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Osteoporosis is a disease characterized by severe imbalance in bone metabolism, progressive reduction of bone mineral density, and increased risk of fractures, which poses a serious threat to human health and quality of life. The paravertebral muscles are an important stabilizing device of the human spine and play a vital role in the upright body of the human body. With the deepening of the study of paravertebral muscles, it is found that the paravertebral muscles are closely related to the bone mineral density of the lumbar vertebrae and even the bone mineral density of the whole body. This is highly consistent with the theory of incompatibility of flesh and blood in traditional Chinese medicine. This paper discusses the combination of various physical and chemical properties of paravertebral muscles with bone mineral density, and correlates them with the theory of incompatibility of flesh and blood, aiming to provide new insights for the diagnosis and treatment of osteoporosis. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the impact of technique of sling exercise with Tuina therapy on improving paravertebral muscle asymmetry in patients with adolescent idiopathic scoliosis (AIS).MethodsA total of 88 patients with AIS who met the inclusion criteria and received treatment at the Rehabilitation Department of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2021 to August 2023 were recruited for this study. They were randomly divided into control group and experimental group, with 44 cases in each group. Routine rehabilitation training was performed in the control group with reference to the German Schroth scoliosis three-dimensional corrective therapy, including manipulation to relax the concave side of the paraspinal muscles, "hip bridge", and "small swallow fly" and other strength exercises. Schroth gymnastics included "muscle column", "rotational sitting movement", "stretching exercise" with angular breathing. The experimental group was treated with sling Tuina exercise technique which mainly included adjusting the position of the spine to restore the neutral position, the methods of plucking, pressing and pushing and other techniques to act back and forth on the Governor vessel, bladder meridian and the convex-concave side of the paravertebral muscle dialectical tonifying and reducing therapy, neutral position control training in supine, prone and lateral position, trunk flexion, extension, rotation and lateral flexion closed chain movement training with the assistance of sling equipment. Before treatment and after 4 weeks of treatment, the surface electromyography (sEMG) was used to measure the paraspinal muscles of the patients during standing weight-bearing position, and the root mean square (RMS) was calculated and analyzed through the included software, and the paraspinal muscle symmetry index was calculated (PMSI=RMSconvex/RMSconcave); Cobb's angle was used to assess the severity of the patients' scoliosis; and the angle of trunk rotation (ATR) was used to assess the degree of rotation of the trunk.ResultsBefore treatment, the PMSI values, Cobb's angle, and ATR values of the two groups were compared, and the differences were not statistically significant (P>0.05). After 4 weeks of treatment, the PMSI values of the experimental group was 1.08 (1.04, 1.14), the Cobb's angle was 5 (2, 9)°, and the ATR value was 2 (1, 3)°, while the PMSI value of the control group was 1.12 (1.09, 1.17), the Cobb's angle was 8.5 (6, 10)°, and the ATR value was 2 (2, 3)°. The intra-group comparison results showed that the Cobb's angle and ATR values decreased in both groups after treatment (PPPPP>0.05).Conclusiontechnique of sling exercise with Tuina therapy can effectively improve the asymmetry of paravertebral muscles and achieve the orthopedic purpose of reducing the Cobb's angle and trunk rotation angle of patients, which is recommended for clinical application.

Osteoporotic vertebral fracture (OVF) is a common complication in patients with osteoporosis. The quality and functional status of the muscles around the spine are one of the important factors influencing the occurrence of OVF. Muscles play a role in both the mechanical and chemical interactions with adjacent bones. The muscles surrounding the spine influence the macrostructure and microstructure of spinal vertebrae through various mechanisms to protect and maintain the stability and strength of the spine. However, abnormal muscle quality and function can have a negative impact on the vertebrae. Screening for muscle quality and function in individuals at risk of OVF using radiographic, physical, and other biochemical methods can be employed for secondary prevention. Meanwhile, utilizing various increasingly mature novel nanomolecular technologies can have a positive impact on the treatment of OVF and vertebral strength, mitigating the clinical consequences of OVF onset.

• Afferent stimulation elicited a greater corticospinal drive to lumbar multifidus muscles in CLBP in comparison to controls. • Afferent stimulation alone elicited a larger reduction in paravertebral muscles activity compared to controls. • These results suggest an alteration of sensorimotor integration in our sample of participants with chronic low back pain. Objective: Chronic low back pain (CLBP) impacts on spine movement. Altered sensorimotor integration can be involved. Afferents from the lumbo-pelvic area might be processed differently in CLBP and impact on descending motor control. This study aimed to determine whether afferents influence the corticomotor control of paravertebral muscles in CLBP. Fourteen individuals with CLBP (11 females) and 13 pain-free controls (8 females) were tested with transcranial magnetic stimulation (TMS) to measure the motor-evoked potential [MEP] amplitude of paravertebral muscles. Noxious and non-noxious electrical stimulation, and magnetic stimulation in the lumbo-sacral area were used as afferent stimuli and triggered 20 to 200 ms prior to TMS. EMG modulation elicited by afferent stimulation alone was measured to control net motoneuron excitability. MEP/EMG ratio was used as a measure of corticospinal excitability with control of net motoneuron excitability. MEP/EMG ratio was larger at 60, 80 and 100-ms intervals in CLBP compared to controls, and afferent stimulations alone reduced EMG amplitude greater in CLBP than controls at 100 ms. Our results suggest alteration in sensorimotor integration in CLBP highlighted by a greater facilitation of the descending corticospinal input to paravertebral muscles. Our results can help to optimise interventions by better targeting mechanisms. [ABSTRACT FROM AUTHOR]

