Physical Functional Ability and Quantitative Assessment of the Multifidus Muscle of the Lumbar Spine in the Elderly

Aging is associated with muscle atrophy and fatty infiltration of skeletal muscle. The multifidus muscle stabilizes the lumbar spine and undergoes adipose accumulation with age, leading to functional decline in the elderly. Therefore, quantitative assessment of the multifidus muscle can be beneficial for the elderly when formulating treatment strategies and reducing future complications. Fifty-seven patients (mean age, 73.89 & PLUSMN; 6.09; 23 male patients) who underwent lumbar Magnetic resonance imaging (MRI) were prospectively recruited. The cross-sectional area (CSA) of the multifidus from the L2-S1 level and the CSA of the L4-5 level psoas muscle were measured. The functional CSA (fCSA) of the multifidus muscle was measured by excluding the fat infiltration area from the multifidus CSA. The CSA to fCSA ratio was obtained by multiplying 100 by the value obtained by dividing CSA by the fCSA. Pfrrmann classification was used to evaluate the degree of disc degeneration. The functional disability measurements were the Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and functional reach test (FRT). Pearson's correlation analysis was used to examine the relationship between the functional disability measurements and the multifidus muscle. The CSA to fCSA ratio value was relatively constant at each spine level and showed a significant correlation with the SPPB, grip strength, FRT, and psoas index (p < 0.05). However, degree of disc and multifidus muscle degeneration was not statistically significant. So, age-related changes play a significant role in developing back muscle fatty infiltration than disc degeneration. Moreover, Grip strength showed a stronger relationship with the quality of the multifidus muscle than other functional disability measurements.

Automated summary

Aging leads to muscle atrophy and fatty infiltration in skeletal muscle, particularly in the multifidus muscle which plays a role in stabilizing the lumbar spine. Quantitative assessment of the multifidus muscle can be beneficial for treatment strategies and reducing complications in the elderly. This study measured the cross-sectional area (CSA) of the multifidus muscle and the functional CSA (fCSA) by excluding fat infiltration area. The CSA to fCSA ratio showed a significant correlation with functional disability measurements, suggesting that age-related changes contribute more to muscle fatty infiltration than disc degeneration. Grip strength showed a stronger relationship with multifidus muscle quality than other measures of functional disability.