The Correlation between Cross-sectional Area of Lumbar Paraspinal Muscles and Sponylolisthesis; A Retrospective Study

요추 주변 근육 단면적과 척추전방전위증의 상관성에 대한 후향적 연구

  • Park, Hye-Sung (Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung-Hee University) ;
  • Kim, Je-In (Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung-Hee University) ;
  • Kim, Koh-Woon (Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung-Hee University) ;
  • Cho, Jae-Heung (Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung-Hee University) ;
  • Song, Mi-Yeon (Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung-Hee University)
  • 박혜성 (경희대학교 한의과대학 한방재활의학과교실) ;
  • 김제인 (경희대학교 한의과대학 한방재활의학과교실) ;
  • 김고운 (경희대학교 한의과대학 한방재활의학과교실) ;
  • 조재흥 (경희대학교 한의과대학 한방재활의학과교실) ;
  • 송미연 (경희대학교 한의과대학 한방재활의학과교실)
  • Received : 2015.12.28
  • Accepted : 2016.01.16
  • Published : 2016.01.31


Objectives To investigate correlation between slip percentage (SP) of spondylolisthesis and cross-sectional area (CSA) of lumbar paraspinal muscles; psoas major (PM), multifidus (MU) and erector spinae (ES). Methods A retrospective study was carried out in 120 spondylolisthesis patients who had visited the Spine center of Kyung Hee University Hospital at Gangdong and had taken lumbar MRI. CSA of lumbar paraspinal muscles was measured from axial T2-weighted MRI and divided by CSA of vertebral body to avoid weight's influence. SP was also measured from sagittal MRI. Results SP increase has significant correlation with decreased CSA-MU (r=0.37, p<0.01) and increased CSA-ES (r=0.19, p<0.05). There was no significant correlation between SP and CSA-PM. Conclusions MU atrophy and ES hypertrophy have significant correlation with SP of spondylolisthesis. CSA of lumbar paraspinal muscles can be a risk factor of progression of spondylolisthesis and compensation for the instability.


