A comparison of statistical associations between oedema in the lumbar fat on MRI, BMI and Back Fat Thickness (BFT)

The effect of aspirin on lumbar degeneration: an imaging-based study

Purpose

This study aims to investigate how aspirin influences lumbar degeneration by analyzing the effect of aspirin on patients with low back pain (LBP) and concurrent atherosclerosis.

Methods

Using 1:1 nearest neighbor matching based on propensity score matching (PSM), 73 patients who regularly took aspirin were assigned to the aspirin group, while another 73 patients who did not take aspirin formed the control group. Radiographs were used to measure lumbar lordosis (LL) and intervertebral height index (IHI). Subcutaneous fat tissue thickness (SFTT), paravertebral muscle fat infiltration area (%FIA), cartilage endplate (CEP) Modic changes, and modified Pfirrmann grading scores were performed based on lumbar MRI.

Results

After PSM analysis, confounders between the aspirin and control groups were balanced. A total of 73 pairs of patients were analyzed in this study. The aspirin group showed lower SFTT(L1/2) and a reduced incidence of CEP Modic changes, compared to the control group (both P < 0.05). Additionally, the %FIA and Pfirrmann scores were lower in the aspirin group, particularly in the upper lumbar spine (both P < 0.05). No significant differences were observed in LL and IHI between the aspirin and control groups.

Conclusion

In summary, conservative treatment with aspirin protects against upper lumbar spine degeneration, although its effect on the lower lumbar spine is less pronounced.

Relevance of Lumbar Subcutaneous Edema and Local Lordosis

Lumbar subcutaneous edema (LSE) is sometimes found within the deep subcutaneous or perifascial tissue on magnetic resonance imaging (MRI) via short-tau inversion recovery or fat-suppressed T2-weighted imaging. It is more likely to occur in older patients and those with obesity. However, no studies have focused on the association between LSE and local alignment. Therefore, the present study aimed to elucidate such an association. This retrospective study included 111 adult symptomatic patients who underwent lumbar plain MRI in a single institution. Patient demographics and the radiographical characteristics of the LSE and non-LSE groups were analyzed. LSE was detected in 30 (27.0%) patients. The L1-S1 angle was significantly lower in the LSE group (P = 0.033), whereas the sacral slope was not different between the groups (P > 0.05). As previously reported, the patients in the LSE group were older (P < 0.001) and had lower body weight (P = 0.015). This study demonstrates that older age and age-related hypolordosis were associated with a significantly higher frequency of LSE.

Posterior Subcutaneous Edema at Lumbar Spine MRI: A Systematic Review

RATIONALE AND OBJECTIVES

Edema in the subcutaneous soft tissue of the lumbar spine is a frequent incidental finding in spinal magnetic resonance imaging, however, its exact explanation is yet to be determined. The aim of this paper is to provide a systematic literature review on posterior lumbar subcutaneous edema (LSE).

MATERIALS AND METHODS

The present systematic literature search was carried out in October 2023 using electronic databases: PubMed, Cochrane library, and Scopus.

RESULTS

The current evidence suggests that lumbar edema is correlated with clinical data such as weight and age, and potentially female sex. Moreover, LSE is related to several specific conditions, including both systemic and spinal disorders, such as heart or kidney disorders, as well as low back pain and degenerative and/or inflammatory diseases.

CONCLUSION

It is important to be aware that there is an association between LSE and a variety systemic and spinal disorders.

Lumbar Disc Degeneration Is Linked to Dorsal Subcutaneous Fat Thickness at the L1-L2 Intervertebral Disc Level Measured by MRI

BACKGROUND

Obese individuals have a higher risk of degenerative disc disease (DDD). Currently, body mass index is not sensitive enough to differentiate between muscle and fat distribution, and obesity-related health issues are linked to the way body fat is distributed. Therefore, this study aims to investigate the association between the dorsal subcutaneous fat thickness (DSFT) of the lumbar spine, an alternative measurement tool of body fat distribution, and DDD.

METHODS

A total of 301 patients with DDD and 123 participants without the disease were recruited. Using length functions of magnetic resonance imaging (MRI) console, the DSFT of L1 to S1 intervertebral disc levels was measured in mid-sagittal spin-echo T2 weighted image. The Mann-Whitney U test and Chi-squared test (X2) were utilized to examine any variations between the case and control groups. Logistic regression models were built to explore the association of the DSFT with DDD.

RESULTS

The logistical regression model showed a positive association between DDD and DSFT [OR: 1.30, 95% CI: 1.02-1.64, p = 0.03]. In the stratified logistic regression analysis, a positive association was found between DDD and DSFT among younger participants and females [OR young: 1.48; 95% CI (1.02-2.20); p = 0.04-OR female: 1.37; 95% CI (1-1.88); p = 0.05].

CONCLUSIONS

Younger females with thicker DSFT at the L1-L2 level are more likely to develop DDD. This suggests that increased DSFT may be a contributing factor to DDD.

