Work

Development and reliability of a systematic method to evaluate lumbar paraspinal muscle size and quality in computed tomography images

Year: 2025

Type: article

Abstract: Background: Lumbar paraspinal muscles (LPMs) are critical for spinal stability, and their morphological alterations are associated with chronic low back pain (cLBP). Computed tomography (CT) offers a feasible alternative to magnetic resonance imaging for assessing LPM morphology; however, its broader use has been hindered by inconsistent measurement methods and limited reliability data. This study aimed to describe a systematic CT-based method for evaluating LPM cross-sectional area (CSA) and attenuation (MA) in adults with cLBP and to determine its intra and inter-examiner procedural reliability. Methods: ) with 95% confidence intervals (CI). Mean ICCs<0.50 indicated poor, 0.50-0.74 moderate, 0.75-0.90 good, and >0.90 excellent procedural reliability. Results: Thirty-six participants (40% female; age 48±15 years; BMI 27.2±4.3 kg/m²) with moderate disability were included. Intraexaminer procedural reliability was excellent for CSA of the erector spinae, psoas, and quadratus lumborum (ICC point estimates >0.916, >0.959, and >0.962, respectively); and good to excellent for multifidi CSA (ICC point estimates: 0.770-0.916), with greater variability at L1 and L2. Inter-examiner procedural reliability was excellent for CSA of the erector spinae, psoas, and quadratum lumborum (ICC point estimates >0.916, >0.946, and >0.941, respectively); and moderate to excellent for multifidi CSA (ICC point estimates: 0.593-0.945), with lower reliability at upper lumbar levels. Intra and inter-examiner procedural reliability for MA was excellent across all LPMs. Conclusions: The presented CT-based protocol provides a standardized and reproducible method for assessing LPM CSA and MA in adults with cLBP. Demonstrated high procedural reliability-including image selection and analysis-supports its use for consistent evaluation of LPM morphology in both clinical and research contexts, particularly where muscle degeneration complicates image-based assessment.

Source: North American Spine Society Journal (NASSJ)

DOI: 10.1016/j.xnsj.2025.100822