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Abstract：
OBJECTIVE: Multiple-level Intervertebral disc degeneration (IDD) in patients with lumbar disc herniation (LDH) is related to postoperative re-herniation and low back pain. Although many investigators believed that there is an interdependence between paraspinal muscles degeneration and IDD, few studies focused on the fatty infiltration of paraspinal muscles on single- and multiple-level IDD in patients with LDH. This study aims to investigate the difference on the fatty infiltration of paraspinal muscles between single- and multiple-levels IDD in patients with LDH. and to explore in patients with LDH whether fatty infiltration is a potential risk factor for multiple-level IDD.
METHODS: This study was conducted as a retrospective observational analysis of 82 patients with LDH from January 1, 2020 to December 30, 2020 in our hospital were enrolled. Twenty-seven cases had single-level IDD (Group A), and 55 cases had multiple-level IDD (Group B). We measured the mean computed tomography (CT) density value of the paraspinal muscles, including multifidus (MF), erector spinae (ES) and psoas muscle (PM) at each disc from L1 to S1. Subgroups were set to further analyze the odds ratio (OR) of fatty infiltration of paraspinal muscles in different sex and BMI groups. We measured sagittal angles and analyzed the relationships between these angles and IDD. Finally, we use logistic regression, adjusted for other confounding factors, to investigate whether fatty infiltration is an independent risk factor for multi-level IDD.
RESULTS: The average age in multi-level IDD (51.40 ± 15.47 years) was significantly higher than single-level IDD (33.37 ± 7.10 years). The mean CT density value of MF, ES and PM in single-level IDD was significantly higher than multi-level IDD (all ps < 0.001). There was no significant difference of the mean value of angles between the two groups. No matter being fat (body mass index [BMI] > 24.0 kg/m2) or normal, patients with low mean muscle CT density value of MF and ES are significantly easier to suffer from multiple-level IDD. In the pure model, the average CT density value of the MF, ES and PM is all significantly associated with the occurrence of multi-IDD. However, after adjusting for various confounding factors, only the OR of the average CT density value for MF and ES remains statistically significant (OR = 0.810, 0.834, respectively).
CONCLUSIONS: In patients with LDH, patients with multiple-level IDD have more severe fatty infiltration of MF and ES than those with single-level IDD. Fatty infiltration of MF and ES are independent risk factors for multiple-level IDD in LDH patients.
METHODS: This study was conducted as a retrospective observational analysis of 82 patients with LDH from January 1, 2020 to December 30, 2020 in our hospital were enrolled. Twenty-seven cases had single-level IDD (Group A), and 55 cases had multiple-level IDD (Group B). We measured the mean computed tomography (CT) density value of the paraspinal muscles, including multifidus (MF), erector spinae (ES) and psoas muscle (PM) at each disc from L1 to S1. Subgroups were set to further analyze the odds ratio (OR) of fatty infiltration of paraspinal muscles in different sex and BMI groups. We measured sagittal angles and analyzed the relationships between these angles and IDD. Finally, we use logistic regression, adjusted for other confounding factors, to investigate whether fatty infiltration is an independent risk factor for multi-level IDD.
RESULTS: The average age in multi-level IDD (51.40 ± 15.47 years) was significantly higher than single-level IDD (33.37 ± 7.10 years). The mean CT density value of MF, ES and PM in single-level IDD was significantly higher than multi-level IDD (all ps < 0.001). There was no significant difference of the mean value of angles between the two groups. No matter being fat (body mass index [BMI] > 24.0 kg/m2) or normal, patients with low mean muscle CT density value of MF and ES are significantly easier to suffer from multiple-level IDD. In the pure model, the average CT density value of the MF, ES and PM is all significantly associated with the occurrence of multi-IDD. However, after adjusting for various confounding factors, only the OR of the average CT density value for MF and ES remains statistically significant (OR = 0.810, 0.834, respectively).
