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Abstract：
OBJECTIVE: In chronic low back pain (CLBP), the relationship between spinal pathologies and paraspinal muscles fat infiltration remains unclear. This study aims to evaluate the relationship between MRI findings and paraspinal muscles morphology and fat infiltration in CLBP patients by quantitative MRI.
METHODS: All the CLBP patients were enrolled from July 2021 to December 2022 in four medical institutions. The cross-sectional area (CSA) and proton density fat fraction (PDFF) of the multifidus (MF) and erector spinae (ES) muscles at the central level of the L4/5 and L5/S1 intervertebral discs were measured. MRI findings included degenerative lumbar spondylolisthesis (DLS), intervertebral disc degeneration (IVDD), facet arthrosis, disc bulge or herniation, and disease duration. The relationship between MRI findings and the paraspinal muscles PDFF and CSA in CLBP patients was analyzed.
RESULTS: A total of 493 CLBP patients were included in the study (198 females, 295 males), with an average age of 45.68 ± 12.91 years. Our research indicates that the number of MRI findings are correlated with the paraspinal muscles PDFF at the L4/5 level, but is not significant. Moreover, the grading of IVDD is the primary factor influencing the paraspinal muscles PDFF at the L4-S1 level (BES at L4/5=1.845, P < 0.05); DLS was a significant factor affecting the PDFF of MF at the L4/5 level (B = 4.774, P < 0.05). After including age, gender, and Body Mass Index (BMI) as control variables in the multivariable regression analysis, age has a significant positive impact on the paraspinal muscles PDFF at the L4-S1 level, with the largest AUC for ES PDFF at the L4/5 level (AUC = 0.646, cut-off value = 47.5), while males have lower PDFF compared to females. BMI has a positive impact on the ES PDFF only at the L4/5 level (AUC = 0.559, cut-off value = 24.535).
CONCLUSIONS: The degree of paraspinal muscles fat infiltration in CLBP patients is related to the cumulative or synergistic effects of multiple factors, especially at the L4/L5 level. Although age and BMI are important factors affecting the degree of paraspinal muscles PDFF in CLBP patients, their diagnostic efficacy is moderate.
METHODS: All the CLBP patients were enrolled from July 2021 to December 2022 in four medical institutions. The cross-sectional area (CSA) and proton density fat fraction (PDFF) of the multifidus (MF) and erector spinae (ES) muscles at the central level of the L4/5 and L5/S1 intervertebral discs were measured. MRI findings included degenerative lumbar spondylolisthesis (DLS), intervertebral disc degeneration (IVDD), facet arthrosis, disc bulge or herniation, and disease duration. The relationship between MRI findings and the paraspinal muscles PDFF and CSA in CLBP patients was analyzed.
RESULTS: A total of 493 CLBP patients were included in the study (198 females, 295 males), with an average age of 45.68 ± 12.91 years. Our research indicates that the number of MRI findings are correlated with the paraspinal muscles PDFF at the L4/5 level, but is not significant. Moreover, the grading of IVDD is the primary factor influencing the paraspinal muscles PDFF at the L4-S1 level (BES at L4/5=1.845, P < 0.05); DLS was a significant factor affecting the PDFF of MF at the L4/5 level (B = 4.774, P < 0.05). After including age, gender, and Body Mass Index (BMI) as control variables in the multivariable regression analysis, age has a significant positive impact on the paraspinal muscles PDFF at the L4-S1 level, with the largest AUC for ES PDFF at the L4/5 level (AUC = 0.646, cut-off value = 47.5), while males have lower PDFF compared to females. BMI has a positive impact on the ES PDFF only at the L4/5 level (AUC = 0.559, cut-off value = 24.535).
CONCLUSIONS: The degree of paraspinal muscles fat infiltration in CLBP patients is related to the cumulative or synergistic effects of multiple factors, especially at the L4/L5 level. Although age and BMI are important factors affecting the degree of paraspinal muscles PDFF in CLBP patients, their diagnostic efficacy is moderate.
摘要：
目标：在慢性下腰痛（CLBP）中，脊柱病变与椎旁肌肉脂肪浸润之间的关系尚不清楚。本研究旨在通过定量MRI评估CLBP患者的MRI表现与椎旁肌肉形态和脂肪浸润之间的关系。
方法：所有CLBP患者均于2021年7月至2022年12月在四家医疗机构入选。测量了L4/5和L5/S1椎间盘中央水平的多裂肌（MF）和竖脊肌（ES）的横截面积（CSA）和质子密度脂肪分数（PDFF）。MRI检查结果包括退行性腰椎滑脱（DLS），椎间盘退变(IVDD),关节突关节,椎间盘突出或突出，和疾病持续时间。分析CLBP患者的MRI表现与椎旁肌PDFF和CSA的关系。
结果：本研究共纳入493例CLBP患者（198例女性，295名男性），平均年龄45.68±12.91岁。我们的研究表明，MRI发现的数量与L4/5水平的椎旁肌PDFF相关，但并不重要。此外，IVDD分级是影响L4-S1水平下椎旁肌PDFF的主要因素(L4/5时BES=1.845,P<0.05)；DLS是影响L4/5水平下MFPDFF的显著因素(B=4.774,P<0.05)。包括年龄之后,性别,和身体质量指数(BMI)作为多变量回归分析中的控制变量，年龄对L4-S1水平的椎旁肌PDFF有显著的积极影响，ESPDFF的AUC最大为L4/5水平（AUC=0.646，截止值=47.5），而男性的PDFF低于女性。BMI仅在L4/5水平(AUC=0.559,截止值=24.535)对ESPDFF有积极影响。
结论：CLBP患者椎旁肌脂肪浸润程度与多因素的累积或协同作用有关，特别是在L4/L5级别。尽管年龄和BMI是影响CLBP患者椎旁肌PDFF程度的重要因素,他们的诊断效能是中等的。
方法：所有CLBP患者均于2021年7月至2022年12月在四家医疗机构入选。测量了L4/5和L5/S1椎间盘中央水平的多裂肌（MF）和竖脊肌（ES）的横截面积（CSA）和质子密度脂肪分数（PDFF）。MRI检查结果包括退行性腰椎滑脱（DLS），椎间盘退变(IVDD),关节突关节,椎间盘突出或突出，和疾病持续时间。分析CLBP患者的MRI表现与椎旁肌PDFF和CSA的关系。
结果：本研究共纳入493例CLBP患者（198例女性，295名男性），平均年龄45.68±12.91岁。我们的研究表明，MRI发现的数量与L4/5水平的椎旁肌PDFF相关，但并不重要。此外，IVDD分级是影响L4-S1水平下椎旁肌PDFF的主要因素(L4/5时BES=1.845,P<0.05)；DLS是影响L4/5水平下MFPDFF的显著因素(B=4.774,P<0.05)。包括年龄之后,性别,和身体质量指数(BMI)作为多变量回归分析中的控制变量，年龄对L4-S1水平的椎旁肌PDFF有显著的积极影响，ESPDFF的AUC最大为L4/5水平（AUC=0.646，截止值=47.5），而男性的PDFF低于女性。BMI仅在L4/5水平(AUC=0.559,截止值=24.535)对ESPDFF有积极影响。
结论：CLBP患者椎旁肌脂肪浸润程度与多因素的累积或协同作用有关，特别是在L4/L5级别。尽管年龄和BMI是影响CLBP患者椎旁肌PDFF程度的重要因素,他们的诊断效能是中等的。
