Objective To evaluate the degeneration patterns of paraspinal muscles in double-level degenerative lumbar spondylolisthesis (dl-DLS) versus single-level degenerative lumbar spondylolisthesis (sl-DLS).
Methods A total of 67 dl-DLS and 73 sl-DLS patients were included. Multifidus (MF), erector spinae (ES), and psoas major (PM)’s fatty infiltration (FI) and relative cross-sectional area (rCSA) were measured. Sagittal parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) were also assessed. Comparisons and correlation analysis were performed between the 2 groups.
Results MF atrophy is worse in dl-DLS patients from L3–4 to L5–S1, with higher FI from L1–2 to L5–S1 compared to sl-DLS patients. ES atrophy and FI are more pronounced in dl-DLS patients from L1–2 to L5–S1. PM atrophy is more significant in dl-DLS patients at L2–3 to L5–S1, with heavier FI from L1–2 to L3–4, though no difference in FI from L4–5 to L5–S1. The rCSA and FI of MF and ES show significant differences between adjacent segments in both groups, except for MF rCSA between L3–4 and L4–5 in dl-DLS. In dl-DLS, PM rCSA negatively correlates with PT from L4–5 to L2–3, while FI of MF and ES in L5–S1 positively correlates with LL. In sl-DLS, PM FI in L4–5 and L5–S1 negatively correlates with LL.
Conclusion Degeneration of MF, ES, and PM is more severe in dl-DLS patients, particularly at the spondylolisthesis level. Severe paraspinal muscle degeneration can lead to spinal force imbalance and progression from sl-DLS to dl-DLS. The degradation of PM and ES correlates negatively with PT and SVA, indicating a link to pelvic decompensation and SVA abnormalities, potentially causing disproportionate degenerative changes in dl-DLS patients.
Citations
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Level-Specific Differences in Degenerative Spondylolisthesis: A Comparative Analysis of L3 versus L4 Spinopelvic Alignment, Facet Joint Morphology, and Muscle Degeneration Patterns Xinghua Zhou, Jianhua Ren, Junkai Kou, Hengrui Chang, Di Zhang, Xianzhong Meng World Neurosurgery.2026; 205: 124629. CrossRef
PVMQ score: a novel imaging parameter for indicating lumbar degeneration and prognosis in patients with L4/5 degenerative lumbar spondylolisthesis Tianshu Feng, Yaoyu Wang, Ruichun Jin, Yonggang Li, Jinbo Zhao, Shuo Wang, Xia Wang, Jun Yan, Mingzheng Chang, Xinyu Liu European Spine Journal.2026;[Epub] CrossRef
Systematic Review of Paraspinal Muscle Changes in Lumbar Spondylolisthesis: MRI and CT Insights Valerio D'Andrea, Caterina Bernetti, Federico Greco, Claudia Volterrani, Carlo C. Quattrocchi, Paul M. Parizel, Johan Van Goethem, Gianfranco Di Gennaro, Bruno Beomonte Zobel, Carlo A. Mallio Orthopaedic Surgery.2026;[Epub] CrossRef
Investigation of spinopelvic sagittal alignment and its correlations in asymptomatic pediatric populations Hao Qi, ZengHui Zhao, Feiyu Zu, Chenchen Wang, Chenxi Wang, Zuzhuo Zhang, Jianhua Ren, Rui Xue, Zhaoxuan Wang, Zhiyong Hou, Wei Chen, Di Zhang Scientific Reports.2025;[Epub] CrossRef
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Association Between Facet Joint Orientation and Degenerative Spondylolisthesis: A Radiological Study of Double-Level Versus Single-Level Degenerative Spondylolisthesis Zhentao Zhang, Qingshuang Zhou, Haicheng Zhou, Bin Wang, Yong Qiu, Zezhang Zhu, Xu Sun Neurospine.2025; 22(3): 803. CrossRef
Research progress on ferroptosis in drug resistance and therapy of gastric cancer Yuexin Liu, Lizhou Jia, Liu Yang, Zhang Ning, Yanmei Li Journal of Cancer Research and Clinical Oncology.2025;[Epub] CrossRef
Objective To investigate the ability of radiological parameter canal bone ratio (CBR) to assess bone mineral density and to differentiate between patients with primary and multiple osteoporotic vertebral compression fracture (OVCF).
Methods A retrospective analysis was conducted on OVCF patients treated at our hospital. CBR was measured through full-spine x-rays. Patients were categorized into primary and multiple fracture groups. Receiver operating characteristic curve analysis and area under the curve (AUC) calculation were used to assess the ability of parameters to predict osteoporosis and multiple fractures. Predictors of T values were analyzed by multiple linear regression, and independent risk factors for multiple fractures were determined by multiple logistic regression analysis.
Results CBR showed a moderate negative correlation with dual-energy x-ray absorptiometry T values (r = -0.642, p < 0.01). Higher CBR (odds ratio [OR], -6.483; 95% confidence interval [CI], -8.234 to -4.732; p < 0.01) and lower body mass index (OR, 0.054; 95% CI, 0.023–0.086; p < 0.01) were independent risk factors for osteoporosis. Patients with multiple fractures had lower T values (mean ± standard deviation [SD]: -3.76 ± 0.73 vs. -2.83 ± 0.75, p < 0.01) and higher CBR (mean ± SD: 0.54 ± 0.07 vs. 0.46 ± 0.06, p < 0.01). CBR had an AUC of 0.819 in predicting multiple fractures with a threshold of 0.53. T values prediction had an AUC of 0.816 with a threshold of -3.45. CBR > 0.53 was an independent risk factor for multiple fractures (OR, 14.66; 95% CI, 4.97–43.22; p < 0.01).
Conclusion CBR is negatively correlated with bone mineral density (BMD) and can be a novel opportunistic BMD assessment method. It is a simple and effective measurement index for predicting multiple fractures, with predictive performance not inferior to T values.
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