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
