腰椎间盘退变与腰椎旁肌肉减少症之间的关系探讨

Study on the relationship between lumbar disc degeneration and lumbar paraspinal sarcopenia

腰椎间盘退变(lumbar disc degeneration,LDD)和腰椎脊柱旁肌疾病经常同时发生[1]。LDD是腰痛最常见的病因之一[2]。随着人口老龄化,慢性腰痛已逐渐成为导致患者发生病态、活动受限、残疾和经济损失的主要原因之一[3]。肌肉质量和肌肉力量的逐渐下降是衰老过程的主要特点[4],由Ⅱ型肌纤维向Ⅰ型肌纤维过渡导致的乳酸积聚也可诱发腰痛。分析指出,男性椎间盘退变组的肌少症发生率明显高于椎间盘非退变组[3,5]。

Degeneration of lumbar intervertebral disc and lumbar paraspinal muscle disease often occur simultaneously.Anatomically,intervertebral disc is composed of nucleus pulposus(NP),annulus fibrosus(AF),and end-plate(EP).Degeneration of lumbar intervertebral disc is one of the major causes of low back pain(LBP)and a variety of degenerative spinal diseases,including lumbar disc herniation(LDH),lumbar spinal canal stenosis,and degenerative scoliosis.The paraspinal muscle is composed of the multifidus(MF),erector spinae(ES),psoas(PS),and quadratus lumborum(QL).Sarcopenia is a syndrome characterized by extensive and progressive loss of skeletal muscle mass and strength,leading to decreased muscle function,decreased quality of life,and an increased risk of adverse events such as falls and death.The mechanism of intervertebral disc degeneration and paraspinal sarcopenia are complex,mainly includes:(1)Changing in spine-pelvic parameters caused by decreased muscle mass and strength,which in turn leads to changes in the biomechanics of the spine,and ultimately affects the structure and function of lumbar intervertebral discs;(2)The degree of fat infiltration in the paraspinal muscles also correlates disc degeneration with paraspinal sarcopenia;(3)Disc herniation as a result of lumbar disc degeneration will compress nerve roots and cause problems in the innervation of the muscles in the low back;meanwhile,low back pain can make the muscles in a disused state for a long time,thus accelerating the progression of paraspinal sarcopenia;(4)Lumbar disc degeneration and paraspinal sarcopenia share multiple risk factors and are often associated with other diseases.In this paper,the relationship between the two will be elaborated in detail based on the research progress at home and abroad.