| 제목 |
Is the Lumbar Spinal Muscle Morphometry related to BMD in Unilateral Lumbar Radiculopathy? |
| 소속 |
Kyung Hee University Medical Center, Department of Physical Medicine & Rehabilitation1, Kyung Hee University Hospital at Gangdong, Department of Rehabilitation Medicine2 |
| 저자 |
Minjung Kim M.D.1*, Jinmann Chon M.D. 1†, Hee-Sang Kim M.D.1, Jong Ha Lee M.D.1, Dong Hwan Yun M.D. 1, Seung Don Yoo M.D.1, Dong Hwan Kim M.D.1, Seung Ah Lee M.D.1, Yunsoo Soh M.D.1, Young Rok Han M.D.1, Myung Chul Yoo M.D.1, Yeocheon Yun M.D.1 |
| 사사 |
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Objective: Bone mineral density (BMD) and muscle mass gradually decrease due to age-related degenerative change. The pathogenesis of reduced muscle mass is multifactorial such as aging, denervation or decreased BMD. The objective of this study is to assess whether decreased BMD or lumbar nerve root denervation affects morphometry in lumbar spinal muscles.
Method: One-hundred-one female patients who diagnosed with unilateral lumbosacral radiculopathy on the electrodiagnostic study in January 2017 to April 2021 were included. BMD T scores in the lumbar spine (L1-L4, except the level with degenerative changes that have restrictions on interpretation) and hip (total femur and femur neck) were measured by dual energy X-ray absorptiometry (DEXA). Muscle cross-sectional area (CSA) were measured on axial T2-weighted MR images in psoas (PS), multifidus (MF) and erector spinae (ES) in the middle between L3 and L4 level (L3/L4), and between L4 and L5 level (L4/L5) respectively. The FCSA was measured with the CSA of region of interest (ROI) in the lean muscle mass excluding fat degeneration (Figure 1). Pearson correlation analyses between BMD T scores and the CSA, FCSA the ratio of FCSA to CSA (ratio), meaning fat degeneration, for each side were performed.
Results: Sixty-four patients with age ranging from 50 to 85 (mean 64.7 ± 7.9) were enrolled. Fourty-seven patients were excluded due to lumbar surgical treatments or poor image qualities. In the correlation analysis, the CSA had no significant correlation between BMD and all lumbar spinal muscles. The FCSA calculated ROI showed significant correlation with lumbar BMD. The functional ratio showed significant correlation with lumbar BMD (Table 1, p < 0.05). There was no correlation with femur BMD and the morphometry of lumbar spinal muscles. The morphometry of lumbar spinal muscles showed no significant correlation with lumbosacral nerve denervation.
Conclusion: Lumbar BMD T scores were correlated with the functional muscle mass and fat degeneration of the lumbar spinal muscles, which means the size and quality of lumbar muscles. The presence or absence of radiculopathy has no significant effect on the asymmetry of lumbar muscle quality. |
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Figure 1. Example of measuring CSAs and FCSAs on T2-weighted MR image Left: Original T2-weighted MR image, Right: The CSA region of interest. The area surrounded by yellow lines means the CSAs and the red zone means the FCSAs. [1]: Psoas, [2]: Multifidus, [3]: Erector spinae CSA, cross-sectional area; FCSA, functional cross-sectional area
Table 1. The Pearson Correlation between the Morphometry of Lumbar Spinal Muscle and BMD T Scores L spine T score was measured in L1-L4 except the level(s) with degenerative changes that have restrictions on interpretation using DEXA method. Femur neck and total femur T score was measured in hip using DEXA method. Cross-sectional areas of lumbar spinal muscles (psoas, multifidus and erector spinae, sum of left and right sides) were meausred in the middle between L3 nad L4 level. * Statistically significant, p-value < 0.05 ** The morphometry of lumbar spinal muscle : the ratio of functional cross-sectional area to cross-sectional area BMD, bone mineral density
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