Correlations between the cross-sectional area and moment arm length of the erector spinae muscle and the thickness of the psoas major muscle as measured by MRI and the body mass index in lumbar degenerative kyphosis patients

Lumbar degenerative kyphosis (LDK) is a subgroup of the flatback syndrome, which is a condition caused by spinal degeneration. LDK is reported to be the most frequent cause of lumbar spine deformity in the farming districts of the 'oriental' countries. We investigated the relationship between the cross-sectional area (CSA) and the moment arm length (MAL) of the erector spinae muscle and the thickness of the psoas major muscle (PT) and the body mass index (BMI) by performing statistical analysis, and we tried to show the crucial role of these variables for diagnosing LDK. From July 2004 to April 2005, we retrospectively reviewed 17 LDK patients who had undergone anterior lumbar interbody fusion (ALIF) with posterior stabilization. We measured both the CSA and MAL on the transverse cross-sectional MR image of the trunk at the fourth to fifth vertebrae (L4/5). The MAL was defined as the anterior-posterior distance between the center of the erector spinae muscle and that of the vertebral body. A comparative study was undertaken between the LDK group and the matched (according to age and gender) control group with regard to the CSA, MAL, PT and BMI. The 17 LDK patients were all females [age: 62.5 ± 4.93 years, height: 157 ± 6.19 cm, weight: 55.59 ± 4.7 kg, and BMI: 22.58 ± 2.08 kg/m2]. The control group patients were all female [age: 63.6 ± 2.27 years, height: 156 ± 5.05 cm, weight: 59.65 ± 7.39 kg and BMI: 24.38 ± 2.94 kg/m2]. Spearman's rho indicated a positive association between the CSA and BMI (rho = 0.49, ρ = 0.046), between the MAL and BMI (rho = 0.808, ρ = 0.000) and between the CSA and PT (rho = 0.566, ρ = 0.018) in the LDK patients. In terms of the CSA versus MAL, there was a positive association in both groups (rho = 0.67, ρ = 0.000, MAL = 0.023CSA + 5.454 in the LDK group; rho = 0.564, ρ 0.018, MAL = 0.02CSA + 5.832 in the control group with using linear regression analysis). Independent t-tests revealed that both groups had statistically different mean values (ρ =0.000) in terms of the CSA and MAL. This study showed that the patients with LDK not only had atrophied erector spinae muscles, but also atrophied psoas major muscles and short MALs, which is harmful because of the increased lower back load in the aged patients. Along with BMI, measurement of the CSA, MAL and PT on the MR images provides an objective assessment of the dimension and severity of the muscle atrophy in the LDK patients