The paravertebral muscles, characterized by their susceptibility to severe size loss and fat infiltration in old age, lack established reference values for age-related variations in muscle parameters. This study aims to fill this gap by establishing reference values for paravertebral muscles in a Chinese adult population. This cross-sectional study utilized the baseline data from the prospective cohort China Action on Spine and Hip (CASH). A total of 4305 community-dwelling participants aged 21–80 years in China were recruited between 2013 and 2017. Pregnant women, individuals with metal implants, limited mobility or diseases/conditions (spinal tumor, infection, etc.) affecting lumbar vertebra were excluded from the study. Psoas and paraspinal muscles were measured in quantitative computed tomography (QCT) images at the L3 and L5 levels using Osirix software. Age-related reference values for muscle area, density, and fat fraction were constructed as percentile charts using the lambda-mu-sigma (LMS) method. The paravertebral muscles exhibited an age-related decline in muscle area and density, coupled with an increase in muscle fat fraction. Between the ages of 25 and 75, the reductions in psoas and paraspinal muscle cross-sectional area at the L3 level were − 0.47%/yr and − 0.53%/yr in men, and − 0.19%/yr and − 0.23%/yr in women, respectively. Notably, accelerated muscle loss was observed during menopause and postmenopause in women (45–75 years) and intermittently during middle and old age in men (35–55 and 60–75 years). Besides, the age-related decreases in PSMA, PMA, and PSMD and the increases in PSMFF were more pronounced in L5 than in L3 This study shows distinct patterns of accelerated muscle loss were identified in menopausal and postmenopausal women and in middle-aged and old men. The findings contribute valuable information for future investigations on paravertebral muscle loss and myosteatosis. [ABSTRACT FROM AUTHOR]

Abstract Background Intervertebral disc degeneration and sarcopenia are both age-related diseases without effective treatments. Their comorbidities may worsen the prognosis, and further studies on interaction and therapy are needed. The purpose of the study was to investigate the prevalence of sarcopenia in intervertebral disc degeneration, and to compare the characteristics of intervertebral disc degeneration with and without sarcopenia and effects of interferential current. Methods One hundred twenty disc degeneration patients were included from 2021 to 2022 in a single institute. Medical records, examination results and radiological reports were reviewed. Patients with sarcopenia were screened and grouped according to Asian Working Group for Sarcopenia 2019. VAS, ODI, SARC-F, SMI, gait speed (GS), grip strength, disc Pfirrmann grading, standard cross-sectional area (SCSA), degree of fatty infiltration (DFF), and nerve conduction velocity (NCV) were assessed before and after treatment. Results The prevalence of sarcopenia in intervertebral disc degeneration was 28.3%. The difference of VAS, ODI, disc Pfirrmann grading, SCSA, DFF and NCV between two groups were significant before intervention (P 0.05). Conclusion The prevalence of sarcopenia was high in intervertebral disc degeneration, and paravertebral muscles degeneration correlated with the degree of disc degeneration. Compared to those without sarcopenia, intervertebral disc degeneration patients with sarcopenia have more severe pain, poorer mobility and neurological function. Interferential current is effective in intervertebral disc degeneration patients and sarcopenia patients.

Background: Intervertebral disc degeneration and sarcopenia are both age-related diseases without effective treatments. Their comorbidities may worsen the prognosis, and further studies on interaction and therapy are needed. The purpose of the study was to investigate the prevalence of sarcopenia in intervertebral disc degeneration, and to compare the characteristics of intervertebral disc degeneration with and without sarcopenia and effects of interferential current. Methods: One hundred twenty disc degeneration patients were included from 2021 to 2022 in a single institute. Medical records, examination results and radiological reports were reviewed. Patients with sarcopenia were screened and grouped according to Asian Working Group for Sarcopenia 2019. VAS, ODI, SARC-F, SMI, gait speed (GS), grip strength, disc Pfirrmann grading, standard cross-sectional area (SCSA), degree of fatty infiltration (DFF), and nerve conduction velocity (NCV) were assessed before and after treatment. Results: The prevalence of sarcopenia in intervertebral disc degeneration was 28.3%. The difference of VAS, ODI, disc Pfirrmann grading, SCSA, DFF and NCV between two groups were significant before intervention (P < 0.05), SCSA and DFF were related to the degree of disc degeneration. The improvement of SMI, GS, grip strength, VAS, SARC-F and ODI in intervertebral disc degeneration with sarcopenia group was significant after intervention, as well as SMI, GS, grip strength, VAS and ODI in those without sarcopenia (P < 0.05). The improvement of grip strength, GS, ODI and SARC-F in intervertebral disc degeneration with sarcopenia group were greater than the one without sarcopenia (P < 0.05), whereas there was no significance in improvement degree of other indicators between the two groups (P > 0.05). Conclusion: The prevalence of sarcopenia was high in intervertebral disc degeneration, and paravertebral muscles degeneration correlated with the degree of disc degeneration. Compared to those without sarcopenia, intervertebral disc degeneration patients with sarcopenia have more severe pain, poorer mobility and neurological function. Interferential current is effective in intervertebral disc degeneration patients and sarcopenia patients. [ABSTRACT FROM AUTHOR]

Objective To quantitatively assess the structural changes of the lumbar paraspinal muscles in patients with chronic non-specific low back pain (CNLBP) using conventional magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in order to provide a reference for the clinical diagnosis and treatment of CNLBP. Methods A total of 45 CNLBP patients admitted to our hospital from April 2022 to March 2023 were enrolled and assigned into CNLBP group, and another 28 healthy volunteers were recruited and assigned into control group. Sagittal and axial T2WI and DTI MRI scans were performed to all the subjects at the same time. The axial T2WI and DTI images at the L3/4, L4/5 and L5/S1 intervertebral disc levels were used to measure the functional cross-sectional area (FCSA), fat infiltration rate (FIR), fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the bilateral multifidus and erector spinae muscle. Visual analog scale (VAS) and Oswestry disability index (ODI) were employed to assess the severity of pain and functional impairment in the patients. The general data (age, sex, height, body weight and BMI), and the relative functional cross-sectional area (RFCSA), FIR, FA and ADC values of bilateral multifidus and erector spinae muscles were compared between the CNBLP group and the control group. Multiple linear regression was applied to analyze the correlations of age, gender, BMI and lower back pain with the FIR value of bilateral multifidus and erector spinae muscle. Spearman analysis was performed to determine the correlations of VAS and ODI scores with RFCSA, FIR, FA and ADC values of the muscles. Results There were no statistical differences in the general data between the CNLBP and control groups. The RFCSA values of the bilateral multifidus and erector spinae muscles were decreased in the former group than the latter group, though no significant difference. The CNLBP group had obviously higher FIR values of the 2 muscles than the control group (P < 0.05). Multiple linear regression analysis showed that age was positively associated with FIR, BMI was not, and the females and the patients with LBP were more likely to develop fatty infiltration. Spearman analysis indicated that the ODI score was negatively correlated with the RFCSA values of the 2 muscles (P < 0.05), and both VAS and ODI scores were positively correlated with the FIR values of the 2 muscles (P < 0.05). A decrease in the FA value and an increase in the ADC value of the 2 muscles were found in the CNLBP group. And the differences in FA of the right multifidus muscle at the L3/4 segment and FA and ADC values of the bilateral multifidus muscle at the L4/5 and L5/S1 segments, and FA values at the L4/5 and L5/S1 segments and ADC values at the L5/S1 segment of the bilateral erector spinae muscle were statistically significant (P < 0.05). Conclusion CNLBP patients are accompanied by muscle atrophy, fat infiltration and changes in muscle fiber structure. Multimodal MRI technology can observe and quantitatively assess these changes in the muscle structure.