The origin of lumbar subcutaneous edema: two case reports

Since magnetic resonance imaging (MRI) is widely used to evaluate complaints of low back pain, there have been many reports of lumbar subcutaneous edema (LSE). However, the mechanism underlying its development is unknown. We herein report 2 cases that showed the reduction of LSE. These cases suggest details concerning the mechanism underlying the development of LSE. The first case was an obese 70-year-old woman with a history of chronic back pain due to lumbar canal stenosis. MRI revealed LSE extending from the level of the L2 vertebral body to the sacrum. However, LSE was reduced following weight loss due to a stomach ulcer. This case clearly indicated obesity as the cause of LSE. The second case was a nonobese 31-year-old woman with acute excruciating low back pain due to thoracolumbar fascia strain. LSE was observed at the level of the L3-L4 vertebral body. Two weeks later, her low back pain and LSE were reduced. This case suggests that the origin of LSE was impairment of the thoracolumbar fascia due to strain. We hypothesize that the mechanism underlying the development of LSE may be lymphatic or interstitial fluid pooling due to disturbance of the lumbar fascia.

Subcutaneous edema on back detected by MRI in hospitalized patients with osteoporotic vertebral compression fracture

Objectives

Almost all hospitalized patients with osteoporotic vertebral compression fracture are given an MRI. At that time, subcutaneous edema on their back is often identified. It is empirically known that patients with subcutaneous edema on their back have a history of compression fracture and vertebral kyphotic deformity. In this study, we examined whether there were any differences between patients who had subcutaneous edema on their back and those who did not; those with a history of compression fractures would be especially assessed.

Materials and methods

The observation period was between January 1, 2009, and December 31, 2020. All patients were on the ward, and there were a total of 375 patients (male: 114; female: 261) aged 66-98 years old (mean: 81.1 years).Patients who had subcutaneous edema on their back and those who did not were compared in terms of sex, age, osteoporosis diagnosis by DEXA and X-ray imaging, body mass index (BMI), serum total protein and albumin, Japanese senile independence score, presence of decubitus, history of vertebral compression fracture and incidents of compression fracture during the observation period.

Results

Significant differences were not observed for sex, osteoporosis diagnosis by DEXA, BMI, blood serum total protein and albumin, or the presence of decubitus. However, age, osteoporosis diagnosis by X-ray imaging, Japanese senile independence score, history of vertebral compression fracture, and incidents of another vertebral compression fracture during the observation period were significantly different between those with and without edema.

Conclusion

It has been suggested that hospitalized patients with subcutaneous edema on their back often have a history of vertebral compression fracture and experience another vertebral compression fracture during the observation period. Hospitalized patients with subcutaneous edema on their back should have their osteoporosis treated more carefully.

When an incidental MRI finding becomes a clinical issue : Posterior lumbar subcutaneous edema in degenerative, inflammatory, and infectious conditions of the lumbar spine

Background

On magnetic resonance imaging (MRI), posterior lumbar subcutaneous edema (PLSE) is a frequent incidental, yet unclear finding within the deep subcutaneous perifascial tissue. This study aimed to investigate PLSE in various pathological lumbar conditions.

Methods

This retrospective study included the MR images of the lumbar spine of 279 patients (age range 18–82 years) without cardiovascular, renal or hepatic diseases, 79 of whom had low-grade disc degeneration, 101 combined endplate and facet joint degeneration, 53 axial spondyloarthritis and 46 infectious spondylodiscitis. There were 232 patients with a body mass index (BMI) <30, and 47 with a BMI ≥30 (obese). For each group, the relationship between PLSE and BMI was analyzed using multiple logistic regression, and between PLSE extension and BMI using ordinal regression.

Results

A PLSE was found in 11/79 (13.9%) patients with disc degeneration, 37/101 (36.6%) with endplate and facet joint degeneration, 7/53 (13.2%) with spondyloarthritis, and 28/46 (60.9%) with spondylodiscitis. For each group, a statistically significant relationship was demonstrated between PLSE and BMI (P = 0.000–P = 0.031), except for spondylodiscitis (P = 0.054), as well as between PLSE extension and BMI (P = 0.000–P = 0.049). A PLSE was found in 21.1% of nonobese and 72.3% of obese patients (P = 0.000).

Conclusion

The presence of PLSE seems to be associated with various lumbar conditions, particularly in obese patients. Its perifascial location may suggest a potential fascial origin; however, PLSE should not to be confused with posttraumatic, postsurgical or infectious edema or edema associated with internal diseases.

Quantifying paraspinal muscle tone and stiffness in young adults with chronic low back pain: a reliability study

The reliability of a handheld myotonometer when used in a clinical setting to assess paraspinal muscle mechanical properties is unclear. This study aimed to investigate the between-session intra-rater reliability of a handheld myotonometer in young adults with low back pain (LBP) in a clinical environment. One assessor recorded lumbar paraspinal muscle tone and stiffness in an outpatient department on two occasions. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD) and Bland-Altman analysis were conducted to assess reliability. The results indicated acceptable between-days intra-rater reliability (ICC > 0.75) for all measurements. The SEM of the muscle tone and stiffness measurements ranged between 0.20-0.66 Hz and 7.91-16.51 N/m, respectively. The SRD was 0.44-1.83 Hz for muscle tone and 21.93-52.87 N/m for muscle stiffness. SEM and SRD at L1-L2 were higher than those at other levels. The magnitude of agreement appeared to decrease as muscle tone and stiffness increased. The myotonometer demonstrated acceptable reliability when used in a clinical setting in young adults with chronic LBP. Measurements of the upper lumbar levels were not as reliable as those of the lower lumbar levels. The crural attachment of the diaphragm at L1 and L2 may affect paraspinal muscle tone and stiffness during respiratory cycles.