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Purpose <p>To explore alterations and correlations of multifidus (MF), erector spinae (ES), psoas major (PM), and gluteus medius (Gmed) in intervertebral disc degeneration (IVDD) using multi-echo Magnetic resonance imaging <i>(</i>MRI<i>)</i> based water-fat separation.</p> Methods <p>We retrospectively collected data from patients who presented to our hospital with low back pain. Proton density fat fraction (PDFF) was measured using the multi-echo Dixon VIBE sequence. IVDD at the L4-L5 level was assessed on T2-weighted sagittal images according to the Pfirrmann grading system. Spearman correlation coefficients were calculated to evaluate the relationships between MF, ES, PM, and Gmed cross-sectional area (CSA), PDFF, and IVDD. Multivariable linear regression analysis was performed to determine independent associations of gender, age, and Pfirrmann grade with CSA and PDFF of the MF, ES, PM and Gmed.</p> Results <p>A total of 506 patients with a mean age of 44.43 ± 13.49 years were included. As Pfirrmann grade increased, the CSA of the MF, ES, and PM progressively decreased. With advancing Pfirrmann grade, the PDFF of the MF, ES, and PM demonstrated a progressive increase. The Pfirrmann grade showed a moderate negative correlation with MF and ES CSA (Rho = -0.395, Rho = -0.348, <i>p</i> &lt; 0.001), and a weak negative correlation with PM CSA (Rho = -0.293, <i>p</i> &lt; 0.05). Conversely, Pfirrmann grade demonstrated a strong positive correlation with MF and ES PDFF (Rho = 0.595, Rho = 0.610, <i>p</i> &lt; 0.001), and a moderate positive correlation with PM PDFF (Rho = 0.415, <i>p</i> &lt; 0.001). Multivariate linear regression analysis revealed that gender, age, and IVDD were independently associated with CSA and PDFF of the MF and ES muscles (<i>P</i> &lt; 0.001). However, for the PM muscle, only its PDFF showed independent correlations with IVDD, gender, and age, while PM CSA was independently linked to gender and age but not to Pfirrmann grade. With an increase in the Pfirrmann grade of intervertebral discs, Gmed CSA shows a tendency to increase. The Pfirrmann grade demonstrated weak positive correlations with both the Gmed CSA and PDFF (Rho = 0.160, Rho = 0.264, <i>p</i> &lt; 0.001). After adjusting for the confounding effects of sex and age, the Pfirrmann grade remained an independent factor associated with Gmed CSA (β = 0.136, <i>p</i> = 0.001).</p> Conclusions <p>MRI reliably evaluates paraspinal muscles and Gmed atrophy, particularly in quantifying fat content. PDFF emerges as a valuable tool for assessing fat infiltration in paraspinal muscles.</p>

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Association between lumbar disc degeneration at L4-L5 level and atrophy of paraspinal muscles and gluteus medius: a cross-sectional study using 3T quantitative magnetic resonance imaging

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  • 发表日期：

    2025年12月29日

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  • Qun Wen,
  • Jiaoyan Wang,
  • Guang Tan,
  • Yanwen Huang,
  • Hui Wang,
  • Xiaoqing Ding,
  • Kaoqiang Liu,
  • Yujie Zhang,
  • Wenli Tan

摘要

Purpose

To explore alterations and correlations of multifidus (MF), erector spinae (ES), psoas major (PM), and gluteus medius (Gmed) in intervertebral disc degeneration (IVDD) using multi-echo Magnetic resonance imaging (MRI) based water-fat separation.

Methods

We retrospectively collected data from patients who presented to our hospital with low back pain. Proton density fat fraction (PDFF) was measured using the multi-echo Dixon VIBE sequence. IVDD at the L4-L5 level was assessed on T2-weighted sagittal images according to the Pfirrmann grading system. Spearman correlation coefficients were calculated to evaluate the relationships between MF, ES, PM, and Gmed cross-sectional area (CSA), PDFF, and IVDD. Multivariable linear regression analysis was performed to determine independent associations of gender, age, and Pfirrmann grade with CSA and PDFF of the MF, ES, PM and Gmed.

Results

A total of 506 patients with a mean age of 44.43 ± 13.49 years were included. As Pfirrmann grade increased, the CSA of the MF, ES, and PM progressively decreased. With advancing Pfirrmann grade, the PDFF of the MF, ES, and PM demonstrated a progressive increase. The Pfirrmann grade showed a moderate negative correlation with MF and ES CSA (Rho = -0.395, Rho = -0.348, p < 0.001), and a weak negative correlation with PM CSA (Rho = -0.293, p < 0.05). Conversely, Pfirrmann grade demonstrated a strong positive correlation with MF and ES PDFF (Rho = 0.595, Rho = 0.610, p < 0.001), and a moderate positive correlation with PM PDFF (Rho = 0.415, p < 0.001). Multivariate linear regression analysis revealed that gender, age, and IVDD were independently associated with CSA and PDFF of the MF and ES muscles (P < 0.001). However, for the PM muscle, only its PDFF showed independent correlations with IVDD, gender, and age, while PM CSA was independently linked to gender and age but not to Pfirrmann grade. With an increase in the Pfirrmann grade of intervertebral discs, Gmed CSA shows a tendency to increase. The Pfirrmann grade demonstrated weak positive correlations with both the Gmed CSA and PDFF (Rho = 0.160, Rho = 0.264, p < 0.001). After adjusting for the confounding effects of sex and age, the Pfirrmann grade remained an independent factor associated with Gmed CSA (β = 0.136, p = 0.001).

Conclusions

MRI reliably evaluates paraspinal muscles and Gmed atrophy, particularly in quantifying fat content. PDFF emerges as a valuable tool for assessing fat infiltration in paraspinal muscles.