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Paraspinal Muscle Alterations in Lumbosacral Transitional Vertebrae: A Volumetric Study of Low Back Pain Patients
Rahmi Eren Ozkan1, Melis Kosar Tunc1, Atalay Aktuna2
1University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu State Hospital, Radiology, Istanbul, Turkey (R.E., M.K.T., H.Y.).
Rationale And Objectives:
Lumbosacral transitional vertebra (LSTV) is a common congenital anomaly that may alter spinal biomechanics and contribute to low back pain (LBP). This study aimed to evaluate the effect of LSTV on paraspinal muscle morphology using volumetric analysis in LBP patients.
Materials And Methods:
This retrospective study included 72 patients with LSTV and 72 matched controls (age, sex, height, weight, BMI, lumbar lordosis). All subjects underwent non-contrast lumbar CT. The multifidus, erector spinae, and psoas muscles were bilaterally segmented from L1 to S1. Total, lean, and fat muscle volumes were quantified. Normality was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Between-group comparisons were performed with Student's t-test or Mann-Whitney U test.
Results:
The LSTV group showed significantly lower lean paraspinal muscle volumes at the lumbosacral level compared to controls (right: 32.5±10.7cm³ vs. 42.1±12.1cm³; left: 30.2±9.5cm³ vs. 39.1±11.4cm³; both p<0.001). Fat volume was not significantly different (p>0.05). Bilateral LSTV was associated with more marked lean muscle reduction than unilateral LSTV (left: 27.3±9.1cm³ vs. 33.5±9.0cm³; p=0.005). Psoas volumes were comparable, except for higher fat in the left psoas at L1-L4 in LSTV patients (1.38±0.95cm³ vs. 1.09±0.85cm³; p=0.023).
Conclusion:
LSTV is associated with reduced lean paraspinal muscle volume, particularly in bilateral cases, suggesting altered mechanical loading.
