SynthesisBMC musculoskeletal disorders2025
Association of paraspinal muscle morphology or composition with sagittal spinopelvic alignment: a systematic review and meta-analysis.
Synthesis in BMC musculoskeletal disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- BMI as an Independent Determinant of Spinal Alignment in Degenerative Scoliosis.Diagnostics (Basel, Switzerland) · 2026Article
- The impact of sarcopenia on proximal junctional kyphosis following long-segment spinal fusion for adult spinal deformity: a propensity score-matched cohort study.Journal of spine surgery (Hong Kong) · 2026Article
- Machine learning outperforms anthropometric scaling in predicting muscle parameters and spinal loading: a subject-specific musculoskeletal modeling study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Association of paraspinal and psoas muscle morphology with recurrent lumbar disc herniation: a retrospective case-control study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Lumbar paraspinal muscle quality and disability in older adults: insights from the SarcoSpine cohort.BMC geriatrics · 2026Observational
- Development and validation of a CT-based predictive model for new vertebral compression fractures: the role of vertebral CT attenuation and paraspinal muscle.Frontiers in medicine · 2026Article
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5 authors.
Funding
Abstract
purposeThe aim of this study was to evaluate the association of paraspinal muscle morphology and composition with sagittal spinopelvic alignment (SSA).
methodsThis review was registered at PROSPERO (CRD42022371879). Four databases including PubMed, Embase, Cochrane, and Web of Science were searched from their inception until December 15, 2024. The scope of paraspinal muscles included multifidus (MF), erector spinae (ES), psoas major (PM), and paraspinal extensor muscles (PEM; combined multifidus and erector spinae). The cross-sectional area (CSA) and fat signal fraction (FSF) were the metrics for quantifying paraspinal muscle morphology and composition, respectively. The outcomes of interest were SSA parameters, including C7-S1 sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and PI minus LL mismatch (PI - LL). The methodological quality and risk of bias of each included studies was assessed using the Newcastle-Ottawa Scale and its adapted form. Correlation coefficients extracted from included studies were transformed to a Fisher's z correlational coefficient to perform a meta-analysis and to generate a pooled effect size (z) and 95% confidence intervals (CIs).
resultsSixteen observational studies with 1535 participants were included in the meta-analysis. We found a positive association of paraspinal muscle CSA with TK (MFCSA, z = 0.17, 95% CI: 0.01 to 0.32, p = 0.041; PEMCSA, z = 0.17, 95% CI: 0.06 to 0.28, p = 0.002) and LL (PMCSA, z = 0.12, 95% CI: 0.02 to 0.22, p = 0.019), whereas a negative correlation with SVA (MFCSA, z = - 0.35, 95% CI: -0.67 to - 0.02, p = 0.036; PEMCSA, z = - 0.25, 95% CI: -0.45 to - 0.05, p = 0.015), PT (PMCSA, z = - 0.22, 95% CI: -0.39 to - 0.05, p = 0.012), PI (PMCSA, z = - 0.13, 95% CI: -0.23 to - 0.02, p = 0.020), and PI-LL (MFCSA, z = - 0.50, 95% CI: -0.69 to - 0.30, p < 0.00001; PMCSA, z = - 0.20, 95% CI: -0.34 to - 0.05, p = 0.007; PEMCSA, z = - 0.28, 95% CI: -0.38 to - 0.18, p < 0.00001). Meanwhile, paraspinal muscle FSF showed a positive correlation with SVA (PEMFSF, z = 0.39, 95% CI: 0.30 to 0.47, p < 0.00001), PT (PEMFSF, z = 0.45, 95% CI: 0.35 to 0.54, p < 0.00001), and PI-LL (PEMFSF, z = 0.29, 95% CI: 0.17 to 0.41, p < 0.00001), while a negative correlation with PI (PMFSF, z = - 0.14, 95% CI: -0.27 to - 0.01, p = 0.029) and SS (PEMFSF, z = - 0.25, 95% CI: -0.41 to - 0.08, p = 0.004). We also observed the associations were stronger in populations without degenerative spinal diseases, in studies that used computed tomography for paraspinal muscle morphology and composition assessment, and in studies with moderate study quality. Of the 15 significant associations reported here, only 3 were supported by moderate to high-level evidence, while others were supported by very low to low evidence certainty.
conclusionParaspinal muscle morphology and composition were associated with SSA. Further studies are warranted to establish causality and to elucidate the underlying mechanisms.
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