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
Beyond the pars defect: multifidus degeneration as an independent predictor of vertebral slippage severity in isthmic lumbar L5 spondylolisthesis.
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. Not yet cited in PubMed.
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Abstract
introductionIsthmic lumbar spondylolisthesis (ILS) results from a defect of the pars interarticularis, leading to anterior vertebral displacement. We hypothesize that paraspinal muscle atrophy contributes to the degree of vertebral slippage in symptomatic ILS.
methodsThis retrospective cross-sectional study included 78 patients (46 females, 32 males). Fat infiltration (FI) and height-adjusted functional cross-sectional area (HI) of the multifidus (MF), erector spinae (ES), and psoas (PS) muscles were quantified applying the Otsu thresholding method. Multivariable linear regression was used to analysis the association between the paraspinal musculature and vertebral slippage. Confounding variables such as sex, age, body mass index (BMI), disc (Pfirrmann classification) and facet joints degeneration (Weishaupt classification) were included.
resultsThe median age was 48.5 (interquartile range [IQR]: 31.5–55) years, median BMI was 26.4 (IQR: 22.8–29.4) kg/m², and the median translation was 33 (IQR: 24–47) %. After adjustment for demographic confounders and degeneration, the MF atrophy showed significant association with vertebral slippage (FI: η² = 0.164, p < 0.001; HI: η² = 0.052, p = 0.028). In contrast, no significant associations were observed for the ES (FI: η² = 0.012, p = 0.315; HI: η² = 0.000, p = 0.936) or PS (FI: η² = 0.001, p = 0.742; HI: η² = 0.000, p = 0.979) muscles.
conclusionThe degree of vertebral slippage in isthmic lumbar spondylolisthesis was specifically associated with multifidus atrophy, while other paraspinal muscles showed no such relationship. These results support the distinct biomechanical role of the multifidus in segmental stability.
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