| Objective:To investigate the effect of Lumbar spinal stenosis(LSS)on lumbar paraspinal muscle atrophy(multifidus,erector spinae and psoas major)and fat infiltration,and to verify whether the number of lumbar stenosis segments is correlated with lumbar paraspinal muscle fat infiltration and muscle area ratio.Methods:A total of 208 patients with lumbar spinal stenosis admitted to the orthopedics department of Jiangsu North People’s Hospital from January 2020 to October 2022 were retrospectively analyzed as the stenosis group,and 60 patients without lumbar spine diseases admitted to the physical examination department of Jiangsu North People’s Hospital were selected as the non-stenosis group.Patients in the stenosis group were divided into five groups according to different stenosis segments:L3-4,L3-S1,L4-5,L4-S1 and L5-S1.Age,sex,Body mass index(BMI),course of disease and lumbar Magnetic resonance imaging(MRI)data were collected for both groups at the time of admission.For muscle area measurement,Image J software was used to determine the muscle images of L3,L4 and L5 segments by scanning images of the lower endplates of L3,L4 and L5 segments.MRI images of the multifidus,erector spinae and psoas major were collected at L3,L4 and L5 segments.Firstly,the contours of the multifidus,erector spinae and psoas major were outlined according to fascia.Lumbar muscle Cross-sectional area(CSA)(mm~2)and Vertebral cross-sectional area(VCSA)were measured through software operation.Fatty infiltration Area(FIA)was measured.Fat-free cross-sectional area(FCSA),Percent of fat infraction(FI%)and ratio of paravertebral muscle CSA(%)were calculated.SPSS 25.0(IBM USA)statistical software was used for data analysis.All data were expressed as mean±standard deviation((?)±s).Independent sample t test was used for comparison between groups.The correlation between the number of different stenosis segments and FI and the ratio of paravertebral muscle CSA was analyzed by One-way analysis of variance(ANOVA).p<0.05 was statistically significant.Results:1.A total of 208 patients in the stenosis group and 60 patients in the non-stenosis group were included in this study.The mean age of patients in the stenosis group was 50.67±5.60 years old,including 101 males and 107 females.The mean BMI was 24.97±2.14 kg/m~2,and the mean course of disease was 11.54±6.09 months.The mean age of the non-stenosis group was 49.42±7.42 years,and the mean BMI of 33males and 27 females was 24.75±2.10 kg/m~2.There was no significant difference in age,gender,BMI between the two groups and the course of disease between the five different stenosis segments in the stenosis group(p>0.05).2.The values of multifidus and erector spinae FCSA in the narrow segment were smaller than those in the non-stenosis group,while the values of FI in the narrow segment were larger than those in the non-stenosis group,and the difference was significant(p<0.05).There was no significant difference in the FCSA and FI of the psoas major between the two groups.3.Among the 208 patients in the stenosis group,139 cases(66.82%)were one level,35cases(16.82%)were two levels,and 34 cases(16.34%)were three levels.The results of One-way analysis of variance(ANOVA)showed that the number of stenosis segments was correlated with the multifidus and erector spinae FI at L3 and L4 levels(p<0.05),and the ratio of paravertebral muscle CSA at L3 and L5 levels was correlated with the number of stenosis segments(p<0.05).Conclusion:There were statistically significant differences in the FCSA and FI of the multifidus muscle and erector spinus muscle in the stenosis group compared with the non-stenosis group,but there were no statistically significant differences in the FCSA and FI of the psoas major muscle compared with the non-stenosis group.L3 and L4multifidus and erector spinus FI were correlated with the number of strictures,while psoas major FI was not.The ratio of paravertebral muscle CSA was correlated with the number of stenosis at L3 and L5 levels. |
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