Correlation Analysis Between Paravertebral Muscle Cross-sectional Area And Single Segment Degenerative Lumbar Spondylolisthesis

Objective:To observe the changes of MRI cross-sectional area of paravertebral muscle in patients with single-segment L4 degenerative lumbar spondylolisthesis,and to explore its significance.Metheods:The clinical data of DLS patients admitted to the outpatient department and inpatient department of hunan people's hospital(tianxinge hospital)of the first affiliated hospital of hunan normal university from January 2009 to January 2019 were retrospectively analyzed.The cases that met the inclusion criteria(a total of 335 cases)were arranged in chronological order,and 60 cases were selected as the slip group by looking up the random number table.By the same method,imaging examination was conducted in our hospital at the same period only with local lumbago symptoms,but no significant positive findings were found.60 cases were selected as the control group from 377 patients who underwent lower back pain or lower limb pain.Lumbar MRI images of the 120 patients(60 in the slipped group and 60 in the control group)were obtained by using the PACS system in our hospital,and t2-weighted images at the level of the lower endplate of the 4th lumbar vertebra were selected on the cross-section.The Image j image processing software was used to draw the contours of the multifidus muscles,the erector spinaemuscles,the psoas majors and the L4 vertebral body,and their cross-sectional area was measured.The cross-sectional area of the bilateral multifidus muscles,the bilateral erector spinae muscles,and the bilateral psoas majors were measured and averaged for each patient.At the same time,the cross-sectional area of the L4 vertebral body at the scanning level was taken as a reference value.The ratio of the average cross-sectional area of the multifidus muscles,the erector spinae muscles and the psoas majors to the cross-sectional area of the L4 vertebral body was used to reflect the degree of muscle atrophy.The smaller the value is,the more severe the degree of atrophy will be.Results:1.The average cross-sectional area of bilateral multifidus muscles in the spondylolisthesis group was 7.81±1.06cm2,while that of the control group was 8.61±0.81cm2.The difference between the two groups was statistically significant(p<0.05).The average cross-sectional area of bilateral psoas majors in the spondylolisthesis group was 13.06±1.92cm2,while that of the control group was 13.73±1.77cm2.The difference between the two groups was statistically significant(p<0.05).The average cross-sectional area of bilateral erector spinae muscles in the spondylolisthesis group was 15.31±2.97cm2,while that in the control group was 15.00±2.61cm2.There was no statistical difference between the two groups(p > 0.05).2.The ratio of the average cross-sectional area of the bilateral multifidus muscle to thecross-sectional area of the L4 vertebral body was0.54±0.05 in the spondylolisthesis group.The ratio of the average cross-sectional area of the bilateral multifidus muscle to thecross-sectional area of the L4 vertebral body was 0.60±0.04 in the control group.There were statistically significant differences between the two groups(p < 0.05).The ratio of the average cross-sectional area of the bilateral psoas major to thecross-sectional area of the L4 vertebral body was0.89±0.04 in the spondylolisthesis group.The ratio of the average cross-sectional area of the bilateral psoas major to thecross-sectional area of the L4 vertebral body was0.95±0.05 in the control group.There were statistically significant differences between the two groups(p < 0.05).The ratio of the average cross-sectional area of the bilateral erector spinae muscle to thecross-sectional area of the L4 vertebral body was 1.04±0.08 in the spondylolisthesis group.The ratio of the average cross-sectional area of the bilateral erector spinae muscle to thecross-sectional area of the L4 vertebral body was 1.03±0.05 in the control group.There were no statistically significant differences between the two groups(p>0.05).3.The comparison of the average cross-sectional area of the bilateral multifidus muscle and its ratio to the cross-sectional area of the L4 vertebral body as well as the ratio of the average cross-sectional area of the bilateral psoas major to thecross-sectional area of the L4 vertebralbody in different age groups between these two groups were statistically significant(p < 0.05).A further comparison showed that the population aged 40-50 years >the population aged 50-60 years old >the population aged 60-70 years old population.The difference betweenother indicators in the different age groups was not statistically significant(p>0.05).Comparing the indicators of the same age group between the two groups,the ratio of the average cross-sectional area of the multifidus muscle to the cross-sectional area of the L4 vertebral body and the ratio of the average cross-sectional area of the psoas major to the cross-sectional area of the L4 vertebral body was significantly greater than that of the spondylolisthesis group in the 40-50 year old group(p <0.05).The ratio of the average cross-sectional area of the multifidus muscle to the cross-sectional area of the L4 vertebral body and the ratio of the average cross-sectional area of the psoas major to the cross-sectional area of the L4 vertebral body was significantly greater than that of the spondylolisthesis group in the 50-60 year old group(p <0.05).The ratio of the average cross-sectional area of the multifidus muscle to the cross-sectional area of the L4 vertebral body and the ratio of the average cross-sectional area of the psoas major to the cross-sectional area of the L4 vertebral body was significantly greater than that of the spondylolisthesis group in the 60-70 year old group(p <0.05).4.The average value of the cross-sectional area of the multifidus muscles and the ratio of its cross-sectional area to the L4 lower endplate in the Lumbar spondylolisthesis group of all ages were greater than those in the control group.That is,with the increase of age,the degree of muscle atrophy of multifidus muscles in the Lumbar spondylolisthesis group was significantly greater than that in the control group.With the increase of age,there was no significant difference in the degree of Psoas major atrophy between the Lumbar spondylolisthesis group and the control group.Conclusions:1.The degeneration and atrophy of multifidus are correlated with DLS.With the increase of age,DLS could aggravate the degeneration and atrophy of multifidus muscle.2.Degeneration and atrophy of psoas major are correlated with DLS.However,with the increase of age,DLS fails to significantly aggravate the degenerative atrophy of psoas major.3.There was no significant correlation between the degeneration and atrophy of erector spinalis and single-segment DLS.