Correlations between the Cross-Sectional Area and Moment Arm Length of the Erector Spinae Muscle and the Thickness of the Psoas Major Muscle as Measured by MRI and the Body Mass Index in Lumbar Degenerative Kyphosis Patients

ABSTRACT

PURPOSE: Lumbar degenerative kyphosis (LDK) is a subgroup of the flatback syndrome, which is a condition caused by spinal degeneration. LDK is reported to be the most frequent cause of lumbar spine deformity in the farming districts of the 'Oriental' countries. We investigated the relationship between the cross-sectional area (CSA) and the moment arm length (MAL) of the erector spinae muscle and the thickness of the psoas major muscle (PT) and the body mass index (BMI) by performing statistical analysis, and we tried to show the crucial role of these variables for diagnosing LDK. MATERIALS AND METHODS: From July 2004 to April 2005, we retrospectively reviewed 17 LDK patients who had undergone anterior lumbar interbody fusion (ALIF) with posterior stabilization. We measured both the CSA & MAL on the transverse cross-sectional MR image of the trunk at the fourth to fifth vertebrae (L4/5). The MAL was defined as the anterior-posterior distance between the center of the erector spinae muscle and that of the vertebral body. A comparative study was undertaken between the LDK group and the matched (according to age & gender) control group with regard to the CSA, MAL, PT and BMI. RESULTS: The 17 LDK patients were all females [age 62.5+/-4.93 years, height 157+/-6.19 cm, weight 55.59+/-4.7 kg, and BMI 22.58+/-2.08 kg/m2]. The control group patients were all females [age 63.6+/-2.27 years, height 156+/-5.05 cm, weight 59.65+/-7.39 kg and BMI 24.38+/-2.94 kg/m2]. Spearman's rho indicated a positive association between the CSA & BMI (rho=0.49, p=0.046), between the MAL & BMI (rho=0.808, p=0.000) and between the CSA & PT (rho=0.566, p=0.018) in the LDK patients. In terms of the CSA versus MAL, there was a positive association in both groups (rho=0.67, p=0.000, MAL=0.023CSA+5.454 in the LDK group; rho=0.564, p=0.018, MAL=0.02CSA+5.832 in the control group with using linear regression analysis). Independent t-tests revealed that both groups had statistically different mean values (p=0.000) in terms of the CSA & MAL. CONCLUSION: This study showed that the patients with LDK not only had atrophied erector spinae muscles, but also atrophied psoas major muscles and short MALs, which is harmful because of the increased lower back load in the aged patients. Along with BMI, measurement of the CSA, MAL & PT on the MR images provides an objective assessment of the dimension & severity of the muscle atrophy in the LDK patients.