Objective To analyze the change characteristics of cross-sectional area (CSA) balance, symmetry and proton density fat fraction (PDFF) of paravertebral muscle in patients with lumbar disc herniation (LDH), and to analyze the effects of gender, age, protruding segments and intervertebral disc reabsorption on the above indexes to provide imaging evidence for curative effect evaluation of non-surgical treatment in LDH. Methods A total of 128 patients with LDH of L4/5 or L5/S1 admitted to Sichuan Province Orthopedic Hospital were enrolled as the research objects between April 2021 and July 2023. All were given a non-surgical treatment regimen and followed up for 1 year. Before and after treatment, all underwent routine T2WI sequence under sagittal view and IDEAL-IQ sequence under axial view in lumbar magnetic resonance imaging (MRI). The fat fraction (FF), CSA and PDFF of the paravertebral muscles[multifidus (MF), erector spinae (ES), psoas major (PS) ]were measured by Image J software. According to the intervertebral disc reabsorption degree after 1 year of follow-up, patients were divided into reabsorption group (n=82) and non-reabsorption group (n=46). The differences in paravertebral muscle indexes among patients with different genders, age groups (<35 years, 35-49 years, >49 years) and protruding segments (n=70 for group L4/5, n=58 for group L5/S1) were compared. Results FF values of MF on affected and healthy sides of L4/5 and L5/S1 segments in females were significantly higher than those in males. PDFF of MF, ES and PS in non-reabsorption group were significantly higher than those in reabsorption group. During follow-up, CSA on affected and healthy sides of L4/5 and affected side of L5/S1 were significantly increased in reabsorption group compared with those before treatment, but there was no significant change in CSA before and after treatment in non-reabsorption group. Age differences: in the three age groups (<35 years, 35-49 years, >49 years), PDFF of MF, ES and PS in non-reabsorption group were significantly higher than those in reabsorption group, and PDFF of paravertebral muscles was overall higher in patients aged >49 years. Before treatment and during follow-up, PDFF of MF and ES on affected side in L5/S1 segment group were significantly higher than those in L4/5 segment group, while CSA of MF and ES on affected side were significantly lower than those in L4/5 segment group, but there was no significant difference in PDFF and CSA of PS between the two groups. Conclusion In LDH patients, fat infiltration of MF is more severe in females. The fat content is higher in those aged >49 years or L5/S1 segment protruding, and CSA is lower in the latter. The decrease of PDFF and increase of CSA in paravertebral muscles may indicate intervertebral disc resorption, which can be applied as potential imaging indexes to evaluate the curative effect of non-surgical treatment.
Key words
lumbar disc herniation /
paravertebral muscle /
cross-sectional area /
proton density fat fraction /
balance, symmetry
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References
[1] AWADALLA AM, ALJULAYFI AS, ALROWAILI AR, et al.Management of lumbar disc herniation: a systematic review[J]. Cureus, 2023, 15(10): e47908.
[2] ZHANG AS, XU A, ANSARI K, et al.Lumbar disc herniation: diagnosis and management[J]. Am J Med, 2023, 136(7): 645-651.
[3] HATSUSHIRO A, TAWAKI Y, MURAKAMI T.A method of predicting posture-related pain using biomechanical parameters for patients with lumbar spinal disc herniation[C]//2023 45th Annu Int Conf IEEE Eng Med Biol Soc (EMBC). Sydney, Australia: IEEE, 2023: 1-5.
[4] 江天蔚, 姚琦, 李志君. 不同术式治疗腰椎间盘突出症疗效及对腰背肌生物力学性能的影响[J]. 川北医学院学报, 2022, 37(10): 1276-1279.
[5] 耿健, 黄朋举, 程晓光. 腰椎间盘退变与腰椎旁肌肉减少症之间的关系探讨[J]. 中国骨与关节杂志, 2022, 11(4): 292-298.
