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Association of paraspinal and psoas muscle morphology with recurrent lumbar disc herniation: a retrospective

Abdurrahim Tekin1, Engin Can1, Enis Furkan Edehan1

  • 1Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Turkey.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|October 5, 2025
PubMed
Abstract

Insights

Multifidus muscle degeneration and psoas muscle hypertrophy are linked to recurrent lumbar disc herniation (rLDH). Maintaining paraspinal muscle health may help prevent rLDH.

Area of Science:

  • Orthopedics
  • Radiology
  • Neurosurgery

Background:

  • Recurrent lumbar disc herniation (rLDH) poses a significant clinical challenge.
  • Understanding predisposing factors for rLDH is crucial for effective prevention and treatment strategies.

Purpose of the Study:

  • To investigate the association between paraspinal and psoas muscle morphology and the occurrence of rLDH.
  • To utilize quantitative magnetic resonance imaging (MRI) analysis for precise morphological assessment.

Main Methods:

  • Retrospective analysis of 43 patients with rLDH and 43 matched controls.
  • Quantitative MRI measurements included functional cross-sectional area (FCSA), fat infiltration (FI), and relative FCSA (rFCSA) for multifidus (MF), erector spinae (ES), and psoas (PS) muscles.

Main Results:

  • Lower FCSA values were observed in MF and ES muscles in the rLDH group compared to controls.
  • Higher FCSA values were found in the PS muscle of the rLDH group.
  • Multivariate analysis indicated that increased MF FCSA was protective (OR=0.665), while increased PS FCSA was a risk factor (OR=1.15) for rLDH.

Conclusions:

  • Multifidus muscle degeneration and psoas muscle hypertrophy are significantly associated with rLDH.
  • Erector spinae muscle degeneration did not show an independent effect on rLDH recurrence.
  • Preserving paraspinal muscle health is vital for preventing rLDH; further research into targeted interventions is warranted.
Keywords:
Erector spinae muscleIntervertebral disc displacementMagnetic resonance imagingMultifidus musclePsoas musclesRecurrence

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