This study investigated age-related changes in trunk muscle function in healthy men and the moderating effect of physical activity. Twelve older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) men performed isokinetic trunk flexion and extension tests across a range of angular velocities (15°/s–180°/s) and contractile modes (concentric and eccentric). For concentric trunk extension, mixed-effects analysis of covariance revealed a significant interaction between Angular velocity × Age group (p =.026) controlling for physical activity. Follow-up univariate analysis of covariance revealed that the younger group produced significantly greater peak torque for all concentric extension conditions. Eccentric trunk strength was somewhat preserved in the older group. Age-related changes in trunk strength were independent of physical activity. The normal loss of trunk muscle strength in older age is muscle- and contractile-mode specific. These findings provide guidance for effective intervention strategies to offset adverse health outcomes related to trunk strength loss in older adults. [ABSTRACT FROM AUTHOR]

Objectives: Investigate sex differences in age-related back extensor muscle degeneration using Dixon MRI and analyze the relationship between quantitative muscle parameters and back muscle strength in healthy adults. Methods: 105 healthy subjects underwent lumbar Dixon MRI. Fat fraction (FF), cross-sectional area (CSA), functional CSA (FCSA), and relative FCSA (RFCSA) of multifidus muscle (MF) and erector spinae (ES) were quantified. Back extension muscle strength was measured using an external fixation dynamometer. ANOVA with post hoc Tukey correction was used for age group comparisons. Partial and Spearman's correlation analyzed relationships between age, muscle parameters, and muscle strength. Results: MF and ES FF significantly increased with age in both genders (r = 0.55–0.85; p < 0.001). Muscle FF increased prominently for females (40–49 years, MF and 50–59 years, ES) and males (60–73 years, MF and ES). In females, total ES FCSA and RFCSA (r = − 0.42, − 0.37; p < 0.01) correlated with age. While in males, all MF and ES muscle size parameters, except total MF CSA, correlated with age (r = − 0.30 to − 0.58; p < 0.05). Back extension muscle strength correlated with mean FF, total CSA, and total FCAS for MF and ES individually (p < 0.001). The combined MF + ES FCSA correlation coefficient (r = 0.63) was higher than FF (r = − 0.51) and CSA (r = 0.59) (p < 0.001). Conclusions: Age-related back extensor muscle degeneration varies by muscle type and sex. FCSA has the highest association with back muscle strength compared to FF and CSA. Clinical relevance statement: The investigation of sex differences in age-related back extensor muscle degeneration utilizing Dixon imaging may hold significant implications for evaluating spine health and enabling earlier intervention. Muscles' FCSA could contribute to acquiring additional evidence for reflecting muscle function change. Key Points: • The multifidus muscle (MF) and erector spinae (ES) fat fraction (FF) increased with age at all lumbar disc levels in females and males. • Age-related changes in muscle morphological quantitative parameters of healthy adults were specific by muscle type and gender. • The muscle functional cross-sectional area (FCSA) measured by Dixon imaging may better monitor back extensor muscle strength changes than muscle FF and cross-sectional area (CSA). [ABSTRACT FROM AUTHOR]

Background: The weakening of paraspinal muscles in the paravertebral area may play a role in developing central lumbar spinal stenosis, resulting in lower back discomfort. Objective: The study thoroughly examined the correlation between the Oswestry Disability Index, Dural Sac cross-sectional area, Schizas grading Scale, Body Mass Index, and the cross-sectional areas of Erector Spinae, Multifidus, and Psoas muscles. The findings were also compared between patients with central Lumbar Spinal Stenosis and healthy individuals. Study design: Retrospective monocentric observational study. Methods: The study recruited 168 consecutive patients aged 60 or older diagnosed with central Lumbar Spinal Stenosis between January 2020 and July 2022. The patients' condition was evaluated by administering a preoperative Oswestry Disability Index questionnaire, measuring their Body Mass Index, and performing preoperative Magnetic Resonance Imaging. The analyzed parameters were the cross-sectional area of paraspinal muscles at the L4-L5 level, dural sac cross-sectional area, and Schizas grading Scale at the most stenotic level, using multiple linear univariate analyses. Two groups of healthy individuals were recruited: Group A (under 60 years old) and Group B (over 60 years old). The same data extrapolated from these groups were compared with those of patients with central lumbar stenosis using a two-tailed Mann-Whitney test. Results: As the Erector Spinae degenerates, the Oswestry Disability Index tends to increase. Similarly, an increase in Body Mass Index is often accompanied by a decrease in the cross-sectional area of the Erector Spinae. Low dural sac cross-sectional area is statistically linked to a reduced Multifidus cross-sectional area. Interestingly, the Schizas grading scale does not appear to correlate with changes in the cross-sectional area of the paraspinal muscles. Additionally, there is no significant difference in the cross-sectional area of the Psoas muscle between individuals with central lumbar spinal stenosis and healthy individuals. Conclusions: Our study found that degeneration of the Erector Spinae plays a crucial role in the progression of perceived disability in Lumbar Spinal Stenosis. Prospective studies should investigate the long-term evolution of paraspinal muscles in decompressed patients. [ABSTRACT FROM AUTHOR]

