Maximilian Muellner1,2, Erika Chiapparelli1, Manuel Moser1,3, Henryk Haffer1,2, Yusuke Dodo1, Dominik Adl Amini1,2, John A Carrino4, Ek T Tan4, Jennifer Shue1, Jiaqi Zhu5, Andrew A Sama1, Frank P Cammisa1, Federico P Girardi1, Alexander P Hughes6. 1. Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA. 2. Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany. 3. Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland. 4. Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA. 5. Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA. 6. Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA. hughesa@hss.edu.
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.
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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