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Relationship Between Paralumbar Muscle Assessment Methods and Spinal Alignment in Adult Spinal Deformity
Donghua Huang1,2, Austin C Kaidi1, Zhan Wang1,2
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Global Spine Journal
|September 3, 2025
Summary
Fat infiltration (FI) and psoas vertebral body index (PVBI) best correlate with spinal alignment in adult spinal deformity (ASD). Higher FI and lower PVBI indicate poorer alignment, especially in older patients.
Area of Science:
- Orthopedics
- Radiology
- Spine Surgery
Background:
- Paralumbar muscle degeneration is associated with adult spinal deformity (ASD).
- Current assessment methods for muscle degeneration, including fat infiltration (FI) for quality and paraspinal total cross-sectional area (PTCSA), psoas vertebral body index (PVBI), and normalized total psoas area (NTPA) for quantity, lack standardization.
- Identifying reliable metrics for muscle degeneration is crucial for understanding and managing ASD.
Purpose of the Study:
- To determine which quantitative and qualitative measures of paralumbar muscle degeneration best correlate with spinal alignment in patients with ASD.
- To compare the effectiveness of FI, PTCSA, PVBI, and NTPA in reflecting spinal deformity.
Main Methods:
- Retrospective cross-sectional study of 116 adult spinal deformity patients.
- Preoperative MRI was used to assess paralumbar muscle quality (FI) and quantity (PTCSA, PVBI, NTPA).
- Spinopelvic parameters were measured to evaluate spinal alignment; correlation analyses were performed between muscle metrics and alignment parameters, including age-stratified subgroup analyses.
Main Results:
- Fat infiltration (FI) and psoas vertebral body index (PVBI) showed significant correlations with multiple sagittal spinal alignment parameters.
- Paraspinal total cross-sectional area (PTCSA) and normalized total psoas area (NTPA) exhibited only weak correlations with alignment.
- Higher FI and lower PVBI were linked to reduced lumbar lordosis (LL) and sacral slope (SS), and increased pelvic tilt (PT) and pelvic incidence (PI)-LL mismatch.
- In patients aged 70 and older, FI demonstrated moderate correlations with LL and SS, while PVBI had limited relevance.
Conclusions:
- Fat infiltration (FI) and psoas vertebral body index (PVBI) are the most relevant metrics for assessing paralumbar muscle status in adult spinal deformity.
- Fat infiltration (FI) appears to be a particularly strong indicator of spinal alignment in elderly ASD patients.