Paravertebral muscles (PVM) act as one of the major dynamic factors to maintain human upright activities and play a remarkable role in maintaining the balance of the trunk. Adult degenerative scoliosis (ADS) has become one of the important causes of disability in the elderly population owing to the changes in spinal biomechanics, atrophy and degeneration of PVM, and imbalance of the spine. Previously, many studies focused on the physical evaluation of PVM degeneration. However, the molecular biological changes are still not completely known. In this study, we established a rat model of scoliosis and performed the proteomic analysis of the PVM of ADS. The results showed that the degree of atrophy, muscle fat deposition, and fibrosis of the PVM of rats positively correlated with the angle of scoliosis. The proteomic results showed that 177 differentially expressed proteins were present in the ADS group, which included 105 upregulated proteins and 72 downregulated proteins compared with the PVM in individuals without spinal deformities. Through the construction of a protein–protein interaction network, 18 core differentially expressed proteins were obtained, which included fibrinogen beta chain, apolipoprotein E, fibrinogen gamma chain, thrombospondin-1, integrin alpha-6, fibronectin-1, platelet factor 4, coagulation factor XIII A chain, ras-related protein Rap-1b, platelet endothelial cell adhesion molecule 1, complement C1q subcomponent subunit A, cathepsin G, myeloperoxidase, von Willebrand factor, integrin beta-1, integrin alpha-1, leukocyte surface antigen CD47, and complement C1q subcomponent subunit B. Further analysis of the Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) and immunofluorescence showed that the neutrophil extracellular traps (NETs) formation signaling pathway plays a major role in the pathogenesis of PVM degeneration in ADS. The results of the present study preliminarily laid the molecular biological foundation of PVM atrophy in ADS, which will provide a new therapeutic target for alleviating PVM atrophy and decreasing the occurrence of scoliosis. [ABSTRACT FROM AUTHOR]

Introduction Nemaline myopathies (NM) are a group of neuromuscular diseases, the distinctive histological feature of which are nemaline rods in myosymplasts. The purpose of this work is to describe the morphology of a rare form of primary nemaline myopathy that progresses in adulthood. Material and methods The surgical material of the paravertebral muscles of a 51-year-old patient with scoliotic deformity at the level of L4-S1, who was repeatedly operated on to correct spinal deformity due to neurological disorders, was studied. Paraffin sections were stained with hematoxylineosin, according to Masson, using the Ptah method, studied using a 3DHISTECH Pannoramic MIDI II BF scanning microscope to digitize preparations using Whole slide imaging technology in two modes: Single layer mode and Extended focus (3DHISTECH, Hungary). Results In the fragments of the altered muscle tissue, filamentous structures of nemaline bodies in myosymplasts were identified, which were located diffusely-dotted throughout the sarcoplasm or formed clusters of various configurations. There was an increased variability in the diameters of muscle fibers, internal nuclei, myosymplasts altered by contraction and with signs of myophagy, patterns of gradual replacement of muscle fibers by adipocytes, massive fatty degeneration of fibers, and fibrosis of the interstitial space. Intramuscular nerve trunks showed signs of complete involution; fibrous perineurium was preserved, and there were single nerve fibers; neuromuscular spindles were distinguished by an enlarged connective tissue capsule. The vessels of the arterial flow had signs of fibrosis and obliteration of the lumen; the vessels of the venous bed were tortuous. Discussion Due to a large number of genes responsible for NM, genetic search can be difficult and is effective only in 50 % of cases. It has been established that nemaline bodies can be distributed diffusely or form clusters of irregular shape, more often subsarcolemmal and characteristic of small fibers. In the presented clinical case, nemaline bodies were observed over the entire area of the fibers and were characteristic of myosymplasts of various sizes. Conclusion The histopathological study of the paravertebral muscles established the neuromuscular nature of the disease, being nemaline myopathy that progressed in adulthood and had not been diagnosed at previous stages of treatment.

Abstract Background This study aimed to reveal the associations of osteoporotic vertebral compression refracture (OVCRF) incidence with sarcopenia and paravertebral muscles (PVM). Methods A total of 214 elderly patients who underwent percutaneous kyphoplasty in our hospital between January 2017 and December 2019 were analyzed. Data on possible risk factors, including sex, age, weight, height, diabetes, treated vertebral levels (thoracolumbar junction [(T10–L2]), vacuum clefts, and body mass index (BMI), were collected. Preoperative bone mineral density (BMD) and appendicular muscle mass were evaluated using dual-energy X-ray absorptiometry. Nutritional status was evaluated using the Mini Nutritional Assessment. Magnetic resonance imaging was performed to evaluate the physiological cross-sectional area of the PVM. Results Overall, 74 (15 men and 59 women) and 60 (55 women and 14 men) patients developed OVCRF and sarcopenia, respectively. Sarcopenia is related to advanced age, ower BMD and BMI values. Sarcopenia-related indicators (PVM fat rate, appendicular muscle mass index, grip strength) were significantly lower in the sarcopenia group. Univariate analysis showed a correlation between OVCRF and BMD, BMI, diabetes, sarcopenia, and age. Multivariate analysis suggested that fatty infiltration of the PVM, BMD, sarcopenia, diabetes, BMI, and treated vertebral level remained as the independent predictors of OVCRF (p

