Clinical StudyThe fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level
Introduction
Age-related changes are important medical and socioeconomic concerns of modern society [1]. Spinal degeneration, one of the results of the aging process, can result in a lower quality of life in old age [2]. Studies of degenerative spinal changes to date have focused on the bone and joint of the spine [3]. However, studies on the spinal muscular biomechanics have shown that age-related changes occur not only in the skeletal system but also in the muscles [4], [5], [6], [7], [8]. Fatty infiltration and muscle atrophy have been described as characteristic changes that occur in muscle degeneration [9]. Many studies about the lumbar paraspinal muscles have been conducted on patients with spine problems, which were not designed to understand the muscular changes according to the aging process [10], [11], [12], [13], [14], [15]. Patients with spinal symptoms may have more spinal degeneration than the non-symptomatic population. Therefore, the natural changes of age-dependent degeneration in the paraspinal muscles have not been studied properly. In the present study, we tried to investigate age-dependent changes of the lumbar paraspinal muscles at each lumbar disc level in the population without lumbar spinal symptoms.
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Materials and methods
This study was conducted on 887 patients who underwent computed tomography of the abdomen and pelvis (APCT) as a part of regular health checkup at Chung-Ang University Hospital between January 2013 and December 2013. A retrospective study was conducted on 650 patients after excluding 237 patients (63 with previous spinal surgery, 152 with medical record histories of back pain or radicular leg pain, and 22 with other conditions such as myopathy, muscular dystrophy, infectious disease, vertebral
Results
The mean ages and gender ratios (male:female) were 32.7±5.3 and 1:0.8, 53.3±5.2 and 1:0.8, and 77.8±8.1 and 1:1.1 in the young, middle, and old groups, respectively. There was no statistically significant difference in the mean age and gender ratio among the three groups (Table).
Discussion
To date, several imaging studies have analyzed the degenerative changes in the paraspinal muscles. Decreased cross sectional area (CSA) and increased fatty degeneration have been found in the population with chronic back pain or degenerative lumbar kyphosis [11], [13], [17]. In addition, some studies of the muscle degenerations were conducted on patients with postsurgical back pain [18], [19]. However, there was no previous study analyzing muscle degeneration in the population without lumbar
Conclusions
Our data indicate that the paraspinal muscle degeneration can be affected by age, disc level, and muscle type. It seems to be more prominent in the extensor muscles, starting from the lowermost lumbar joint and spreading upwardly. Although our data seem to show that the increased tension stress in the extensors of lower lumbar level is related with the muscle degeneration, more studies are required to confirm the hypothesis.
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Author disclosures: SHL: Non-financial. SWP: Grant: Technology Innovation Program (D, Paid to the author, Advanced Technology Center [ATC], 10048523, Development of fluorography system under 50% irradiation dose with image quality on par with angiographic equipment to global leader in next generation, funded by the Ministry of Trade, Industry & Energy [MI, Korea]), pertaining to the submitted manuscript. YBK: Non-financial. TKN: Non-financial. YSL: Non-financial.
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