Evidence map›Paper›PMID 41128872›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Fatty infiltration of paraspinal muscles and its association with sagittal spinal malalignment in the general population.

Keiji Nagata, Hiroshi Hashizume, Yoshiki Asai, Hiroyuki Oka, Shigeyuki Muraki, Masatoshi Teraguchi, Hiroki Iwahashi, Takahide Sasaki, Kanae Mure, Toshiko Iidaka and 4 more

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In one paragraph

Article in 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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Keiji NagataWakayama Medical University, Wakayama City, Japan. gensan@wakayama-med.ac.jp.
Hiroshi HashizumeWakayama Medical University, Wakayama City, Japan.
Yoshiki AsaiWakayama Medical University, Wakayama City, Japan.
Hiroyuki OkaThe University of Tokyo, Tokyo, Japan.
Shigeyuki MurakiThe University of Tokyo, Tokyo, Japan.
Masatoshi TeraguchiWakayama Medical University, Wakayama City, Japan.
Hiroki IwahashiWakayama Medical University, Wakayama City, Japan.
Takahide SasakiWakayama Medical University, Wakayama City, Japan.
Kanae MureWakayama Medical University, Wakayama City, Japan.
Toshiko IidakaThe University of Tokyo, Tokyo, Japan.
Munehito YoshidaSumiya Orthopaedic Hospital, Wakayama City, Japan.
Sakae TanakaThe University of Tokyo, Tokyo, Japan.
Noriko YoshimuraThe University of Tokyo, Tokyo, Japan.
Hiroshi YamadaWakayama Medical University, Wakayama City, Japan.

Funding

Japan Society for the Promotion of Science JP17K16699 (Takahide Sasaki), JP26861286 (Masatoshi Teraguchi), JP15K20013 (Hiroki Iwahashi), JP201417014A, JP26293139, JP23390172, JP15K15219 (Noriko Yoshimura), JP2629333, JP20591774, JP26670307 (Shigeyuki Muraki), JP24659666 (Hiroyuki Oka), JP26462249, JP21K09306 (Hiroshi Hashizume), JP16K10834, JP25462305 (Hiroshi Yamada), and JP21K18291 (Kanae Mure).Japan Society for the Promotion of Science JP18K17391 and JP21K10475MEXT KAKENHI JP08033011-00262 (Noriko Yoshimura)the Japanese Orthopedics and Traumatology Foundation No. 287the Ministry of Health, Labour and Welfare JPMH21FA0601 (Hiroshi Yamada)
6 · The paper itself

Abstract

introductionAge-related spinal sagittal malalignment is commonly attributed to factors such as disc degeneration, osteoporotic vertebral fractures, and paraspinal muscle degeneration. These factors often coexist, making it challenging to discern their relative contributions to spinal malalignment in the elderly population. Understanding these contributions is crucial for both prevention and treatment strategies for spinal deformities in aging individuals.

methodsA cross-sectional analysis was conducted within the second survey of the Wakayama Spine Study (2012-2013). A total of 952 participants were recruited, and 794 (239 men, 555 women; mean age, 63.5 ± 13.1 years) were eligible for magnetic resonance imaging (MRI) and standing radiographic evaluation of spinal alignment. Primary outcome measures included the C7 sagittal vertical axis (SVA), pelvic incidence (PI), and pelvic tilt (PT) from standing lateral radiographs. Secondary outcomes included MRI-based assessments of disc degeneration using the Pfirrmann classification, vertebral fractures via the semi-quantitative (SQ) method, and paraspinal muscle fatty infiltration ratio at the L1/L2 level. Spinal sagittal malalignment was defined as C7 SVA ≥ 50 mm. Statistical analyses, including logistic regression, were performed to identify significant factors associated with spinal malalignment.

resultsSpinal sagittal malalignment was observed in 98 participants (12%), with 53 (55%) reporting low back pain in the past month. Significant factors associated with sagittal malalignment included age ≥ 70 years (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.33-4.69), PT ≥ 18.7° (OR, 3.12; 95% CI, 1.77-5.63), vertebral fracture (morphometric fracture index ≥ 4; OR, 2.01; 95% CI, 1.15-3.51), and paraspinal muscle fatty infiltration ratio ≥ 10.6% (OR, 4.98; 95% CI, 2.74-9.27).

conclusionParaspinal muscle fatty infiltration was the most significant factor associated with spinal malalignment in the general population. Among the identified risk factors, paraspinal muscle degeneration is potentially reversible, underscoring its importance in postural correction strategies and surgical planning. These findings suggest that interventions targeting muscle quality may be crucial in managing spinal malalignment in elderly individuals.

Indexed as

Adipose TissueParaspinal MusclesSpinal CurvaturesAgedAged, 80 and overCross-Sectional StudiesFemaleHumansIntervertebral Disc DegenerationMagnetic Resonance ImagingMaleMiddle AgedSpinal FracturesAdult spine deformityROAD studySpinal sagittal malalignmentWakayama spine study

Identifiers

PMID41128872

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.