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. 2025 Oct 7;17(10):e94072.
doi: 10.7759/cureus.94072. eCollection 2025 Oct.

MRI Analysis of Paraspinal Muscle Morphology in Patients With Chronic Low Back Pain: A Case-Control Study

Nishanth Varma  1 , Harini Bopaiah  1 , Anil K Sakalecha  1 , Rishi Prajwal H L  1 , Sneha D N  1
Affiliations

MRI Analysis of Paraspinal Muscle Morphology in Patients With Chronic Low Back Pain: A Case-Control Study

Nishanth Varma et al. Cureus. .

Abstract

Background: Chronic low back pain (CLBP) is a major contributor to musculoskeletal disability worldwide. The paraspinal muscles, particularly those along the thoracolumbar spine, are essential for spinal stability and extension. Morphological alterations in these muscles may have diagnostic and therapeutic implications. This study aimed to determine the cross-sectional area (CSA) of each paraspinal muscle at the level of the L4 superior endplate in patients with chronic back pain (CBP) compared to age-matched individuals without any history of low back pain. We hypothesized that patients with CLBP would demonstrate selective reductions in the CSA of the multifidus, while the psoas major (PS) would remain relatively preserved.

Methods: A cross-sectional observational study was conducted with 80 participants: 40 patients with CBP and 40 age-matched controls without low back pain. The PS, multifidus, erector spinae (ES), and quadratus lumborum (QL) muscles were assessed bilaterally using magnetic MRI. An independent t-test was used to assess the statistical significance between the two groups, with significance set at p < 0.05.

Results: The mean ages of the cases and controls were 50.54 and 49.94 years, respectively, with no statistically significant difference. Among the paraspinal muscles evaluated, statistically significant differences in the CSA were found in the multifidus, ES, and QL muscles, but not in the PS.

Conclusion: Statistically significant reductions in the CSA were observed in most paraspinal muscles, except for the PS, in patients with CBP. These preliminary, hypothesis-generating findings highlight the potential value of paraspinal muscle assessment in CLBP and warrant confirmation in larger, multi-center studies before therapeutic implications can be considered.

Keywords: atrophy; chronic; degeneration; inflammation; muscle fat infiltration; muscles; pain; spine; vertebrae.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Sri Devaraj URS Academy of Higher Education & Research, Central Ethics Committee issued approval SDUAHER/R&D/CEC/SDUMC-PG/28/NF/2025-26. The Central Ethics Committee of Sri Devaraj Urs Academy of Higher Education and Research, Kolar, has examined the research project proposal and the detailed write-up on 10th April 2025. The Central Ethics Committee has unanimously approved the project and granted permission to investigators to carry out the research work. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. MRI axial T2-weighted image demonstrating the cross-sectional area (cm²) of paraspinal muscles—erector spinae, multifidus, psoas major, and quadratus lumborum—at the level of the L4 superior endplate.
MRI: Magnetic Resonance Imaging; L4: Fourth Lumbar Vertebra; ES: Erector Spinae; MF: Multifidus; PS: Psoas Major; QL: Quadratus Lumborum
Figure 2
Figure 2. MRI sagittal T2W image of the lumbar spine demonstrating the L4-L5 intervertebral disc.
MRI: Magnetic Resonance Imaging
See this image and copyright information in PMC

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