The Correlation Between Paraspinal Muscular Morphology, Spinopelvic Parameters, and Back Pain: A Comparative Cohort Study

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Figure 1
(A) Example of paraspinal muscle cross-sectional area segmentation at L4 to L5 level. The multifidus muscle segmentation is in green, the erector spinae in red, and the psoas major in yellow. (B) Axial T2-weighted scan. (C) Sagittal T2-weighted scan. (D) Coronal T2-weighted scan. MRI scan of the whole lumbar segment. On the left of each image is the MRI. On the right, semiquantitative contouring of fatty infiltration for 3-dimensional model building.
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Figure 2
Flow chart of the patients’ selection process.
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Figure 3
(A) Median and interquartile range (IQR) values of the psoas major cross-sectional area (CSA; cm²) between back pain and no back pain patients. (B) Median and IQR values of multifidus CSA (cm²) between back pain and no back pain patients. (C) Median and IQR values of erector spinae CSA (cm²) between back pain and no back pain patients. (D) Median and IQR values of percentages of paraspinal muscle fatty infiltration between back pain and no back pain patients.

Table 1

Summary of clinicodemographic and structural parameters differences between groups.

Abbreviations: IQR, interquartile range; ODI, Oswestry Disability Index; VAS, visual analog scale.

Table 2

Summary of CSA, volumetric analysis, and spinopelvic parameters values.

Outcome Measure	Back Pain	No Back Pain	P
CSA
Erector spinae, cm², mean ± SD	15.7 ± 3.8	17.1 ± 4.7	0.032
Multifidus, cm², mean ± SD	5.9 ± 2.0	6.9 ± 2.2	0.004
Psoas major, cm², mean ± SD	8.6 ± 3.2	10.8 ± 3.4	0.004
Paraspinal Muscle Volumetry
Muscle clean volume, %, mean ± SD	67.7 ± 12.4	80.9 ± 8.5	<0.0001
Fatty infiltration, %, mean ± SD	32.4 ± 12.4	19.0 ± 8.3	<0.0001
Spinopelvic Parameters
Pelvic incidence, mean ± SD	54.4° ± 13.5°	49.9° ± 14.8°	0.044
Pelvic tilt, mean ± SD	19.7° ± 9.3°	13.7° ± 8.9°	0.0001
Lumbar lordosis (L1–S1), mean ± SD	45.6° ± 20.2°	51.2° ± 13.6°	0.064
Lumbar lordosis,^{^a} %	81.2	55.6	0.171
Pelvic mismatch,^{^b} %	53.6	9.6	0.704

Abbreviation: CSA, cross-sectional area.
↵a Percentage of patients with L1 to S1 lumbar lordosis values outside confidence interval values for age and sex.
↵b Percentage of patients with pelvic mismatch values outside confidence interval values for age and sex.

Table 3

Summary of multivariate analysis models for FI and muscles cross-sectional area interactions with degenerative and structural parameters.

Independent Variables	OR	Multivariate Analysis (95% CI)	P	Adjusting Factors (Dependent Variables)
FI^{^a}
Back pain	8.75	1.85–39.65	0.006	Sex, age, and BMI
ODI	3.41	1.12–10.31	0.030	Sex, age, and BMI
P muscle
Back pain	3.61	1.30–10–2	0.015	Sex, age, and BMI
ODI	4.13	1.52–11.2	0.005	Sex, age, and BMI
Disc height, mm^{^b}	8.06	3.07–21.2	0.000	Sex, age, and BMI
ES muscle
Disc height, mm^{^b}	5.32	2.10–13.43	0.000	Sex, age, and BMI
MF muscle
Disc height, mm^{^b}	4.71	1.98–11.46	0.001	Sex, age, and BMI

Abbreviations: BMI, body mass index; ES, erector spinae; FI, fatty infiltration; MF, multifidus; ODI, Oswestry Disability Index; P, psoas.
↵a FI > 30% of total paravertebral muscles volume.
↵b Average disc height from T12 to S1.