The prevalence of idiopathic scoliosis (IS) is 2–3% worldwide and is more common in girls. Estrogen receptors (ERs) is supposed to be related to sex differences and development of IS. Meanwhile, paravertebral muscle (PVM) abnormalities play important roles in the pathogenesis of IS. But the changes of ERs between the PVMs from IS patients and controls, and the mechanism by which ERs may affect IS patients remain unclear. Thus, the expression levels of ERs, myogenesis regulator (MYOG) and adipogenesis related factors (CEBPA, PPARγ, FABP4), as well as morphological changes in the PVMs and primary skeletal muscle mesenchymal progenitor cells (hSM-MPCs) of IS patients and controls were investigated. Increased expression levels of ERs and CEBPA, PPARγ, FABP4, together with severe myofiber necrosis and fat infiltration, were found in the PVMs of IS patients. Meanwhile, upregulated ERs, FABP4 and CEBPA, downregulated MYOG and impaired myogenesis were also revealed in the hSM-MPCs of IS patients compared with those of controls. Upregulation of ERs inhibited myogenesis but increased expression of CEBPA and FABP4 in C2C12 myoblasts. Nevertheless, treatment of ER antagonist increased expression of MYOG, enhanced myogenesis and decreased expression of CEBPA and FABP4 in skeletal muscle cells of IS patients. Therefore, our study suggested that PVMs specific upregulation of ERs could impair myogenesis and increase the expression of adipogenesis related factors, further leading to PVMs abnormalities in IS patients. • Increased myofiber necrosis, fat infiltration and upregulated ERs in the PVMs of IS patients. • Impaired myogenesis, elevated ERs and adipogenesis related factors levels in IS-hSM-MPCs. • Upregulation of ERs inhibited myogenesis but elevated adipogenesis related factors levels in C2C12 myoblasts. • ER antagonist enhanced myogenesis and decreased expression of adipogenesis related factors in the IS-hSM-MPCs. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of CT imaging features of paravertebralmuscles in predicting abnormal bone mass in patients with type 2 diabetes mellitus. Methods: The clinical and QCT data of 149 patients with type 2 diabetes mellitus were collected retrospectively. Patients were randomly divided into the training group (n = 90) and the validation group (n = 49). The radiologic model and Nomogram model were established by multivariate Logistic regression analysis. Predictive performance was evaluated using receiver operating characteristic (ROC) curves. Results: A total of 829 features were extracted from CT images of paravertebral muscles, and 12 optimal predictive features were obtained by the mRMR and Lasso feature selection methods. The radiomics model can better predict bone abnormality in type 2 diabetes mellitus, and the (Area Under Curve) AUC values of the training group and the validation group were 0.94(95% CI, 0.90-0.99) and 0.90(95% CI, 0.82-0.98). The combined Nomogram model, based on radiomics and clinical characteristics (vertebral CT values), showed better predictive efficacy with an AUC values of 0.97(95% CI, 0.94-1.00) in the training group and 0.95(95% CI, 0.90-1.00) in the validation group, compared with the clinical model. Conclusion: The combination of Nomogram model and radiomics-clinical features of paravertebral muscles has a good predictive value for abnormal bone mass in patients with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: This study aimed to reveal the associations of osteoporotic vertebral compression refracture (OVCRF) incidence with sarcopenia and paravertebral muscles (PVM). Methods: A total of 214 elderly patients who underwent percutaneous kyphoplasty in our hospital between January 2017 and December 2019 were analyzed. Data on possible risk factors, including sex, age, weight, height, diabetes, treated vertebral levels (thoracolumbar junction [(T10–L2]), vacuum clefts, and body mass index (BMI), were collected. Preoperative bone mineral density (BMD) and appendicular muscle mass were evaluated using dual-energy X-ray absorptiometry. Nutritional status was evaluated using the Mini Nutritional Assessment. Magnetic resonance imaging was performed to evaluate the physiological cross-sectional area of the PVM. Results: Overall, 74 (15 men and 59 women) and 60 (55 women and 14 men) patients developed OVCRF and sarcopenia, respectively. Sarcopenia is related to advanced age, ower BMD and BMI values. Sarcopenia-related indicators (PVM fat rate, appendicular muscle mass index, grip strength) were significantly lower in the sarcopenia group. Univariate analysis showed a correlation between OVCRF and BMD, BMI, diabetes, sarcopenia, and age. Multivariate analysis suggested that fatty infiltration of the PVM, BMD, sarcopenia, diabetes, BMI, and treated vertebral level remained as the independent predictors of OVCRF (p < 0.05). Conclusions: The association between sarcopenia and PVM as independent risk factors for OVCRF was established in this study; therefore, sarcopenia should be greatly considered in OVCRF prevention. [ABSTRACT FROM AUTHOR]

Purpose: Imaging studies about the relevance of muscles in spinal disorders, and sarcopenia in general, require the segmentation of the muscles in the images which is very labour-intensive if performed manually and poses a practical limit to the number of investigated subjects. This study aimed at developing a deep learning-based tool able to fully automatically perform an accurate segmentation of the lumbar muscles in axial MRI scans, and at validating the new tool on an external dataset.Methods: A set of 60 axial MRI images of the lumbar spine was retrospectively collected from a clinical database. Psoas major, quadratus lumborum, erector spinae, and multifidus were manually segmented in all available slices. The dataset was used to train and validate a deep neural network able to segment muscles automatically. Subsequently, the network was externally validated on images purposely acquired from 22 healthy volunteers.Results: The median Jaccard index for the individual muscles calculated for the 22 subjects of the external validation set ranged between 0.862 and 0.935, demonstrating a generally excellent performance of the network, although occasional failures were noted. Cross-sectional area and fat fraction of the muscles were in agreement with published data.Conclusions: The externally validated deep neural network was able to perform the segmentation of the paravertebral muscles in an accurate and fully automated manner, although it is not without limitations. The model is therefore a suitable research tool to perform large-scale studies in the field of spinal disorders and sarcopenia, overcoming the limitations of non-automated methods. [ABSTRACT FROM AUTHOR]

Epidural electrical stimulation (EES) has been used to improve motor function in patients with chronic spinal cord injury (SCI). The effect of EES on paravertebral muscles in patients with SCI has been unnoticed. We reported a case of paravertebral muscles hypertrophy after the electrode shifted in a patient with spinal cord injury. We also discussed possible mechanistic accounts for this occurs.

Purpose To compare and analyze structural changes in the vascular bed of the spine skin, paravertebral muscles in the zone of surgical intervention (at the apex of the spine deformity), as well as serum concentrations of vascular endothelial growth factors and their receptors in patients with kyphoscoliosis due to neurofibromatosis type I (NF-I). Material and methods The work is based on the results of examining a continuous cohort of patients with NF-I (n = 12). During the examination the concentrations of vascular endothelial growth factors (VEGF, VEGF-А, FGF-basic) and receptors for these factors (VEGF-R2, VEGF-R3) were determined in blood serum using the immunoenzyme analysis. Histological techniques of light and scanning electron microscopy were used for studying the biopsy material of the spine skin and paravertebral muscles obtained in the projection of the spine deformity apex during surgical correction of kyphoscoliosis. Results Concentration of VEGF and VEGF-A was 8 % (р = 0.00908) and 417 % (р = 0.00392) higher than reference values, respectively. VEGF-R2 receptor was 215 % (р = 0.00622) and exceeded the level of reference values. On the contrary, VEGF-R3 receptor concentration was 58.1 % (р = 0.00415), lower than the relative reference values. FGF-basic growth factor in blood serum was within control values (р = 0.05613). Changes in the histostructure of the vascular walls of large- and medium-size arteries and veins, fibrosis and obliteration of some vessel lumens, hyperemia of venous and capillary microvessels, formation of inflammatory infiltrates in adventitia of large- and medium-size vessels and in perivascular spaces, hemorrhages were revealed in bioptates of the spine skin. Pathological changes in muscles manifested themselves as fibrosis and constriction (up to complete obliteration) of the lumens of arterial vessels, increase in the diameter of thin-walled venous vessels, increase in their permeability leading to widespread extensive hemorrhages. Conclusion Increased concentration of vascular endothelial growth factors and their imbalance with receptors in patients with NF-I are combined with pathohistological structural changes in the vascular system of the spine skin and paravertebral muscles due to the inflammatory process present. The obtained results should be taken into account both in surgical treatment of this complex disease manifestations, and when planning treatment and rehabilitation measures in general

