yamazaki, M. (2021). The fatty degeneration of the lumbar erector spinae muscles affects dynamic spinal compensation ability during gait in adult spinal deformity. Scientific reports, 11(1), 18088.
• 23.Menezes-Reis, R., Bonugli, G. P., Salmon, C. E. G., Mazoroski, D., Herrero, C. F. P. D. S., & Nogueira-Barbosa, M. H. (2018). Relationship of spinal alignment with muscular volume and fat infiltration of lumbar trunk muscles. PloS one, 13(7), e0200198.
• 24.Jun HS, Kim JH, Ahn JH, et al. The Effect of Lumbar Spinal Muscle on Spinal Sagittal Alignment: Evaluating Muscle Quantity and Quality. Neurosurgery. 2016;79(6):847-855.