E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Comparative Evaluation of Paraspinal Muscle Volume and Fatty Infiltration Using Semiautomated Image Processing-Assisted Analysis in Patients with Migrated Lumbar Disc Herniation
MERT SAHİNOGLU✉ ,
ÖMER FARUK KENİŞ ,
DERYA KARAOGLU GUNDOGDU ,
BURAK GEZER ,
İBRAHİM AKKÖSE ,
BEHCHAT ALAKBAROV ,
Murat Ertaş ,
ENDER KOKTEKIR
Neurosurgery, Selcuk University School of Medicine
Accepted: 01/10/2026
Article in Press
Corresponding Author:
MERT SAHİNOGLU (msahinoglu09@gmail.com)
Abstract
Aim
This study compared quantitative measurements of psoas, multifidus (MF), and erector spinae (ES) muscle volume and fatty infiltration (FI) obtained using semiautomated image processing-assisted analysis (SAIPA) between patients with migrated lumbar disc herniation (LDH) successfully treated conservatively and those subsequently requiring surgery
Material and Methods
A total of 150 patients were classified into Group 1 (successful conservative treatment, n = 75) and Group 2 (failed conservative treatment followed by discectomy, n = 75). MF, ES, and psoas muscle volumes and FI were quantitatively evaluated on axial T2-weighted magnetic resonance images using a custom-designed SAIPA. MF and ES FI was categorized as low (≤10%), intermediate (>10%–50%), or high (>50%).
Results
Compared with Group 1, Group 2 had significantly lower multifidus, erector spinae, and total muscle volumes. Psoas volume was higher in Group 2, whereas psoas fatty Group 2 had significantly lower MF, ES, and total muscle volumes than Group 1. Psoas muscle volume was significantly greater in Group 2, whereas psoas FI did not differ significantly. MF and ES FI was significantly greater in Group 2, with high FI (>50%) observed exclusively in Group 2 (MF, 36.0%; ES, 33.3%; both p < 0.001). Physical activity, pretreatment and posttreatment visual analog scale (VAS) scores, and Oswestry Disability Index (ODI) scores also differed significantly between groups. Age, smoking status, body mass index (BMI), comorbidity burden, and LDH level did not differ significantly. Although sex distribution differed significantly, muscle volume differences remained significant in sex-stratified and multivariable analyses.
Conclusion
SAIPA enabled quantitative assessment of lumbar muscle volume and FI. Compared with the conservatively treated group, the surgical group had lower MF and ES muscle volumes, greater FI of these muscles, and greater psoas muscle volume, whereas psoas FI was comparable. These cross-sectional associations cannot establish causality, and their clinical utility requires prospective validation.
This study compared quantitative measurements of psoas, multifidus (MF), and erector spinae (ES) muscle volume and fatty infiltration (FI) obtained using semiautomated image processing-assisted analysis (SAIPA) between patients with migrated lumbar disc herniation (LDH) successfully treated conservatively and those subsequently requiring surgery
Material and Methods
A total of 150 patients were classified into Group 1 (successful conservative treatment, n = 75) and Group 2 (failed conservative treatment followed by discectomy, n = 75). MF, ES, and psoas muscle volumes and FI were quantitatively evaluated on axial T2-weighted magnetic resonance images using a custom-designed SAIPA. MF and ES FI was categorized as low (≤10%), intermediate (>10%–50%), or high (>50%).
Results
Compared with Group 1, Group 2 had significantly lower multifidus, erector spinae, and total muscle volumes. Psoas volume was higher in Group 2, whereas psoas fatty Group 2 had significantly lower MF, ES, and total muscle volumes than Group 1. Psoas muscle volume was significantly greater in Group 2, whereas psoas FI did not differ significantly. MF and ES FI was significantly greater in Group 2, with high FI (>50%) observed exclusively in Group 2 (MF, 36.0%; ES, 33.3%; both p < 0.001). Physical activity, pretreatment and posttreatment visual analog scale (VAS) scores, and Oswestry Disability Index (ODI) scores also differed significantly between groups. Age, smoking status, body mass index (BMI), comorbidity burden, and LDH level did not differ significantly. Although sex distribution differed significantly, muscle volume differences remained significant in sex-stratified and multivariable analyses.
Conclusion
SAIPA enabled quantitative assessment of lumbar muscle volume and FI. Compared with the conservatively treated group, the surgical group had lower MF and ES muscle volumes, greater FI of these muscles, and greater psoas muscle volume, whereas psoas FI was comparable. These cross-sectional associations cannot establish causality, and their clinical utility requires prospective validation.
Keywords
Lumbar Disc Herniation
Paraspinal Muscles
Fatty Infiltration