Characteristics of paraspinal muscle fat infiltration in asymptomatic Chinese adults: a cross-sectional study

BACKGROUND: Paraspinal muscle fat infiltration is closely related to the occurrence and development of lumbar spine disorders and postoperative complications. This study aimed to explore the effects of age, sex, muscle, and level on paraspinal muscle fat infiltration among Chinese adults to identify the best single level of assessing whole-level paraspinal muscle fat infiltration and to define the standardized identification thresholds for paraspinal muscle fat infiltration by means of magnetic resonance imaging. METHODS: This was a single-center, cross-sectional study conducted on 336 asymptomatic Chinese volunteers aged 20 to 69 years recruited from Beijing and surrounding communities through designed advertisements from May 2022 to October 2022. The fat signal fraction of multifidus (FSF(MF)), erector spinae (FSF(ES)), psoas major (FSF(PM)), and the sum of multifidus, erector spinae, and psoas major (FSF(Total)) at lumbar levels L1–L5 were measured with magnetic resonance imaging. The Student t-test and Mann-Whitney test were performed, and Pearson correlations and intraclass correlation coefficients were determined. Subgroups were compared using analysis of variance followed by a post hoc Bonferroni test or Kruskal-Wallis test. RESULTS: FSF(Total) (14.02%±4.71% vs. 10.34±4.08%; P<0.001), FSF(MF) (21.14%±6.77% vs. 16.21%±6.26%; P<0.001), and FSF(ES) (15.97%±5.56% vs. 12.37%±4.80%; P<0.001) were higher in females than in males and increased with age and lumbar level, whereas FSF(PM) did not significantly differ by age (all P values >0.05) or sex (P=0.12) and showed a decreasing trend from L1 to L5. The FSF(Total) at L4 showed both the strongest correlation (Pearson correlation coefficient =0.95; P<0.001) and agreement (intraclass correlation coefficient =0.92; P<0.001) with the whole-level FSF(Total). Pathological paraspinal muscle fat infiltration identification thresholds of FSF(Total), FSF(MF), FSF(ES), and FSF(PM) were 10.0–33.9%, 19.2–47.4%, 16.2–43.6%, and 4.8%, respectively, in each age (range, 20–69 years) and sex group. CONCLUSIONS: In asymptomatic Chinese adults, paraspinal muscle fat infiltration can be influenced by age, sex, muscle type, and location. The L4 level can serve as an optimal substitution in whole-level fat infiltration measurement. We present the first data concerning the identification thresholds of pathological paraspinal muscle fat infiltration, which will provide a valuable resource for researchers in the field.