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. 2023 Dec 1;48(23):1627-1634.
doi: 10.1097/BRS.0000000000004826. Epub 2023 Sep 12.

Understanding the Interplay Between Paraspinal Muscle Atrophy and Lumbar Endplate Degeneration: A 3-Year Longitudinal Study

Lukas Schönnagel  1   2 , Jiaqi Zhu  3 , Ali E Guven  1   2 , Gaston Camino-Willhuber  1 , Soji Tani  1   4 , Thomas Caffard  1 , Henryk Haffer  1   2 , Maximilian Muellner  1   2 , Erika Chiapparelli  1 , Krizia Amoroso  1 , Artine Arzani  1 , Manuel Moser  1   5 , Jennifer Shue  1 , Ek T Tan  6 , John A Carrino  6 , Thomas Jöns  7 , Andrew A Sama  1 , Federico P Girardi  1 , Frank P Cammisa  1 , Alexander P Hughes  1
Affiliations

Understanding the Interplay Between Paraspinal Muscle Atrophy and Lumbar Endplate Degeneration: A 3-Year Longitudinal Study

Lukas Schönnagel et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective analysis of longitudinal data.

Objective: To assess the association between the paraspinal musculature (PM) and lumbar endplate degeneration.

Background: The PM is essential for spinal stability, while the vertebral endplate is pivotal for nutrient transport and force distribution. The clinical importance of both has been highlighted in recent literature, though little is known about their interaction.

Methods: We identified patients with lumbar MRI scans due to low back pain, with a 3-year interval between MRI scans. Endplate damage was assessed by the total endplate score (TEPS) at each lumbar level. The PM was evaluated for its functional cross-sectional area and fatty infiltration (FI) at the L4 level. We used a generalized mixed model to analyze the association between PM parameters and TEPS at timepoint one, adjusting for age, sex, BMI, diabetes, hypertension, and smoking status. The association with the progression of endplate damage was analyzed through an ordinal regression model, additionally adjusted for TEPS at baseline.

Results: In all, 329 patients were included, with a median follow-up time of 3.4 years. Participants had a median age of 59 and a BMI of 25.8 kg/m 2 . In the univariate analysis, FI of the posterior PM was significantly associated with TEPS at baseline (β: 0.08, P <0.001) and progression of TEPS [Odds Ratio (OR): 1.03, P =0.020] after adjustment for confounders. The β and OR in this analysis are per percent of FI. In a binary analysis, patients with FI≥40% had an OR of 1.92 ( P =0.006) for the progression of TEPS.

Conclusions: This is the first longitudinal study assessing the relationship between PM and endplate degeneration, demonstrating the association between PM atrophy and the progression of endplate degeneration. This insight may aid in identifying patients at risk for degenerative lumbar conditions and guide research into preventive measures.

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Conflict of interest statement

A.A.S. reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, IVY II, LLC, ISPH II, LLC, ISPH 3, LLC, HS2, LLC, HSS ASC Development Network, LLC, and Centinel Spine (Vbros Venture Partners V); consulting fee from Depuy Synthes Products, Inc., Clariance, Inc., Kuros Biosciences AG, Ortho Development Corp., Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of the scientific advisory board of Depuy Synthes Products, Inc., Clariance, Inc., and Kuros Biosciences AG; Medical Device Business Service, Inc. and trips/travel of Medical Device Business; research support from Spinal Kinetics, Inc., outside the submitted work. F.P.C. reports royalties from NuVasive, Inc. Accelus; ownership interest for 4WEB Medical/4WEB, Inc.; Healthpoint Capital Partners, LP; ISPH II, LLC; ISPH 3 Holdings, LLC; Ivy Healthcare Capital Partners, LLC; Medical Device Partners II, LLC; Medical Device Partners III, LLC; Orthobond Corporation; Spine Biopharma, LLC; Tissue Differentiation Intelligence, LLC; VBVP VI, LLC; VBVP X, LLC; Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., DePuy Synthes, NuVasive, Inc., Spine Biopharma, LLC, and Synexis, LLC, Accelus; membership of scientific advisory board/other office of Healthpoint Capital Partners, Medical Device Partners II, LLC, Orthobond Corporation, Spine Biopharma, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine, outside the submitted work. F.P.G. reports royalties from Lanx, Inc., and Ortho Development Corp.; private investments for BCIMD; and stock ownership of Healthpoint Capital Partners, LP, outside the submitted work. A.P.H. reports research support from Kuros Biosciences AG; and fellowship support from NuVasive, Inc. and Kuros Biosciences BV, outside the submitted work. The remaining authors declare no conflicts of interest.

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