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Hip, Abdomen and Paraspinal Muscle Morphology and its Effect on Pain and Disability in Patients with Degenerative Lumbar Scoliosis

  • 이종민 (Jong Min Lee, 아주대학교 일반대학원)

초록/요약

Background context: Sarcopenia, an overall reduction in skeletal muscle mass, was shown to correlate with pain and disabil i ty in pat ients with degenerat ive lumbar scol iosis (DLS). Previous s tudies report that paraspinal muscle morphology correlates with radiographic paramete rs of DLS. However , no s tudy investigated the effects of overal l core muscle morphology, including hip and abdomen muscles , on pain and disabi l i ty in these patients . Purpose: The pr imary goal of this s tudy was to investigate the correlat ion between core muscle morphology with pain and disabil i ty in DLS pat ients . The secondary outcome was the correlat ion between core muscle morphology and radiographic parameters . Design: Cross-sect ional s tudy Pat ient sample: Seventy -six women and f i fteen men (mean age 70.2 ± 8.4 years) with de novo degenerative lumbar or thoracolumbar scol iosis , referred to a s ingle ter t iary hospi tal , were ret rospect ively analyzed. Pat ients with complete cl inical quest ionnaires , whole spine radiographs and an avai lable t runcal computed tomography (CT) scan were included. Outcome measures: Pain was assessed uti l iz ing visual analog score for back (back VAS) and leg pain (leg VAS), whi le disabi l i ty was assessed using the Oswestry Disabi l i ty Index (ODI) and Short Form -36 (SF-36) scores . Coronal ver t ical a l ignment (CVA) and sagi t tal vert ical a l ignment (SVA) as wel l as Cobb angle (CA), lumbar lordosis (LL) and spinopelvic parameters , such as pelvic incidence (PI) , pelvic t i l t (PT) and pelvic obl iqui ty (PO) were measured. Methods: Relat ive cross -sect ional areas (rCSA) and intramuscular fatty inf i l t rat ion rat io (FI) were calculated for hip, abdomen, and paraspinal muscles . Univar iable and multivar iable l inear regression analyses were conducted for pain and disabi l i ty scores . Pearson ’s correlat ion analysis between muscle morphology and radiographic parameters was done. Results: In both univar iable and mult ivariable analysis , gluteus maximus FI was shown to affect back VAS (p=0.022; p=0.045, respectively) and SF-36 PCS (p=0.005; p=0.023, respect ively) , whi le gluteus medius FI was shown to affect SF -36 PCS (p=0.002; p=0.011, respectively) . Abdomen and paraspinal muscles did not show any s tat is t ical s ignif icance with pain and disabil i ty scores . Coronal ver t ical a l ignment was only associated with gluteus maximus FI (p=0.000) and gluteus medius FI (p=0.001) , whereas sagit ta l v er t ical al ignment was associated with gluteus maximus FI (p=0.022) , gluteus medius FI (p=0.022) , mult i f idus rCSA (p=0.000) and erector spinae rCSA (p=0.030) . Conclusions: Fat ty inf i l trat ion of hip muscles , gluteus maximus and gluteus medius, affect back pain and disabi l i ty in DLS pat ients , and correlate with global spinal malalignment . Paraspinal muscles does not s ignificantly affect pain and disabil i ty between DLS pat ient s , but correlates with lumbar deformity, multiple spinopelvic parameters and sagi t ta l spinal a l ignment . Abdomen muscles were not s ignif icant ly associated with neither radiographic nor cl inical parameters in DLS. Key word: Lumbar Vertebrae; Scoliosis; Muscles; Tomography, X -Ray Computed; Pain Measurement; Disabil i ty Evaluat ion; Cross -Sect ional Studies

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목차

I . Introduction 1
I I . Methods 3
A. Study design 3
B. Evaluation of pain and disability 4
C. Evaluation of coronal and sagittal radiographic parameters 4
D. Evaluation of core muscle morphology 5
E. Statistical analysis 9
I I I . Results 10
A. Patient demographics 10
B. Effect of core muscle morphology on pain and disability scores 13
C. Association of core muscle morphology with radiographic parameters 16
IV. Discussion 18
V. Conclusion 22

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