Correlation between strength/endurance of paraspinal muscles and sagittal parameters in patients with degenerative spinal deformity

Abstract

Background: Sagittal imbalance is a common cause of low back pain and dysfunction in patients with degenerative spinal deformity (DSD), which greatly affects their quality of life. Strength and endurance are important functional physical indexes for assessing muscle condition. However, the correlation between sagittal parameters and paraspinal muscle strength/endurance is not yet clear. The purpose of this study was to analyze the correlation between strength/endurance of paraspinal muscles and sagittal parameters in patients with DSD.

Methods: There were 105 patients with DSD and 52 healthy volunteers (control group) enrolled. They were divided into the balance group [sagittal vertical axis (SVA) < 5 cm, n = 68] and imbalance group (SVA ≥ 5 cm, n = 37). The maximal voluntary exertion (MVE)/Endurance time (ET) of paravertebral muscles were assessed using the prone position test stand, and the sagittal parameters of the subjects were measured, namely, SVA, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Pearson coefficients were used to assess the correlation between paraspinal muscle MVE/ET and sagittal parameters.

Results: MVE and ET of paravertebral muscles in the control group were significantly higher than those in the balance and imbalance groups (P < 0.05), whereas MVE in the balance group was significantly higher than that in the imbalance group (P < 0.05). SVA in the imbalance group was significantly higher than those in the control and balance groups (P < 0.05). SS and TK in the control group were significantly higher than those in the imbalance group (P < 0.05), and PT and PI in the control group were significantly lower than those in the balance and imbalance groups (P < 0.05). LL in the imbalance group was significantly lower than that in the balance and control groups (P < 0.05). MVE, MVE/BH, and MVE/BW of paraspinal muscles in the imbalance group were negatively correlated with SVA and PT. Moreover, they were positively correlated with LL.

Conclusions: Deformity may cause the decrease of MVE and ET of paraspinal muscles in the prone position in patients with DSD. Furthermore, the decline in MVE of paraspinal muscles may be a predisposing factor for the imbalance observed. The decrease of MVE/BW of paraspinal muscles may be involved in spinal compensation, and it is a sensitive indicator for sagittal imbalance and lumbar lordosis.

Keywords: Correlation; Endurance; Paraspinal muscles; Sagittal parameters; Strength.