Influence of patient-specific factors when comparing multifidus fat infiltration between chronic low back pain patients and asymptomatic controls

Alexander M Ballatori; Shane Shahrestani; Priya Nyayapati; Vibhu Agarwal; Roland Krug; Misung Han; Aaron J Fields; Conor O'Neill; Sibel Demir-Deviren; Jeffrey C Lotz; Jeannie F Bailey

doi:10.1002/jsp2.1217

Influence of patient-specific factors when comparing multifidus fat infiltration between chronic low back pain patients and asymptomatic controls

JOR Spine. 2022 Jul 14;5(4):e1217. doi: 10.1002/jsp2.1217. eCollection 2022 Dec.

Authors

Alexander M Ballatori^{1

2}, Shane Shahrestani^{1

3}, Priya Nyayapati^{2

4}, Vibhu Agarwal⁵, Roland Krug⁶, Misung Han⁶, Aaron J Fields², Conor O'Neill², Sibel Demir-Deviren², Jeffrey C Lotz², Jeannie F Bailey²

Affiliations

¹ Keck School of Medicine of USC Los Angeles California USA.
² Department of Orthopaedic Surgery University of California San Francisco California USA.
³ Department of Medical Engineering California Institute of Technology Pasadena California USA.
⁴ Albany Medical College Albany New York USA.
⁵ Department of Quantitative Sciences Stanford University Stanford California USA.
⁶ Department of Radiology University of California San Francisco California USA.

Abstract

Introduction: Many studies have attempted to link multifidus (MF) fat infiltration with muscle quality and chronic low back pain (cLBP), but there is no consensus on these relationships.

Methods: In this cross-sectional cohort study, 39 cLBP patients and 18 asymptomatic controls were included. The MF muscle was manually segmented at each lumbar disc level and fat fraction (FF) measurements were taken from the corresponding advanced imaging water-fat images. We assessed the distribution patterns of MF fat from L1L2 to L5S1 and compared these patterns between groups. The sample was stratified by age, sex, body mass index (BMI), subject-reported pain intensity (VAS), and subject-reported low back pain disability (oswestry disability index, ODI).

Results: Older patients had significantly different MF FF distribution patterns compared to older controls (p < 0.0001). Male patients had 34.8% higher mean lumbar spine MF FF compared to male controls (p = 0.0006), significantly different MF FF distribution patterns (p = 0.028), 53.7% higher mean MF FF measurements at L2L3 (p = 0.037), and 50.6% higher mean MF FF measurements at L3L4 (p = 0.041). Low BMI patients had 29.7% higher mean lumbar spine MF FF compared to low BMI controls (p = 0.0077). High BMI patients only had 4% higher mean lumbar spine MF FF compared to high BMI controls (p = 0.7933). However, high BMI patients had significantly different MF FF distribution patterns compared to high BMI controls (p = 0.0324). Low VAS patients did not significantly differ from the control cohort for any of our outcomes of interest; however, high VAS patients had 24.3% higher mean lumbar spine MF FF values (p = 0.0011), significantly different MF FF distribution patterns (p < 0.0001), 34.7% higher mean MF FF at L2L3 (p = 0.040), and 34.6% higher mean MF FF at L3L4 (p = 0.040) compared to the control cohort. Similar trends were observed for ODI.

Conclusions: This study suggests that when the presence of paraspinal muscle fat infiltration is not characteristic of an individual's age, sex, and BMI, it may be associated with lower back pain.

Keywords: IDEAL; chronic low back pain; fat infiltration; multifidus.