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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(01): 008-011
DOI: 10.1055/s-0042-1758522
Original Article

Alteration in the Cross-sectional Area (CSA) Ratio of the Paraspinal Muscles following Vertebral Insufficiency Fractures

Ali Shah 
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
Karthikeyan P. Iyengar 
2   Department of Orthopedics, Southport and Ormskirk, Southport, United Kingdom
,
Christine Azzopardi
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
Shahnawaz Haleem 
3   Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
Jwalant Mehta
3   Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
Rajesh Botchu
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
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Abstract

Background Vertebral insufficiency fractures in the elderly are associated with increased morbidity and mortality. Early diagnosis is essential to direct patient-specific rehabilitation.

Aims We hypothesize that in patients with vertebral insufficiency fractures, there is atrophy of the psoas and paraspinal muscles with alteration in the cross-sectional area (CSA) of the muscles.

Materials and Methods Magnetic resonance imaging (MRI) studies for 100 consecutive patients, older than 60 years presenting with lower back pain, were included in the study. For each MRI study, the CSA of the psoas and paraspinal muscles (multifidus) at the level of L4/5-disc space was measured to calculate the cross-sectional area ratio (CSAR) by two readers. One reader repeated the measurements after an interval of 2 weeks. We divided the patients (n = 100) into various groups based on the number of vertebral fractures.

Results In total, 77 patients with vertebral body fractures (48 with one, 16 with two and 13 with more than two fractures) were identified with a mean age of 73 (range 60–92) years. The ratio of multifidus CSA to psoas CSA was calculated with mean values of each group (1–4) as 2.56, 1.89, 2.09 and 2.16, respectively. There was statistically significance difference of the CSAR between the cohorts (p-value = 0.0115).

Conclusion Vertebral insufficiency fractures in the elderly are associated not only with atrophy of psoas and the multifidus group of muscles as evident by the CSA values, but they also affect the CSAR depending on the number of fractures. This finding may help to direct targeted patient-specific physiotherapy rehabilitation and interventions to prevent further such fractures.

Keywords

spinal fractures - vertebral body - fragility fracture - paraspinal muscles - atrophy - magnetic resonance imaging


Publication History

Article published online:
24 November 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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