[6] 范华雨, 曹向阳, 庞志峰, 等. 基于德尔菲法探究腰椎间盘突出MRI影像诊断路径[J]. 暨南大学学报 (自然科学与医学版), 2023, 44(4): 399-405.
[7] IDILMAN IS, YILDIZ AE, KARAOSMANOGLU AD, et al. Proton density fat fraction: magnetic resonance imaging applications beyond the liver[J]. Diagn Interv Radiol, 2022, 28(1): 83-91.
[8] LI J, GÖSSEL L, KUNZE B, et al. Traumatic lumbar disc herniation: A systemic case review and meta-analysis[J]. Brain Spine, 2023, 3: 102350.
[9] HORNUNG AL, BARAJAS JN, RUDISILL SS, et al.Prediction of lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical phenotype study[J]. Spine J, 2023, 23(2): 247-260.
[10] 中华医学会老年医学分会老年康复学组, 肌肉衰减综合征专家共识撰写组. 肌肉衰减综合征中国专家共识 (草案)[J]. 中国综合临床, 2018, 34(3): 193-199.
[11] SHEN SC, CHEN HC, TSOU HK, et al.Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation based on image analysis and clinical findings: a retrospective review of 345 cases[J]. Medicine , 2023, 102(5): e32832.
[12] 臧传艳, 杨文全, 贾文萍, 等. 腰椎间盘突出症患者椎旁肌形态与功能变化的研究进展[J]. 广西医学, 2021, 43(19): 2363-2365.
[13] ROSSMAN S, MEYER E, RUNDELL S.Development of a finite element lumbar spine model to predict intervertebral disc herniation risk factors[J]. Comput Methods Biomech Biomed Engin, 2022, 25(1): 1-13.
[14] 曾晶晶, 田曼曼, 王经英, 等. MRI评价腰椎间盘突出症患者的椎旁肌改变[J]. 浙江临床医学, 2023, 25(4): 576-577, 580.
[15] JIANG L, DU X, PAN Z, et al.Lumbar disc herniation in juveniles: a case-control study of MRI characteristics and etiological insights[J]. J Orthop Res, 2023, 41(12): 2685-2693.
[16] 汪青, 黄昊强, 洪嵘, 等. 绝经后超重及肥胖女性四肢肌肉/脂肪比与骨质疏松性椎体骨折的相关性: 一项横断面研究[J]. 中华骨质疏松和骨矿盐疾病杂志, 2022, 15(5): 463-468.
[17] KUPCZYK PA, KURT D, ENDLER C, et al.MRI proton density fat fraction for estimation of tumor grade in steatotic hepatocellular carcinoma[J]. Eur Radiol, 2023, 33(12): 8974-8985.
[18] XIA T, DU M, LI H, et al.Association between liver MRI proton density fraction and liver disease risk[J]. Radiology, 2023, 309(1): e231007.
[19] ORCEL T, CHAU HT, TURLIN B, et al.Evaluation of proton density fat fraction (PDFF) obtained from a vendor-neutral MRI sequence and MRQuantif software[J]. Eur Radiol, 2023, 33(12): 8999-9009.
[20] 张雯双, 刘亚军, 王玲, 等. 定量CT与化学位移编码磁共振成像测量椎旁肌肉脂肪含量的相关性研究[J]. 中华骨与关节外科杂志, 2022, 15(9): 669-674.
[21] 刘志壮, 蔡余力, 王晓英, 等. 多裂肌横截面积对腰椎间盘突出症经皮椎间孔镜手术后复发的预测价值分析[J]. 中国医刊, 2022, 57(6): 642-646.
[22] DIALLO TD, ROSPLESZCZ S, FABIAN J, et al.Associations of myosteatosis with disc degeneration: a 3T magnetic resonance imaging study in individuals with impaired glycaemia[J]. J Cachexia Sarcopenia Muscle, 2023, 14(3): 1249-1258.
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