• Lukas Schönnagel, Jiaqi Zhu, Ali E Guven, Gaston Camino-Willhuber, Soji Tani, Thomas Caffard, Henryk Haffer, Maximilian Muellner, Erika Chiapparelli, Krizia Amoroso, Artine Arzani, Manuel Moser, Jennifer Shue, Ek T Tan, John A Carrino, Thomas Jöns, Andrew A Sama, Federico P Girardi, Frank P Cammisa, and Alexander P Hughes.
• Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY.
• Spine. 2023 Dec 1; 48 (23): 162716341627-1634.

Study DesignRetrospective analysis of longitudinal data.ObjectiveTo assess the association between the paraspinal musculature (PM) and lumbar endplate degeneration.BackgroundThe 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.MethodsWe 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.ResultsIn 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.ConclusionsThis 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.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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