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The effect of age on psoas and paraspinal muscle morphology in patients undergoing posterior lumbar fusion surgery

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Abstract

Purpose

The aim of this study was to determine the effect of age on the psoas and posterior paraspinal muscles (PPM; multifidus muscle and erector spinae) and to evaluate potential sex-related differences.

Methods

MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the fat area (FAT) and the proportion of intramuscular fat (FI) were conducted on patients undergoing lumbar fusion surgery between 2014 and 2021. The regions of interest were the psoas muscle and the PPM at the superior endplate of L4. The left and right sides of the muscle groups were summarized and normalized by the patient’s height (cm2/m2). The relationships between age and muscular parameters were analyzed stratified by sex.

Results

A total of 195 patients (57.9%female) with a median age of 64.2 years and a body mass index of 28.3 kg/m2 were analyzed. The CSAPsoas was 7.7 cm2/m2 and differed significantly between females and males (p < 0.001); likewise, the fCSAPsoas differed significantly between the sexes. The CSAPPM was 18.8 cm2/m2 with no sex-specific differences. Significant differences were found in the FIPPM (males: 41.1% vs. females: 47.9%; p < 0.001), but not in the FIPsoas (males: 3.7% vs. females: 4.5%; p = 0.276). Considering the effect of age on FI, a significant positive correlation was observed for the PPMs for both sexes. Only in women, there was a negative correlation between age and CSAPsoas (ρ =  − 0.248; p = 0.008), FATPsoas (ρ =  − 0.421; p < 0.001) and FIPsoas (ρ =  − 0.371; p < 0.001).

Conclusion

This study demonstrated sex-specific differences in spinal muscle morphology in relation to patient age. With increasing age there was a decrease in FIPsoas in women only, unlike in the PPMs in which there was increased FI that was significantly higher in women compared to men.

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Acknowledgements

Dr. Sama reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, IVY II, LLC, ISPH 3, LLC, and VBros Venture Partners X Centinel Spine; consulting fee from Clariance, Inc., Kuros Biosciences AG, and Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of scientific advisory board of Clariance, Inc., and Kuros Biosciences AG; and trips/travel of Medical Device Business research support from Spinal Kinetics, Inc., outside the submitted work. Dr. Cammisa reports royalties from NuVasive, Inc. Accelus; private investments for 4WEB Medical/4WEB, Inc., Bonovo Orthopedics, Inc., Healthpoint Capital Partners, LP, ISPH II, LLC, ISPH 3 Holdings, LLC, Ivy Healthcare Capital Partners, LLC, Medical Device Partners II, LLC, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, Tissue Differentiation Intelligence, LLC, VBVP VI, LLC, VBVP X, LLC (Centinel) and Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., DePuy Synthes Spine, NuVasive, Inc., Spine Biopharma, LLC, and Synexis, LLC, Accelus; membership of scientific advisory board/other office of Healthpoint Capital Partners, LPIVY, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine, outside the submitted work. Dr. Girardi reports royalties from Lanx, Inc., and Ortho Development Corp.; private investments for Centinel Spine, and BCMID; stock ownership of Healthpoint Capital Partners, LP; and consulting fees from NuVasive, Inc., and DePuy Synthes Spine, outside the submitted work. Dr. Hughes reports research support from NuVasive, Inc. and Kuros Biosciences AG; and fellowship support from NuVasive, Inc. and Kuros Biosciences AG, outside the submitted work.

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Science of the National Institute of Health Under Award Number UL1TR002384.

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Authors and Affiliations

  1. Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA

    Maximilian Muellner, Erika Chiapparelli, Manuel Moser, Henryk Haffer, Yusuke Dodo, Dominik Adl Amini, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany

    Maximilian Muellner, Henryk Haffer & Dominik Adl Amini

  3. Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland

    Manuel Moser

  4. Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA

    John A. Carrino & Ek T. Tan

  5. Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA

    Jiaqi Zhu

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Contributions

M contributed to conception and design. M, C, H, M, and AA performed acquisition of data. M and H carried out analysis and interpretation of data. M drafted the article. All authors critically revised the article and reviewed submitted version of manuscript. H performed study supervision and approved the final version of the manuscript on behalf of all authors. M and Z performed statistical analysis. T, C, and S provided administrative/technical/material support.

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Correspondence to Alexander P. Hughes.

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The authors declare that there is no conflict of interest regarding this work.

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The institutional review board of the Hospital for Special Surgery approved this study. The investigation was approved by the institutional review board (IRB 2019-2137).

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The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Muellner, M., Chiapparelli, E., Moser, M. et al. The effect of age on psoas and paraspinal muscle morphology in patients undergoing posterior lumbar fusion surgery. Eur Spine J 31, 2619–2628 (2022). https://doi.org/10.1007/s00586-022-07346-0

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