Paraspinal muscle fatty degeneration as a predictor of progressive vertebral collapse in osteoporotic vertebral compression fractures

Abstract

Background context: Most osteoporotic vertebral compression fractures (OVCFs) are treated conservatively; however, in some patients, progressive vertebral body collapse leads to spinal deformity and cord compression. These complications are strongly associated with impaired performance activities of daily living and a poor quality of life.

Purpose: To identify the role of the paraspinal muscle as a risk factor for progressive vertebral body collapse in patients with OVCF.

Study design: This was a retrospective observational study.

Patient sample: Fifty-five consecutive patients with OVCF who were treated conservatively from January 2018 to June 2020 in a single spine center and had a minimum follow-up of 6 months.

Outcome measures: A lateral plain radiograph in a neutral posture was taken when the patient was first diagnosed and at 1, 3, and 6 months after the first diagnosis. Vertebral height was measured at the point of maximal collapse of the affected vertebral body; vertebral collapse (%) was also measured. The cross-sectional area (CSA) and fatty degeneration of the paraspinal muscle were measured using the open-source software Image J. The visual analogue scale (VAS) scores were collected at the time of initial fracture diagnosis and at 1, 3, and 6 months.

Methods: The clinical and radiological data were analyzed. In the L4-5 intervertebral disc level, axial T2-weighted magnetic resonance imaging was used to measure the CSA and fatty degeneration of the paraspinal muscles. Correlation and multiple regression analyses were performed to analyze the risk factors associated with progressive vertebral body collapse.

Results: The vertebral collapse difference was strongly associated with paraspinal muscle fatty degeneration (r=0.684, p=.000) and body mass index (r=0.300, p=.026). Multiple linear regression analysis demonstrated that the risk factor for progression of vertebral collapse was paraspinal muscle fatty degeneration (β=0.724, p=.000). There was a statistically significant correlation between the progression in vertebral collapse and VAS score at 3 (r=0.402, p=.002) and 6 months (r=0.604, p=.000).

Conclusions: In patients with OVCF, fatty degeneration of the paraspinal muscle was a predictive factor for progressive vertebral body collapse. This study suggests that more attention should be paid to patients with paraspinal sarcopenia among those with OVCFs.

Keywords: Osteoporosis; Osteoporotic fractures; Paraspinal muscles; Risk factors; Sarcopenia; Spine.