| Objective:To explore the role of paravertebral muscles in the occurrence and development of degenerative and isthmic lumbar spondylolisthesis by studying the correlation between the cross-sectional area(CSA)of paravertebral muscles(psoas major,multifidus,erector spinae)and the slip percentage(SP)of degenerative and isthmic lumbar spondylolisthesis.Method:A retrospective analysis of the imaging data of 112 patients with lumbar spondylolisthesis who underwent lumbar functional radiograph,CT and lumbar MRI examination at Dazhou Central Hospital from August 2019 to October 2020 was performed.The patients were divided into group A(degenerative group)included 57 patients with L4/5 single-level degenerative spondylolisthesis,group B(isthmic group)included 55 patients with L4/5 single-level isthmic spondylolisthesis.A total of 56 healthy patients with complete clinical data who underwent physical examination in our hospital during the same period were collected as group C(control group).T2-weighted axial MRI images through the lower edge of the L4/5vertebral were selected to measure the cross-sectional area of the vertebral body and the left and right paravertebral muscles,and T2-weighted midsagittal images were selected to measure the percentage of vertebral slippage in patients with lumbar spondylolisthesis.The above data were measured independently by two senior deputy chief physicians in our hospital,and the ratio between the sum of CSA of each muscle group on both sides of the paravertebral muscles and CSA of the vertebral body was calculated,which was called the ratio of paravertebral muscles to reflect the degree of paravertebral muscle atrophy.SPSS23.0 statistical software was used for processing and analysis.Consistency test was carried out on the data measured by two senior associate chief physicians.T-test was used to analyze the difference of slip percentage,the ratio psoas major,the ratio multifidus muscle and the ratio erector spine between group A,B and C;The correlation between the ratio of paravertebral muscle and slip percentage was tested by Pearson test.The effect of paravertebral muscle ratio on slip percentage was predicted by simple linear regression analysis.P<0.05 was considered statistically significant.Results:Consistency test were performed on the psoas major ratio data,multifidus ratio data,erector spine ratio data and slip percentage data measured by two independent evaluators(ICC values were all>0.9),which indicated that the data measured by two independent evaluators were highly consistent.There was no significant difference in age,gender and BMI among the three groups(P>0.05).There were statistically significant differences in the ratio of psoas major muscle,multifidus muscle and erector spine muscle among the three groups(P<0.05),and group A and B was significantly lower than group C.There was no significant correlation between the ratio of paravertebral muscles and SP in group A.In group B,the ratio of psoas major muscle and multifidus muscle were highly negatively correlated with SP(P<0.05),and the correlation coefficients were(r=-0.23,r=-0.25).The regression analysis predicted that the ratio of psoas major muscle and multifidus muscle had A significant effect on SP in group B,and the ratio of multifidus muscle had A greater effect on SP than that of psoas major muscle.However,no influencing factors of SP were found in group A.Conclusions:In patients with isthmic spondylolisthesis,there was a positive correlation between the degree of psoas major muscle and multifidus muscle atrophy and the degree of lumbar spondylolisthesis,and the effect of multifidus on the slip percentage was greater than that of psoas major.The atrophy of paravertebral muscle in patients with degenerative spondylolisthesis has no significant correlation with the slip percentage. |
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