Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration

Kyung-Sub Song; Seung-Hwan Lee; Byeong-Mun Park; Su-Keon Lee; Moses Lee; Ji-Ung Yeom; Chang-Yk Lee; Hwan-Mo Lee

doi:10.4184/jkss.2018.25.2.47

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Song, Lee, Park, Lee, Lee, Yeom, Lee, and Lee: Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration

Original Article

Journal of Korean Spine Surg 2018;25(2):47-53.

Published online: 30 June 2018

DOI: https://doi.org/10.4184/jkss.2018.25.2.47

Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration

Kyung-Sub Song, M.D., Seung-Hwan Lee, M.D., Byeong-Mun Park, M.D., Su-Keon Lee, M.D., Moses Lee, M.D., Ji-Ung Yeom, M.D., Chang-Yk Lee, M.D., Hwan-Mo Lee, M.D.^∗

Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea

^∗Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea

Corresponding author: Seung-Hwan Lee, M.D. ORCID ID: Seung-Hwan Lee: https://orcid.org/0000-0002-0432-3857 Kyung-Sub Song: https://orcid.org/0000-0001-8345-5550 Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, 36 Digital-ro, Gwangmyeong City, Gyeongido, 14241, Korea TEL: +82-2-2680-7699, FAX: +82-2-2680-7755 E-mail: java5885@gmail.com

Received 10 December 20173 January 2018 Accepted 2 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective evaluation.

Objectives

To determine the relationship between lumbar disc degeneration and back muscle degeneration.

Summary of Literature Review

In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles.

Materials and Methods

In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed.

Results

The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant.

Conclusions

There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

Keywords: Back muscle degeneration, Lumbar disc degeneration, MRI

REFERENCES

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Fig. 1.

Qualitative analysis of the fatty infiltration of lumbar back muscles. (A) Grade 1: mild (<10% fatty infiltration). (B) Grade 2: moderate (10-50% fatty infiltration). (C) Grade 3: severe (>50% fatty infiltration). Black arrow: multifidus, dotted arrow: erector spinae.

Table 1.

Descriptive data of patients

Age (yr)	61.65±7.01
Weight (kg)	62.03±9.61
Height (cm)	161.12±6.93
BMI (kg/m²)	23.80±2.69
Lumbar lordosis	41.60±12.24
Pelvic tilt	14.94±11.31
Sacral slope	35.51±10.02
Pelvic incidence	48.80±12.60
L2-3 degeneration	2.68±0.75
Multifidus FI (%)	34.64±12.55
Erector spinae FI (%)	25.58±10.27
Male/Female	34/31

BMI: body mass index, FI: fat infiltration.

Table 2.

Correlation analysis between radiological factor and fat infiltration(FI) grade of multifidus

	Age	BMI	LL	PT	SS	PI	Disc deg
FI grade1	60.71±6.58	23.49±3.23	38.96±10.76	14.68±9.84	34.07±8.72	47.36±10.63	2.50±0.69
FI grade2	60.90±6.58	23.98±2.25	45.87±12.09	15.53±13.25	38.47±10.55	52.03±14.25	2.70±0.70
FI grade3	68.57±7.55	24.26±2.26	33.86±13.35	13.43±8.70	28.57±9.05	40.71±8.16	3.29±0.95
Pearson r	0.250	0.104	0.038	−0.007	−0.020	−0.030	0.288
p-value	0.044	0.410	0.766	0.957	0.877	0.811	0.020

BMI: body mass index, LL: lumbar lordosis, PT: pelvic tilt, SS: sacral slope, PI: pelvic incidence.

Table 3.

Correlation analysis between radiological factor and fat infiltration(FI) grade of erector spinae

	Age	BMI	LL	PT	SS	PI	Disc deg
FI grade1	60.11±6.20	23.54±3.16	39.09±10.31	15.49±9.90	34.34±8.21	48.31±10.23	2.51±0.66
FI grade2	63.04±7.31	24.08±2.01	46.37±12.07	14.26±13.13	38.04±11.25	50.44±15.28	2.85±0.82
FI grade3	67.00±10.58	24.23±2.61	28.00±19.98	14.67±13.32	26.33±13.65	39.67±10.21	3.00±1.00
Pearson r	0.264	0.101	0.102	−0.047	0.035	−0.022	0.235
p-value	0.034	0.422	0.418	0.711	0.782	0.863	0.060

BMI: body mass index, LL: lumbar lordosis, PT: pelvic tilt, SS: sacral slope, PI: pelvic incidence.

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