Vedat AÇIK, Semih Kıvanç OLGUNER, Ali ARSLAN, Ismail ISTEMEN

Morphometric MRI assessment of lumbar region in healthy individuals

Aim: In our study, we aimed to obtain normal anatomical data in healthy individuals by magnetic resonance imaging, which we frequently use in our daily practice. We encounter quite frequently with the lumbar pathologies. To identify the pathological one, the normal one must first be defined. For this, anatomical studies are the most ideal methods, but costly and challenging studies.Morphometric assessment of the lumbar region by magnetic resonance imaging in the normal population is not common in the literature.Material and Methods: The workup of 100 patients who presented to our clinic, did not have low back pain, underwent lumbar MRI examination for different reasons and whose results were reported to be normal, were evaluated using the PACS system. Morphological evaluation of the paravertebral muscles, ligamentum flavum, and the spinal canal was performed on the right and left sides separately. The data were analyzed by age, gender, and body mass index.Results: Forty-nine patients were females, and 51 were males. The mean age of the patient group was 34.62±9.54 years, and mean BMI was 24.96±3.32 kg/m2. Ligamentum flavum thickness and muscle areal measurements were similar between both sides. The comparisons of clinical measurements between females and males revealed that the areas of muscles were significantly higher among males and all other measurements were similar between sexes. There was a weak and positive correlation between age and both right and left erector spinae area. The only parameters that weakly and positively correlated with body mass index were right and left erector spinae areas.Conclusion: In our study, we reported the morphological characteristics of the lumbar region in healthy individuals. An increase in thecross-sectional areas of the erector spinae and the spinal canal at the L5-S1 level was observed with the age. An asymmetry may develop in LF measurements with the age. There was also a positive correlation between body mass index and the cross-sectional area of erector spinae.

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1. Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: The relationship to pain and disability. Spine (Phila Pa 1976) 2004;29:515-9.
2. De Sèze MP, Guérin P, Gille O, et al. Reliability of magnetic resonance imaging measurements of the cross-sectional area of the muscle contractile and non-contractile components. Surg Radiol Anat 2011;33:735-41.
3. Henderson L, Kulik G, Richarme D, et al. Is spinal stenosis assessment dependent on slice orientation? A magnetic resonance imaging study. Eur Spine J 2012;21:760-4.
4. Boissière L, Moal B, Gille O, et al. Lumbar spinal muscles and spinal canal study by MRI three-dimensional reconstruction in adult lumbar spinal stenosis. Orthop Traumatol Surg Res 2017;103:279-83.
5. Gulec A, Kacira BK, Kutahya H, et al. Morphometric analysis of the lumbar vertebrae in the Turkish population using three-dimensional computed tomography: Correlation with sex, age, and height. Folia Morphol 2017;76:433-9.
6. Moal B, Bronsard N, Raya JG, et al. Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity. World J Orthop 2015;6:727-37.
7. Yasar B, Simsek S, Er U, et al. Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal: Clinical article. J Neurosurg Spine 2009;11:347-52.
8. Lang G, Vicari M, Siller A, et al. Preoperative assessment of neural elements in lumbar spinal stenosis by upright magnetic resonance imaging: An implication for routine practice? Cureus 2018;10.
9. Hides J, Gilmore C, Stanton W, et al. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 2008;13:43-9.
10. Lee SW, Chan CKM, Lam TS, et al. Relationship between low back pain and lumbar multifidus size at different postures. Spine (Phila Pa 1976) 2006;31:2258-62.
11. Wallwork TL, Stanton WR, Freke M, et al. The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther 2009;14:496- 500.
12. Niemeläinen R, Briand MM, Battié MC. Substantial asymmetry in paraspinal muscle cross-sectional area in healthy adults questions its value as a marker of low back pain and pathology. Spine (Phila Pa 1976) 2011;36:2152-7.
13. Marras WS, Jorgensen MJ, Granata KP, et al. Female and male trunk geometry: Size and prediction of the spine loading trunk muscles derived from MRI. Clin Biomech 2001;16:38-46.
14. Valentin S, Licka T, Elliott J. Age and side-related morphometric MRI evaluation of trunk muscles in people without back pain. Man Ther 2015;20:90-5.
15. Fortin M, Macedo LG. Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: A systematic review with a focus on blinding. Phys Ther 2013;93:873-88.
16. Mengiardi B, Schmid MR, Boos N, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: Quantification with MR spectroscopy. Radiology 2006;240:786-92.
17. Meakin JR, Fulford J, Seymour R, et al. The relationship between sagittal curvature and extensor muscle volume in the lumbar spine. J Anat 2013;222:608-14.
18. Fortin M, Videman T, Gibbons LE, et al. Paraspinal muscle morphology and composition: A 15-yr longitudinal magnetic resonance imaging study. Med Sci Sports Exerc 2014;46:893-901.
19. Takahashi K, Takahashi HE, Nakadaira H, et al. Different changes of quantity due to aging in the psoas major and quadriceps femoris muscles in women. J Musculoskelet Neuronal Interact 2006;6:201-5.
20. Lexell J, Taylor CC, Sjöström M. What is the cause of the ageing atrophy? Total number, size and proportion of different fiber types studied in whole vastus lateralis muscle from 15- to 83-year-old men. J Neurol Sci 1988;84:275-94.
21. Sions JM, Tyrell CM, Knarr BA, et al. Age- and strokerelated skeletal muscle changes a review for the geriatric clinician. J Geriatr Phys Ther 2012;35:155-61.
22. Fortin M, Yuan Y, Battié MC. Factors associated with paraspinal muscle asymmetry in size and composition in a general population sample of men. Phys Ther 2013;93:1540-50.
23. Kjaer P, Bendix T, Sorensen JS, et al. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med 2007;5:1-10.
24. Pezolato A, De Vasconcelos EE, Defino HLA, et al. Fat infiltration in the lumbar multifidus and erector spinae muscles in subjects with sway-back posture. Eur Spine J 2012;21:2158-64.
25. Abbas J, Hamoud K, Masharawi YM, et al. Ligamentum flavum thickness in normal and stenotic lumbar spines. Spine (Phila Pa 1976) 2010;35:1225-30.
26. Safak AA, Is M, Sevinc O, et al. The thickness of the ligamentum flavum in relation to age and gender. Clin Anat 2010;23:79-83.
27. Kolte VS, Khambatta S, Ambiye MV. Thickness of the ligamentum flavum: Correlation with age and its asymmetry-an magnetic resonance imaging study. Asian Spine J 2015;9:245-53.
28. Kim YU, Park JY, Kim DH, et al. The role of the ligamentum flavum area as a morphological parameter of lumbar central spinal stenosis. Pain Physician 2017;20:419-24.
29. Altinkaya N, Yildirim T, Demir S, et al. Factors associated with the thickness of the ligamentum flavum: Is ligamentum flavum thickening due to hypertrophy or buckling? Spine (Phila Pa 1976) 2011;36:1093-7.
30. Kim YU, Kong YG, Lee J, et al. Clinical symptoms of lumbar spinal stenosis associated with morphological parameters on magnetic resonance images. Eur Spine J 2015;24:2236-43.