CONCLUSIONS: In patients with LDH, patients with multiple-level IDD have more severe fatty infiltration of MF and ES than those with single-level IDD. Fatty infiltration of MF and ES are independent risk factors for multiple-level IDD in LDH patients.
摘要：
目的：腰椎间盘突出症（LDH）患者的多节段椎间盘退变（IDD）与术后再突出和下腰痛有关。尽管许多研究人员认为椎旁肌肉变性和IDD之间存在相互依存关系，很少有研究关注LDH患者单水平和多水平IDD的椎旁肌脂肪浸润。本研究旨在探讨LDH患者单水平和多水平IDD之间椎旁肌脂肪浸润的差异。探讨LDH患者脂肪浸润是否是多水平IDD的潜在危险因素。
方法：本研究对我院2020年1月1日至2020年12月30日收治的82例LDH患者进行回顾性观察分析。27例单级碘缺乏病（A组），55例患者出现多水平IDD(B组)。我们测量了椎旁肌肉的平均计算机断层扫描（CT）密度值，包括多裂(MF)，从L1到S1，每个椎间盘的竖脊肌（ES）和腰大肌（PM）。设置亚组，进一步分析不同性别和BMI组的椎旁肌脂肪浸润比值比（OR）。我们测量了矢状角，并分析了这些角度与IDD之间的关系。最后,我们使用逻辑回归，调整了其他混杂因素，探讨脂肪浸润是否是多水平IDD的独立危险因素。
结果：多水平IDD的平均年龄（51.40±15.47岁）明显高于单水平IDD（33.37±7.10岁）。MF的平均CT密度值，单水平IDD中ES和PM显著高于多水平IDD(均ps<0.001)。两组之间的角度平均值差异无统计学意义。无论是脂肪（体重指数[BMI]>24.0kg/m2）还是正常，MF和ES平均肌肉CT密度值低的患者明显更容易患多级IDD。在纯模型中，MF的平均CT密度值，ES和PM均与多IDD的发生显著相关。然而,在调整了各种混杂因素后，仅MF和ES的平均CT密度值的OR仍然具有统计学意义（OR分别为0.810、0.834）。
结论：在LDH患者中，与单水平IDD患者相比，多水平IDD患者的MF和ES脂肪浸润更严重。MF和ES的脂肪浸润是LDH患者多水平IDD的独立危险因素。
方法：本研究对我院2020年1月1日至2020年12月30日收治的82例LDH患者进行回顾性观察分析。27例单级碘缺乏病（A组），55例患者出现多水平IDD(B组)。我们测量了椎旁肌肉的平均计算机断层扫描（CT）密度值，包括多裂(MF)，从L1到S1，每个椎间盘的竖脊肌（ES）和腰大肌（PM）。设置亚组，进一步分析不同性别和BMI组的椎旁肌脂肪浸润比值比（OR）。我们测量了矢状角，并分析了这些角度与IDD之间的关系。最后,我们使用逻辑回归，调整了其他混杂因素，探讨脂肪浸润是否是多水平IDD的独立危险因素。
结果：多水平IDD的平均年龄（51.40±15.47岁）明显高于单水平IDD（33.37±7.10岁）。MF的平均CT密度值，单水平IDD中ES和PM显著高于多水平IDD(均ps<0.001)。两组之间的角度平均值差异无统计学意义。无论是脂肪（体重指数[BMI]>24.0kg/m2）还是正常，MF和ES平均肌肉CT密度值低的患者明显更容易患多级IDD。在纯模型中，MF的平均CT密度值，ES和PM均与多IDD的发生显著相关。然而,在调整了各种混杂因素后，仅MF和ES的平均CT密度值的OR仍然具有统计学意义（OR分别为0.810、0.834）。
结论：在LDH患者中，与单水平IDD患者相比，多水平IDD患者的MF和ES脂肪浸润更严重。MF和ES的脂肪浸润是LDH患者多水平IDD的独立危险因素。