Background and Objective: Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine are fundamental non-invasive tools to investigate the status of the bone and soft tissue in vivo. A novel and promising approach is to investigate the quality and quantity of paraspinal muscles even beyond the clinical question. The aim of the present review is to summarize current evidence on CT and MRI about the relationship between paraspinal muscular status and bone health in osteoporosis (OP) and fracture risk., Methods: Literature research was carried out on September 2023 using PubMed, Scopus, and Cochrane databases., Key Content and Findings: Research investigating the intricate interplay between musculature and bone health reveals that degenerating paraspinal muscles, characterized by shrinking and fatty infiltration, are associated with lower bone mineral density (BMD) and the development of OP. Additionally, research indicates that weaker paraspinal muscles are linked to a higher risk of fractures, including those at the spine., Conclusions: The findings suggest that paraspinal muscle health may be a significant factor in identifying individuals at risk for OP and fractures. Further investigation is needed to explore the potential of paraspinal muscles in preventing these conditions., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1770/coif). C.A.M. serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The other authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Aim: The aim of this study was to evaluate age-related changes in lumbar paravertebral muscle (LPM) morphology in healthy younger and older adult men.Methods: T2-weighted axial MRI of the lumbar spine were obtained for 12 healthy older (67.3 ± 6.0 years) and younger (24.7 ± 3.1 years) men. Normalised muscle volume (NMV) and muscle fat infiltrate (MFI) were determined bilaterally for the psoas (PS), quadratus lumborum (QL), erector spinae (ES) and multifidus (MF). MANOVA was used to compare NMV and MFI between age groups. Follow-up ANOVA compared NMV and MFI for each muscle between age groups, with physical activity (PA) as a covariate. Stepwise regression was used to explore the association between muscle morphology.Results: NMV of the ES and QL were significantly lower in the older group (OG) (p = 0.040 and p < 0.001, respectively). MFI across all muscles was significantly greater in the OG (p < 0.001). PA did not moderate the relationship between aging and muscle degeneration. Non-dominant handgrip strength was associated with NMV (p = 0.003).Conclusions: Age-related atrophy is muscle specific in the lumbar spine; changes in lumbar musculature is independent of PA, handgrip strength may reflect morphological changes in the postural muscles with age. This study supports establishing effective targeted exercise interventions in the lumbar musculature. [ABSTRACT FROM AUTHOR]

Abstract Background It has been suggested that the quantification of paravertebral muscle composition and morphology (e.g. size/shape/structure) with magnetic resonance imaging (MRI) has diagnostic, prognostic, and therapeutic potential in contributing to overall musculoskeletal health. If this is to be realised, then consensus towards standardised MRI methods for measuring muscular size/shape/structure are crucial to allow the translation of such measurements towards management of, and hopefully improved health for, those with some musculoskeletal conditions. Following on from an original paper detailing methods for measuring muscles traversing the lumbar spine, we propose new methods based on anatomical cross-reference that strive towards standardising MRI-based quantification of anterior and posterior cervical spine muscle composition. Methods In this descriptive technical advance paper we expand our methods from the lumbar spine by providing a detailed examination of regional cervical spine muscle morphology, followed by a comprehensive description of the proposed technique defining muscle ROI from axial MRI. Cross-referencing cervical musculature and vertebral anatomy includes an innovative comparison between axial E12 sheet-plastinates derived from cadaveric material to a series of axial MRIs detailing commonly used sequences. These images are shown at different cervical levels to illustrate differences in regional morphology. The method for defining ROI for both anterior (scalenes group, sternocleidomastoid, longus colli, longus capitis) and posterior (multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis) cervical muscles is then described and discussed in relation to existing literature. Results A series of steps towards standardising the quantification of cervical spine muscle quality are described, with concentration on the measurement of muscle volume and fatty infiltration (MFI). We offer recommendations for imaging parameters that should additionally inform a priori decisions when planning investigations of cervical muscle tissues with MRI. Conclusions The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. We intend to stimulate discussion towards establishing measurement consensus whereby data-pooling and meaningful comparisons between imaging studies (primarily MRI) investigating cervical muscle quality becomes available and the norm.

Objective. Evaluation of skin sensitivity and analysis of morphological changes in paravertebral muscles and back skin in kyphoscoliotic deformity projection in patients with type 1 neurofibromatosis (NF-1).Materials and methods. Ten NF-1 patients who underwent surgery to treat kyphoscoliosis were examined. Using an electrical esthesiometer thermal pain sensitivity before the surgery was studied in dermatomes corresponding to the apex of the deformity. Skin and muscle biopsy samples were collected intraoperatively in the projection of the apex of the deformity curve and were subsequently analyzed by light and scanning electron microscopy.Results. Patients with kyphoscoliosis with underlying NF-1 were characterized by abnormal thermal pain sensitivity, pathological structural changes in skin and muscles accompanied by disrupted innervation and blood supply.Discussion. The observed changes may be responsible for lowered postoperative reparative potential of tissues and they must be considered in prevention and prognosis of treatment and rehabilitation efficacy.

