J Korean Soc Spine Surg.  2018 Sep;25(3):108-114. 10.4184/jkss.2018.25.3.108.

Relationship between Lumbar Extensor Muscle Degeneration Classification and Osteoporotic Vertebral Compression Fracture

• Heo JY
• Park JH
• Kim MW
• Lee SM
• Lim SA
• Choi HS
• Choi YS

• KMID: 2421602
• DOI: http://doi.org/10.4184/jkss.2018.25.3.108

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To investigate the reliability of the lumbar extensor muscle degeneration classification as an indicator of potential risk for osteoporotic vertebral compression fractures (OVCF). SUMMARY OF LITERATURE REVIEW: Fatty degeneration of lumbar extensor muscles has attracted increased interest in the literature as a risk factor for OVCF.
MATERIALS AND METHODS
Ninety-one patients with OVCF (group 1) and 60 patients without OVCF (group 2) were investigated. Magnetic resonance imaging was used to measure and to analyze the muscle mass and fatty degeneration of the lumbar extensor muscle. The degree of fatty degeneration of the lumbar extensor muscle was classified into 4 stages: less than 10%, 10%-25%, 25%-50%, and more than 50%.
RESULTS
Fatty degeneration of the lumbar extensor muscle and the bone mineral density T-score were 29.66%±12.28% and −3.56±1.13 in group 1 and 24.04%±13.29% and −2.27±1.46 in group 2, which were statistically significant differences (p < 0.05). Logistic regression analysis revealed that as the fatty degeneration of the lumbar extensor muscle increased, the risk of OVCF increased (odds ratio [OR]=1.21; p=0.01). The risk of OVCF increased as the lumbar extensor muscle degeneration classification scores increased (OR=13.53; p=0.02). Furthermore, as the muscle mass of the multifidus decreased, lumbar lordosis and sacral inclination decreased (β=0.33; p=0.01 and β=0.25; p=0.04, respectively). However, no factor affected thoracic kyphosis.
CONCLUSIONS
Fatty degeneration of the lumbar extensor muscle was correlated with OVCF. A lumbar extensor muscle degeneration classification higher than stage 3 should be considered a risk factor of OVCF.

Keyword

Osteoporosis; Vertebral compression fractures; Lumbar extensor muscle

MeSH Terms

Animals
Bone Density
Classification*
Fractures, Compression*
Humans
Kyphosis
Logistic Models
Lordosis
Magnetic Resonance Imaging
Muscles
Osteoporosis
Paraspinal Muscles
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1. Paralumbar muscle mass and fatty degeneration on a T1 axial section of magnetic resonance imaging at the L3 level. M, multifidus; L, longissimus; I, iliocostalis; P, psoas. (A) Multifidus fatty degeneration (MF): 7.5%, longissimus fatty degeneration (LF): 12.3%, iliocostalis fatty degeneration (IF): 6.7%, mean extensor muscle fatty degeneration (EF): 8.8%, lumbar extensor muscle fatty degeneration classification: stage 1. (B) MF: 18.5%, LF: 17.1%, IF: 10.9%, mean EF: 15.5%: stage 2. (C) MF: 53.7%, LF:41.8%, IF: 30.3%. mean EF: 41.9%: stage 3. (D) MF: 47.2%, LF: 52.4%, IF: 69.4%, mean EF: 56.3%: stage 4.

• 

  Fig. 2. Distribution of the fatty degeneration classification of the paralumbar extensor muscle between patients with and without osteoporotic vertebral compression fractures.

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  Fig. 3. Receiver operating characteristic curve of fatty degeneration of the lumbar extensor muscle and osteoporotic vertebral compression fracture; the cut-off value of fatty degeneration as a predictor of osteoporotic vertebral compression fracture was 24.6% (sensitivity: 0.73, specificity: 0.75).

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