Introducing the Paraspinal Muscle Quality (PMQ) Score: A Novel T2 MRI-Based Intensity Parameter for Lean Muscle Assessment in Spine Patients.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-05-07 DOI:10.1097/BRS.0000000000005385

Ali E Guven, Kyle Finos, Isaac Nathoo, Paul Köhli, Marco D Burkhard, Erika Chiapparelli, Artine Arzani, Jan Hambrecht, Gisberto Evangelisti, Koki Tsuchiya, Bruno Verna, Jennifer Shue, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes

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引用次数: 0

Abstract

Study design: Retrospective cross-sectional study.

Objective: To analyze the relationship between the novel paraspinal muscle quality (PMQ) score and muscle atrophy parameters, patient demographics, comorbidities, and functional disability.

Background: Paraspinal muscle atrophy is linked to degenerative spine conditions, chronic back pain, and poor postoperative outcomes. Conventional parameters like fatty infiltration (FI) and functional cross-sectional area (fCSA) fail to account for lean muscle quality. Increased T2 MRI intensity reflects muscle aging and reduced function. The PMQ score, normalizing T2 intensity of lean muscle to cerebrospinal fluid (CSF), is introduced as a novel metric.

Methods: Patients undergoing primary posterior lumbar surgery for degenerative disease (Dec 2014-July 2023) were analyzed. Demographics, comorbidities, and preoperative Oswestry Disability Index (ODI) were collected. FI and fCSA of erector spinae, and multifidus were quantified at the L4 upper endplate on T2-weighted MRIs. The PMQ score was defined as lean muscle-to-CSF intensity ratio. Interrater reliability for the PMQ score was assessed (n=46) using intraclass correlation coefficients (ICC). Spearman's correlation and proportional odds models adjusted for age, sex, BMI, and FI evaluated associations with the ODI subsection, back pain intensity.

Results: Among 463 patients (53.7% female; median age 66 years; BMI 28.7 kg/m²), PMQ score correlated positively with age, female sex, BMI, ASA score, hypertension, and FI but negatively with vertebral bone mineral density and fCSA. Pain intensity was predicted by the erector spinae (OR: 6.07, 95% CI: 1.16 - 31.74, P=0.033) and multifidus PMQ scores (OR: 4.88, 95% CI: 1.31 - 18.20, P=0.019). Interrater reliability was high (ICC: 0.867 [95% CI: 0.720 to 0.932] for erector spinae, 0.874 [95% CI: 0.767 to 0.931] for multifidus).

Conclusion: The PMQ score correlates with patient demographics, comorbidities, muscle atrophy, and back pain. While serving as a muscle aging parameter, it may also enhance clinical assessment by detecting early changes, such as edema and denervation, that are not initially identifiable with FI and fCSA, warranting further study.

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介绍棘旁肌质量（PMQ）评分：一种新的基于T2 mri的脊柱患者瘦肌肉评估强度参数。

研究设计：回顾性横断面研究。目的：分析新型棘旁肌质量（PMQ）评分与肌萎缩参数、患者特征、合并症和功能障碍的关系。背景：棘旁肌萎缩与脊柱退行性疾病、慢性背痛和术后预后不良有关。传统的参数如脂肪浸润（FI）和功能横截面积（fCSA）不能解释瘦肌肉质量。T2 MRI强度升高反映肌肉老化和功能下降。PMQ评分，将瘦肌肉对脑脊液（CSF）的T2强度归一化，作为一种新的度量标准引入。方法：对2014年12月至2023年7月因退行性疾病行腰椎后路手术的患者进行分析。统计数据、合并症和术前Oswestry残疾指数（ODI）。在t2加权mri上量化L4上终板上竖脊和多裂的FI和fCSA。PMQ评分定义为瘦肌肉与脑脊液强度比。采用类内相关系数（ICC）评估PMQ评分的组间信度（n=46）。根据年龄、性别、BMI和FI调整的Spearman相关和比例优势模型评估了ODI分项、背痛强度的相关性。结果：463例患者中，女性占53.7%；中位年龄66岁；BMI （28.7 kg/m²）、PMQ评分与年龄、女性性别、BMI、ASA评分、高血压、FI呈正相关，与椎体骨密度、fCSA呈负相关。竖脊肌（OR: 6.07, 95% CI: 1.16 ~ 31.74， P=0.033）和多裂肌PMQ评分（OR: 4.88, 95% CI: 1.31 ~ 18.20， P=0.019）预测疼痛强度。间信度较高（竖脊肌的ICC: 0.867 [95% CI: 0.720 ~ 0.932]，多裂肌的ICC: 0.874 [95% CI: 0.767 ~ 0.931]）。结论：PMQ评分与患者人口统计学、合并症、肌肉萎缩和背痛相关。在作为肌肉老化参数的同时，它还可以通过检测早期变化来增强临床评估，例如水肿和去神经控制，这些变化最初无法通过FI和fCSA识别出来，值得进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.