Eur J Med Res. 2025 Dec 6. doi: 10.1186/s40001-025-03609-w. Online ahead of print.
ABSTRACT
OBJECTIVE: To analyze the correlation between paraspinal muscle atrophy, facet joint degeneration, and degenerative scoliosis (DS).
METHODS: A retrospective study included 231 chronic low back pain patients from Zhongda Hospital Affiliated to Southeast University (January 2023-January 2024). Radiographic diagnosis assigned 150 patients to DS group (subclassified into mild [n = 72], moderate [n = 56], severe [n = 22]) and 81 to non-DS control group. Using T2-weighted MRI at L3-S1 levels, ImageJ software measured multifidus (MF) and erector spinae (ES) cross-sectional area (CSA) and functional muscle ratio (LCSA/GCSA). Surgimap software quantified facet joint angle (FJA), facet overhang (FO) length, and facet joint space width (FJSW). Logistic regression analyzed risk factors with ROC curves determining diagnostic thresholds.
RESULTS: The non-DS group demonstrated a significantly higher proportion of males (P = 0.023) and greater bone mineral density (P = 0.043) compared to the DS group. Regarding paraspinal muscle parameters, the non-DS group exhibited significantly larger MF CSA, MF + ES CSA, and LCSA/GCSA at the L3/4, L4/5, and L5/S1 levels, as well as a larger ES CSA at the L3/4 level (all P < 0.05). Conversely, the ES CSA at the L5/S1 level was significantly smaller in the non-DS group. For facet joint parameters, the non-DS group showed significantly smaller FJA, FO Length at the L3/4, L4/5, and L5/S1 levels, and smaller FJSW at the L3/4 and L4/5 levels (all P < 0.05). Within the DS group, significant differences were observed between the convex and concave sides at all L3-S1 levels for LCSA/GCSA, MF CSA, ES CSA, FJA, FO Length, and FJSW (all P < 0.05). With increasing severity of DS, there was a progressive decrease in LCSA/GCSA, MF CSA, and ES CSA, and a progressive increase in FJA and FO Length across the L3-S1 levels (all P < 0.01). Post-hoc analysis revealed significant differences in the majority of muscle parameters between severe DS and mild/moderate DS (P < 0.05). Correlation analysis indicated that, except for FJSW at L5-S1 (P = 0.526), the Cobb angle was negatively correlated with MF CSA, ES CSA, LCSA/GCSA, and FJSW, and positively correlated with FJA and FO Length (all P < 0.001). In both the DS and non-DS groups, most LCSA/GCSA and other CSA measurements demonstrated no significant correlations with FJA, FO length, and FJSW. Among the few statistically significant correlations observed, all were weak (rho < 0.30). Multivariate logistic regression analysis identified the following risk-associated factors for DS: lower BMD (OR = 0.802, P = 0.032), reduced LCSA/GCSA (OR = 0.005, P = 0.003), smaller MF CSA (OR = 0.969, P = 0.027), smaller ES CSA (OR = 0.973, P = 0.014), larger FJA (OR = 1.075, P = 0.016), and greater FO length (OR = 1.067, P = 0.001). ROC analysis yielded AUCs/cut-offs: BMD (0.581/- 0.900 T-score), LCSA/GCSA (0.712/0.805), MF CSA (0.608/635 mm2), ES CSA (0.463/832 mm2), FJA (0.627/57°), FO length (0.651/6.550 mm).
CONCLUSION: DS patients demonstrate progressive paraspinal muscle atrophy, sagittal-oriented facet joints, and advanced facet degeneration correlating with scoliosis severity. Diagnostic thresholds indicating DS probability are BMD < – 0.900 T-score, LCSA/GCSA < 0.805, MF CSA < 635 mm2, ES CSA < 832 mm2, FJA > 57°, and FO length > 6.550 mm.
PMID:41353546 | DOI:10.1186/s40001-025-03609-w
