Asymmetric Degeneration of Paravertebral Muscles in Patients With Degenerative Lumbar Scoliosis

In Brief Study Design. A prospective observational study. Objective. To evaluate the paravertebral muscle (PVM) degeneration in patients with degenerative lumbar scoliosis (DLS), using magnetic resonance imaging. Summary of Background Data. Several studies have described the histological and morphological changes to the PVM in patients with chronic low back pain and lumbar radiculopathy. However, there is little knowledge about the PVM changes in patients with DLS. Methods. Fifty-seven patients with lumbar spinal stenosis (LSS) with DLS (DLS group) and 50 control patients with LSS without DLS (LSS group) were examined. The cross-sectional area (CSA) and percentage of fat infiltration area (%FIA) of the bilateral multifidus and longissimus muscles at the L1–S1 levels were measured using T2-weighted axial magnetic resonance imaging and computer software. A multifidus muscle biopsy and histological evaluation were performed in some patients. Results. In the DLS group, the CSA of the multifidus muscle was significantly smaller and the %FIA of both muscles was significantly higher on the concave side than on the convex side at all levels (P < 0.0001 for each). These differences were also found in the longissimus muscles at the L4–L5 and L5–S1 levels (P < 0.0001 for each). Histologically, the multifidus muscle exhibited reductions in the muscle fiber size and number of nuclei on the concave side. In the LSS group, the total CSA and %FIA did not differ significantly between the left and right sides. However, in patients with unilateral radiculopathy, the CSA of the multifidus muscle was significantly smaller (P < 0.05) and the %FIA of both muscles was significantly higher (P < 0.05) on the symptomatic side, especially at 1 level below. Conclusion. This observational study with magnetic resonance imaging and histology showed that muscle degeneration was more common on the concave side in patients with DLS. Radiculopathy and spinal deformity may contribute to the PVM degeneration. In this study, paravertebral muscles were analyzed using magnetic resonance image in patients with lumbar spinal stenosis. Paravertebral muscle degeneration was more severe in concave side of group with degenerative lumbar scoliosis and in symptomatic side of group with lumbar spinal stenosis with unilateral symptom. Radiculopathy and spinal deformity may contribute to the paravertebral muscle degeneration.