Morphological Study Of Paraspinal Muscles In Patients With Lumbar Degenerative Scoliosis

ObjectivesTo observe the morphological changes of paraspinal muscles in patients with lumbar degenerative scoliosis,to compare the relationship between different positions of parietal vertebrae and asymmetric degeneration of paraspinal muscles in patients with lumbar degenerative scoliosis,and to explore its clinical significance.Methods:A retrospective analysis was made on 84 patients with lumbar degenerative scoliosis(scoliosis group)treated in our hospital from January 2015 to December 2017 and 84 patients with non-lumbar scoliosis treated in the same period as the control group(non-scoliosis group).In the scoliosis group,there were 28 males and 56 females,the age was 66.50 ±5.16 years old,the scoliosis angle was 14.8±5.6°,the left convex direction was 53 cases,and the right convex direction was 31 cases.In the non-scoliosis group,there were 48 males and 36 females,with an age of 67.20±5.61 years.The patients in the scoliosis group were divided into three subgroups according to the position of the parietal vertebra:group A,the parietal vertebra was located in the L2-3 intervertebral disc(n=28);B group,the parietal vertebra was located in the L3 vertebra(n=27);C group,the parietal vertebra was located in the L3-4 intervertebral disc(n=29).The cross-sectional area and fat area of multifidus(MF),erector spine muscle(ES),psoas quadratus muscle(QL)and psoas major muscle(PS)on T2 axial images of L1-S1 intervertebral disc were measured by Image-Pro Plus soft wore.Calculate the ratio of muscle area to corresponding intervertebral disc area(M/D)and calculate the degree of fat infiltration of muscle.Results:In the lumbar scoliosis group,the ratio of paraspinal muscle to intervertebral disc area in the convex side was larger than that in the concave side,and the degree of muscle fat infiltration in the convex side was less than that in the con.In the non-lumbar scoliosis group,there was no significant difference in the ratio of paraspinal muscle to intervertebral disc area and the degree of muscle fat infiltration between the left and right sides.In each subgroup of scoliosis group,there was no significant difference in general statistical data among groups A,B and C.In group A,the area ratio of MF muscle to intervertebral disc in the convex side was larger than that in the concave side,the area ratio of PS muscle to intervertebral disc in the convex side was smaller than that in the concave side,and the degree of fat infiltration of MF and PS muscle in the convex side was lower than that in the concave side.In group B,the area ratio of PS muscle to intervertebral disc on the parietal vertebra segment in the convex side was smaller than that in the concave side,and the degree of fat infiltration of MF and PS muscle in the convex side was less than that in the concave side.In group C,the degree of muscle fat infiltration of MF and PS in the segment of parietal vertebra in convex side was less than that in concave side,but there was no significant difference in other results.In each subgroup,the ratio of muscle to intervertebral disc area and the degree of muscle fat infiltration in each segment of the parietal vertebra were similar to those in the apical vertebra segment.Conclusions:In patients with lumbar degenerative scoliosis,there is asymmetric degeneration of each muscle around the vertebrae,the degree of degeneration of the convex and concave side is different,and the concave is focused on the convex side.In patients with lumbar degenerative scoliosis,muscle asymmetric degeneration mainly occurred in the parietal vertebra and one segment above and below,and the law of degeneration was the same,and the degree of muscle fat infiltration of MF and PS in the concave side was mainly increased.It is suggested that the asymmetric changes of paraspinal muscles should be considered in the selection of surgical segments.