  1. Tebet MA. Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis. Rev Bras Ortop. 2014 ;49(1):3-12.
  2. You JW, Moon YL, Spondylolisthesis - Anatomy, classification, and natural history -. J Korean Soc Spine Surg. 2001;8(3):336-44.
  3. Matsunaga S, Ijiri K, Hayashi K. Nonsurgically managed patients with degenerative spondylolisthesis: a 10-to 18-year follow-up study. J Neurosurg Spine. 2000;93(2): 194-8.
  4. DeVine JG, Schenk-Kisser JM, Skelly AC. Risk factors for degenerative spondylolisthesis: a systematic review. Evid Based Spine-Care J. 2012;3(2):25-34.
  5. Enyo Y, Yoshimura N, Yamada H, Hashizume H, Yoshida M. Radiographic natural course of lumbar degenerative spondylolisthesis and its risk factors related to the progression and onset in a 15-year community-based cohort study: the Miyama study. J Orthop Sci. 2015; 20(6):978-84.
  6. Ergun T, Sahin MS, Lakadamyal H. Evaluation of the relationship between L5-S1 spondylolysis and isthmic spondylolisthesis and lumbosacral-pelvic morphology by imaging via 2-and 3-dimensional reformatted computed tomography. J Comput Assist Tomogr. 2011;35(1):9-15.
  7. Lee JD, Byun JY. CT study of spondylolisthesis comparison between isthmic and degenerative type. J Korean Acupuncture & Moxibustion Society. 2000;17(4):79-87.
  8. Tamrakar BB, Tandra N, Yonghui H, Dapeng L, Jifu S. Radiological Evaluation of Lumbar Instability. J Dent Med Sci. 2014;13(4):83-7.
  9. Cooper RG, Forbes WSC, Jayson MIV. Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain. Rheumatology. 1992;31(6): 389-94.
  10. Takayama K, Kita T, Nakamura H, Kanematsu F, Yasunami T, Sakanaka H, Yamano Yl. A New Predictive Index For Lumbar Paraspinal Muscle Degeneration Associated With Aging. Spine. 2015;13(4):83-7.
  11. Ranson CA, Burnett AF, Kerslake R, Batt ME, O'Sullivan PB. An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles. Eur Spine J. 2006;15(6):764-73.
  12. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Bourgois J, Dankaerts W, De Cuyper H J. Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. Br J Sports Med. 2001;35(3):186-91.
  13. Nava-Bringas TI, Ramirez-Mora I, Coronado-Zarco R, Macias-Hernandez SI, Cruz-Medina E, Arellano-Hernandez A, Hernandez- Lopez M, Leon-Hernandez SR. Association of strength, muscle balance, and atrophy with pain and function in patients with degenerative spondylolisthesis. J Back Musculoskelet Rehabil. 2014;27(3): 371-6.
  14. Kalichman L, Hodges P, Li L, Guermazi A, Hunter DJ. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J. 2010;19(7):1136-44.
  15. Wang G, Karki SB, Xu S, Hu Z, Chen J, Zhou Z, Fan S. Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis. J Back Musculoskelet Rehabil. 2014;28(2):277-85.
  16. Kalpakcioglu B, Altinbilek T, Senel K. Determination of spondylolisthesis in low back pain by clinical evaluation. J Back Musculoskelet Rehabil. 2009;22(1):27-32.
  17. Timon SJ, Gardner MJ, Wanich T, Poynton A, Pigeon R, Widmann RF, Rawlins BA, Burke SW. Not all spondylolisthesis grading instruments are reliable. Clin Orthop. 2005;434:157-62.
  18. Deng X, Zhu Y, Wang S, Zhang Y, Han H, Zheng D, Ding Z, Wong KK. CT and MRI Determination of Intermuscular Space within Lumbar Paraspinal Muscles at Different Intervertebral Disc Levels. PloS One. 2015; 10(10):e0140315.
  19. Seong IH, Lee KS, Jung JH, Kim WW, Cho CY, Choi CW, Ha IH, The association between cross-section of lumbar regional muscle analyzed by MRI and stability, center of pressure assessed by Tetrax. J Korea CHUNA Manual Medicine for Spine & Nerves. 2013;8(2):39-46.
  20. Nizard RS, Wybier M, Laredo JD. Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin North Am. 2001;39(1):55-71.
  21. Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine. 2004;29(22):515-9.
  22. Suri P, Fry AL, Gellhorn AC. Do Muscle Characteristics on Lumbar Spine Magnetic Resonance Imaging or Computed Tomography Predict Future Low Back Pain, Physical Function, or Performance? A Systematic Review. PM&R [Internet]. 2015; Available from:
  23. Wan Q, Lin C, Li X, Zeng W, Ma C. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain. Br J Radiol. 2015;88(1053): 20140546.
  24. Izzo R, Guarnieri G, Guglielmi G, Muto M. Biomechanics of the spine. Part II: Spinal instability. Eur J Radiol. 2013;82(1):127-38.
  25. Fan S, HuZ, Zhao F, Zhao X, Huang Y, Fang X. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2010;19(2):316-24.
  26. Moseley GL, Hodges PW, Gandevia SC. Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements. Spine. 2002;27(2):29-36.
  27. Lindboe CF, Platou CS. Disuse atrophy of human skeletal muscle. Acta Neuropathol (Berl). 1982;56(4):241-4.
  28. Dangaria TR, Naesh O. Changes in Cross-Sectional Area of Psoas Major Muscle in Unilateral Sciatica Caused by Disc Herniation. Spine. 1998;23(8):928-31.
  29. Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-35.
  30. McNeely ML, Torrance G, Magee DJ. A systematic review of physiotherapy for spondylolysis and spondylolisthesis. Man Ther. 2003;8(2):80-91.
  31. Kim S, Kim H, Chung J. Effects of Spinal Stabilization Exercise on the Cross-sectional Areas of the Lumbar Multifidus and Psoas Major Muscles, Pain Intensity, and Lumbar Muscle Strength of Patients with Degenerative Disc Disease. J Phys Ther Sci. 2014;26(4):579-82.
  32. Lee KJ, Heo KH, Park YH, Keum DH. Radiological changes on spondylolisthesis using cox technique and acupuncture therapy treatment : clinical cases. J Korean Rehab Med. 2007;17(4):229-42.
  33. Lee HJ, Seo JC, Kwak MA, Park SH, Min BM, Cho MS, Shin IH, Jung JY, Roh WS. Acupuncture for low back pain due to spondylolisthesis:study protocol for a randomized controlled pilot trial. Trials. 2014;15(1):105.
  34. Kim SJ, Yoon JP, Kim SY. Clinical Analysis of 40 Cases with Spondylolisthesis. J Korean Rehab Med. 2002;12(3): 1-10.
  35. Kim HJ, Lee SR, Byun JY, Ahn SG. Clinical Study of the Treatment of Spondylolisthesis. J Korean Acupuncture & Moxibustion Society. 2000;17(3):106-15.
  36. Lee KJ, Park YH, Keum DH. The retrospective study on the correlation between the multifidus muscle atrophy on low back pain patients and the magnetic resonance images. J Korean Rehab Med 2009;19(4):151-63.