Aims: Symptoms of jaw dysfunction are often associated with neck muscle dysfunction or other musculoskeletal problems. This study attempted so quantify she effect of jaw clenching on the electromyographic (EMG) activity of certain neck, trunk, and jaw muscles. Methods: The authors recorded EMG muscle activity in the sternocleidomastoid, trapezius, paravertebral, and rectus abdominis muscles in 10 university students at rest and during strong jaw clenching in supine and sitting positions. Results: In both positions, jaw clenching resulted in increases in neck muscle activity ranging from 7.6 to 33 times resting muscle activity; for the trunk muscles, the increases ranged from 1.4 to 3.3 times resting activity. Conclusion: These results add further information to the concept of she interrelatedness of jaw, neck. and trunk muscle activity. [ABSTRACT FROM AUTHOR]

It is proved that the paravertebral muscles play an important role in the recovery of patients with degenerative diseases of the lumbar spine after treatment. Objective: to create an algorithm for predicting the results of surgical treatment of patients with degenerative diseases of the lumbar spine based on an assessment of the state of the paravertebral muscles before surgery. Methods: 74 patients were examined. They had surgeries because of instability of moving vertebral segments (15 patients), hernias of intervertebral disks (25), spondylolisthesis (15), spinal canal stenosis (19). Pain syndrome was assessed using VAS, quality of life was assessed with Oswestry index. Patients underwent transpedicular fixation on one or two levels LIII, LIV, LV, SI. A CT examination was made and the content of adipose, muscular and connective tissues in the paravertebral muscles of lumbar spine was determined using an original high accuracy computer software. Results: before the treatment 13 (17.6%) patients had serious disabilities, 30 (40.5%) were disabled, and 31 (41.9%) were clinging to the bed. Minor disabilities were observed in 24 patients (32.4%), moderate — in 37 patients (50.0%), serious and incapacitating ones remained in 13 patients (17.6%) after the surgery. The importance of the signs for predicting treatment outcomes was evaluated with a 100-point scale. The most significant of these is the total fat content in the paravertebral muscles and connective tissue in m. erector spinae. It is followed by the content of muscle tissue in m. quadratus lumborum and connective tissue in m. multifidus. Conclusions: the correlation between the results of the surgical treatment of patients with degenerative diseases of the lumbar spine and the state of the paravertebral muscles has been proved. The main influencing factor is the content of adipose tissue in muscles: the higher it is, the worse is the result. The accuracy of the proposed algorithm is 89.19%. [ABSTRACT FROM AUTHOR]

Degenerative lumbar spinal stenosis (DLSS) is a condition in which the body is held in a poor posture for a long period of time, resulting in a change in the stress structure of the lumbar spine that causes degenerative changes in the muscles of the spine. The sagittal balance of the spine and pelvis and the degeneration of the paravertebral muscles have been the focus of recent research. To explore the relationship between paraspinal muscle degeneration and changes in spine-pelvic sagittal parameters in patients with DLSS, 95 patients with DLSS (experimental group) and 70 healthy volunteers (control group) hospitalized in the Ordos Central Hospital between January 2020 and January 2022 were included as study subjects. All patients underwent lumbar magnetic resonance imaging and spinal X-ray using uniform criteria. The correlation between paravertebral muscle parameters and sagittal-pelvic sagittal parameters in patients with DLSS was obtained from two imaging examinations, and the data were organized and grouped in order to explore the correlation between these parameters. There was no significant difference in the general data between the two groups (P>0.05). In the L4-5 DLSS patient group, the ratio of fat infiltration in the right erector spinae (ES) muscle was negatively correlated with thoracic kyphosis (TK) (r=-0.536; P<0.05) but not significantly in the left side. The relative cross-sectional area of the left multifidus muscle (MF RCSA) was positively correlated with TK (r=0.685; r=0.615; P<0.05) but not significantly in the right side. In the L5-S1DLSS patient group, the right MF RCSA and right ES RCSA were significantly positively correlated with TK (r=0.685; r=0.615; P<0.05) but not significant in the left side. Thus, paravertebral muscle parameters were correlated with spinal-pelvic sagittal parameters in patients with DLSS. [ABSTRACT FROM AUTHOR]

Objective The study tested whether combining repetitive peripheral magnetic stimulation (RPMS) and motor training of the superficial multifidus muscle (MF) better improved the corticomotor control of spine than training alone in chronic low back pain (CLBP). Methods Twenty-one participants with CLBP were randomly allocated to [RPMS + training] and [Sham + training] groups for three sessions (S1–S3) over a week where MF was stimulated before training (volitional contraction). Training was also home-practiced twice a day. Changes were tested at S1 and S3 for anticipatory postural adjustments (APAs) of MF and semi-tendinosus (ST), MF EMG activation, cortical motor plasticity (transcranial magnetic stimulation) and pain/disability. Results The RPMS group showed immediate decrease of pain at S1, then improvement of MF activation, ST APA, M1 facilitation, and pain/disability at S3. Changes were larger when brain excitability was lower at baseline. Disability index remained improved one month later. Conclusions Combining RPMS with training of MF in CLBP impacted motor planning, MF and lumbopelvic spine motor control and pain/disability one week after the onset of protocol. Brain plasticity might have favoured motor learning and improved daily lumbopelvic spine control without pain generation. Significance Clinically, RPMS impacted the function by improving the gains beyond those reached by training alone in CLBP. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in paravertebral muscle composition as a potential prognostic and diagnostic element in lumbar spine health. As a consequence, it is becoming popular to use magnetic resonance imaging (MRI) to examine muscle volume and fatty infiltration in lumbar paravertebral muscles to assess both age-related change and their clinical relevance in low back pain (LBP). A variety of imaging methods exist for both measuring key variables (fat, muscle) and for defining regions of interest, making pooled comparisons between studies difficult and rendering post-production analysis of MRIs confusing. We therefore propose and define a method as an option for use as a standardized MRI procedure for measuring lumbar paravertebral muscle composition, and to stimulate discussion towards establishing consensus for the analysis of skeletal muscle composition amongst clinician researchers.Method: In this descriptive methodological study we explain our method by providing an examination of regional lumbar morphology, followed by a detailed description of the proposed technique. Identification of paravertebral muscles and vertebral anatomy includes axial E12 sheet-plastinates from cadaveric material, combined with a series of axial MRIs that encompass sequencing commonly used for investigations of muscle quality (fat-water DIXON, T1-, and T2-weighted) to illustrate regional morphology; these images are shown for L1 and L4 levels to highlight differences in regional morphology. The method for defining regions of interest (ROI) for multifidus (MF), and erector spinae (ES) is then described.Results: Our method for defining ROIs for lumbar paravertebral muscles on axial MRIs is outlined and discussed in relation to existing literature. The method provides a foundation for standardising the quantification of muscle quality that particularly centres on examining fatty infiltration and composition. We provide recommendations relating to imaging parameters that should additionally inform a priori decisions when planning studies examining lumbar muscle tissues with MRI.Conclusions: We intend this method to provide a platform towards developing and delivering meaningful comparisons between MRI data on lumbar paravertebral muscle quality. [ABSTRACT FROM AUTHOR]

