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Magnetic Resonance Imaging Characteristics and Age-Related Changes in the Psoas Muscle: Analysis of 164 Patients with Back Pain and Balanced Lumbar Sagittal Alignment.

Abstract

OBJECTIVE

The psoas muscle (PS), 1 of the paravertebral core muscles, is associated with sarcopenia. It also has clinical relevance in lateral-access spinal surgery (LASS) as a determinant structure affecting the operative window. We aimed to identify age-related patterns of PS degeneration, and we propose that our results be used to evaluate the operative window in LASS.

METHODS

We included 164 participants with back pain, no leg symptoms or claudication, and normal lumbar lordosis and sagittal balance. We evaluated the cross-sectional morphology of the PS on magnetic resonance imaging, specifically assessing the anterior to posterior (AP)/medial to lateral (ML) ratio and the cross-sectional area (CSA). We assessed the locational relationship of the PS and the intervertebral disc using the anterior margin gap (AMG; the distance between the anterior margins of the PS and the intervertebral disc) and the center gap, and compared all measurements by surgical level, sex, and age group.

RESULTS

At the L2-3 to L4-5 levels, the PS showed a decreased AP/ML ratio, increased CSA, ventral retraction of the anterior margin without center shift, and decreased operative window length. The degeneration patterns were decreased ML width and CSA and dorsal retraction of the anterior margin. Youth, male sex, and lower lumbar level were associated with higher AMGs, indicating an increased need for the transpsoas approach in LASS.

CONCLUSIONS

In patients without sagittal imbalance, the PS showed significant imaging characteristics. Our detailed data may aid the identification of degeneration patterns and specific preoperative planning regarding the operative window for LASS.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, South Korea.Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, South Korea.Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, South Korea.Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, South Korea.Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, South Korea.Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, South Korea.Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, South Korea.Mechanical Engineering Applied Bioengineering Lab, Incheon National University, Incheon, South Korea.Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, South Korea. Electronic address: schsbj@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31302267

Citation

Jang, Hae-Dong, et al. "Magnetic Resonance Imaging Characteristics and Age-Related Changes in the Psoas Muscle: Analysis of 164 Patients With Back Pain and Balanced Lumbar Sagittal Alignment." World Neurosurgery, 2019.
Jang HD, Won SH, Kim DW, et al. Magnetic Resonance Imaging Characteristics and Age-Related Changes in the Psoas Muscle: Analysis of 164 Patients with Back Pain and Balanced Lumbar Sagittal Alignment. World Neurosurg. 2019.
Jang, H. D., Won, S. H., Kim, D. W., Kim, E. H., Lee, J. C., Choi, S. W., ... Shin, B. J. (2019). Magnetic Resonance Imaging Characteristics and Age-Related Changes in the Psoas Muscle: Analysis of 164 Patients with Back Pain and Balanced Lumbar Sagittal Alignment. World Neurosurgery, doi:10.1016/j.wneu.2019.07.048.
Jang HD, et al. Magnetic Resonance Imaging Characteristics and Age-Related Changes in the Psoas Muscle: Analysis of 164 Patients With Back Pain and Balanced Lumbar Sagittal Alignment. World Neurosurg. 2019 Jul 11; PubMed PMID: 31302267.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Magnetic Resonance Imaging Characteristics and Age-Related Changes in the Psoas Muscle: Analysis of 164 Patients with Back Pain and Balanced Lumbar Sagittal Alignment. AU - Jang,Hae-Dong, AU - Won,Sung Hun, AU - Kim,Dae Woong, AU - Kim,Eung-Ha, AU - Lee,Jae Chul, AU - Choi,Sung-Woo, AU - San Park,Seong, AU - Goo,Woonhoe, AU - Shin,Byung-Joon, Y1 - 2019/07/11/ PY - 2019/03/29/received PY - 2019/07/03/revised PY - 2019/07/04/accepted PY - 2019/7/16/pubmed PY - 2019/7/16/medline PY - 2019/7/15/entrez KW - Degenerative lumbar KW - Direct lateral lumbar interbody fusion KW - Lateral lumbar spinal surgery KW - Psoas muscle KW - Sarcopenia KW - Transpsoas approach JF - World neurosurgery JO - World Neurosurg N2 - OBJECTIVE: The psoas muscle (PS), 1 of the paravertebral core muscles, is associated with sarcopenia. It also has clinical relevance in lateral-access spinal surgery (LASS) as a determinant structure affecting the operative window. We aimed to identify age-related patterns of PS degeneration, and we propose that our results be used to evaluate the operative window in LASS. METHODS: We included 164 participants with back pain, no leg symptoms or claudication, and normal lumbar lordosis and sagittal balance. We evaluated the cross-sectional morphology of the PS on magnetic resonance imaging, specifically assessing the anterior to posterior (AP)/medial to lateral (ML) ratio and the cross-sectional area (CSA). We assessed the locational relationship of the PS and the intervertebral disc using the anterior margin gap (AMG; the distance between the anterior margins of the PS and the intervertebral disc) and the center gap, and compared all measurements by surgical level, sex, and age group. RESULTS: At the L2-3 to L4-5 levels, the PS showed a decreased AP/ML ratio, increased CSA, ventral retraction of the anterior margin without center shift, and decreased operative window length. The degeneration patterns were decreased ML width and CSA and dorsal retraction of the anterior margin. Youth, male sex, and lower lumbar level were associated with higher AMGs, indicating an increased need for the transpsoas approach in LASS. CONCLUSIONS: In patients without sagittal imbalance, the PS showed significant imaging characteristics. Our detailed data may aid the identification of degeneration patterns and specific preoperative planning regarding the operative window for LASS. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31302267/Magnetic_resonance_imaging_characteristics_and_age-related_changes_in_the_psoas_muscle:_Analysis_of_164_patients_with_back_pain_and_balanced_lumbar_sagittal_alignment L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)31954-0 DB - PRIME DP - Unbound Medicine ER -