Background Context: An overload of the paravertebral muscles after surgical intervention is suggested to be the major cause of postoperative pain. In cross-sectional area analyses, increased atrophy of the multifidus muscle (MF) after conventional open versus minimally invasive posterior lumbar interbody fusion (PLIF) has been described. The three-dimensional characteristics of the paravertebral muscles and separate evaluation of the longissimus muscle (LS) have not been addressed in analyses thus far.Purpose: The purpose of the present study was to compare the MF and LS volume atrophy and fatty degeneration between single-level minimally invasive transforaminal lumbar interbody fusion (miTLIF) and conventional midline approach-based PLIF (coPLIF) of L4/L5 or L5/S1 at the index and superior adjacent segments.Design: This was a prospective, randomized, controlled, non-blinded study.Patient Sample: Fifty patients with single-level segment degeneration (Pfirrmann ≥III and Modic ≥3) of L4/L5 or L5/S1 not requiring decompression were randomly assigned to two groups.Outcome Measures: Paraspinal lumbar residual muscle tissue volume, change in the relative fat content of MF and LS at the index and superior adjacent segments, and clinical parameters, including a visual analogue scale (VAS) for low back pain and the Oswestry Disability Questionnaire (ODI) were the outcome measures in this study.Methods: Twenty-five patients were treated with miTLIF, and the remaining patients were treated with coPLIF (both with transpedicular fixation). Clinical scoring was performed preoperatively and at 1 week and 12 months postoperatively, and computed tomography was performed at the latter two follow-ups.Results: The LS damage at the index segment was similar in both groups (3% greater fat content increase in the coPLIF vs. the miTLIF group, p=.032), whereas MF atrophy and degeneration were increased (p<.001) in the coPLIF group. At the adjacent segment, muscle atrophy and increased fatty infiltration (p<.05) were minimal in both muscles but were similar in both groups. Visual analogue scale and ODI scores improved (p<.001), without differences between the groups.Conclusions: The muscle damage after miTLIF was inferior to that after coPLIF; spatially, however, the muscle sparing was predominantly attributed to the MF and, surprisingly, not to the LS. [ABSTRACT FROM AUTHOR]

Background Context: Various factors are reported to affect the spinal alignment in degenerative lumbar scoliosis (DLS). Although trunk muscles also appear to affect spinal alignment, the role of the trunk muscles is not yet clear.Purpose: The aim was to elucidate the role of the multifidus (MF) and psoas (PS) in maintaining global spinal alignment in patients with DLS.Study Design: This was a multicenter retrospective matched cohort study.Patient Sample: Surgically treated 60 paired DLS and lumbar spinal stenosis (LSS) female (120 patients), matched for age and body mass index (BMI; DLS age 68.0±6.8 vs. LSS 67.1±8.9 years; BMI 21.6±3.3 vs. 23.2±3.8 kg/m(2)), were included and were followed for at least 2 years.Outcome Measures: Spinal alignment, muscle area, and volume were measured from radiographs, magnetic resonance images (MRIs), and whole-body dual-energy X-ray absorptiometry (DXA) scans. Muscle strength was measured by grip power and peak expiratory flow (PEF).Methods: As a surrogate of muscle area, we obtained the cross-sectional area (CSA) at the L5-S level from preoperative MRIs.Results: The MF and PS CSAs were significantly smaller in the DLS group than in the LSS group (MF 477.7±192.5 vs. 779.8±248.6 mm(2), p<.01; PS 692.3±201.2 vs. 943.4±272.4 mm(2), p=.002), whereas percentage of difference between the right and left sides was significantly larger in the DLS group (MF 18.4±30.6 vs. 2.4±3.3%, p<.01; PS 14.4±15.8 vs. 2.1±2.2%, p<.01). In the extremities, there were no significant differences in the left- or right-side lean composition and grip strength or PEF tests between the groups. Correlation coefficient tests showed moderate correlations between the MF average CSA (avCSA) and global spinal alignment and spinopelvic alignment (pelvic incidence-lumbar lordosis; R=-0.37, -0.38) in the DLS group. The MF avCSA was correlated with the postoperative progression of kyphosis at the unfused thoracic vertebrae in the DLS group (R=0.34).Conclusions: The CSAs of the MF and PS were significantly smaller in the DLS group. Whole-body DXA showed no significant difference in the lean composition between the groups. There were significant correlations in the DLS patients between the MF CSA and sagittal spinal alignment. These findings suggest the causal relationship between muscles and global spine alignment. [ABSTRACT FROM AUTHOR]

The patient was a 64-year-old man who presented with gait disturbance at the age of 58. He was later diagnosed with Parkinson’s disease. At the age of 64, he felt severe right abdominal pain because his right abdomen was compressed by his abnormal posture. Neurological examinations showed axial flexion to the anterior and right sides, i.e. a combination of camptocormia and Pisa syndrome, and hypertrophy of the right lumbar paraspinal muscles in addition to parkinsonism. Surface electromyography and body computed tomography suggested axial dystonia, i.e. right dominant hyperactivity and hypertrophy of the lumbar paraspinal muscles. Botulinum toxin was injected into the right lumbar paraspinal muscles. One month later, his abnormal posture improved and his right abdominal pain was also relieved. In general, botulinum toxin treatment of the paraspinal muscles has the potential to improve Pisa syndrome but carries the risk of worsening camptocormia. However, in our case, not only Pisa syndrome but also camptocormia improved. Therefore, we should note that botulinum toxin treatment of paraspinal muscles is able to improve not only Pisa syndrome but also camptocormia. As a plausible explanation, botulinum toxin treatment could control the hyperactivity of the bilateral paraspinal muscles symmetrically, which might improve camptocormia in addition to Pisa syndrome. [ABSTRACT FROM AUTHOR]