Papers by Israel Hershkovitz
Background: The condition of paraspinal muscles is known to be associated with some variables suc... more Background: The condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain. It is generally agreed that these muscles play an important role in the stability and functional movements of the lumbar vertebral column. Although spinal instability has been shown to play an essential role in degenerative lumbar spinal stenosis (DLSS), the role of paraspinal muscles remains elusive. The main purpose of this study was to shed light on the relationship between the condition of paraspinal muscles and symptomatic DLSS.
Methods: Two sample populations were studied. The first included 165 individuals with DLSS (age range: 40–88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40–99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2 circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS.
Results: Individuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS.
Conclusions: Our results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.
Keywords: Degenerative lumbar spinal stenosis, Paraspinal muscles density, Muscle cross-sectional area size,
Computerized tomography (CT)
Analysis of ca. 17,000 fish remains recovered from the late Upper Paleolithic/early Epi-Paleolith... more Analysis of ca. 17,000 fish remains recovered from the late Upper Paleolithic/early Epi-Paleolithic (LGM; 23,000 BP) waterlogged site of Ohalo II (Rift Valley, Israel) provides new insights into the role of wetland habitats and the fish inhabiting them during the evolution of economic strategies prior to the agricultural evolution. Of the current 19 native fish species in Lake Kinneret (Sea of Galilee), eight species were identified at Ohalo II, belonging to two freshwater families: Cyprinidae (carps) and Cichlidae (St. Peter fish). Employing a large set of quantitative and qualitative criteria (NISP, species richness, diversity, skeletal element representation, fragmentation, color, spatial distribution, etc.), we demonstrate that the inhabitants of Ohalo II used their knowledge of the breeding behavior of different species of fish, for year-round intensive exploitation.
Early Ahmarian, Levantine Aurignacian and Post-Levantine Aurignacian archeological assemblages sh... more Early Ahmarian, Levantine Aurignacian and Post-Levantine Aurignacian archeological assemblages show that the karstic Manot Cave, located 5 km east of the Mediterranean coast in the Western Galilee region of Israel, was intensively occupied during the Early Upper Paleolithic. The coexistence of these rich archaeological layers with speleothems in Manot Cave provides a window of opportunity for determining the relationships between climatic conditions and the nature of human activity and mobility patterns in the Western Galilee region during the Early Upper Paleolithic period. This study, based on four stalagmites that grew almost continuously from ∼75 to 26.5 ka, covers most of the last glacial, and overlaps with the human occupation of the cave. The speleothems oxygen (δ18O) and carbon (δ13C) isotopic records indicate that climate and environmental conditions fluctuated during the last glacial, some of which correspond with Dansgaard–Oeschger (D-O) cycles 12, 10, 7 and Heinrich (H) events VI and V. Consistent with independent evidence from botanic and faunal remains, these climatic shifts brought about significant environmental changes in the region, ranging from dominant thick Mediterranean forest to more open landscape. A good correlation with less negative δ13C values is most pronounced during the Early Ahmarian time period, but there was also a change to less negative δ13C values during the Levantine Aurignacian and Post-Levantine Aurignacian industries in the Levant. These positive δ13C shifts suggest that environmental transformation towards a more open grassy landscape dominated by C4 vegetation might have played an important role in the development of these cultural entities (mainly the Early Ahmarian) in Manot Cave region.
The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associa... more The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study including 274 individuals was divided into two groups: control (82 males and 81 females) and stenosis (59 males and 52 females). All participants have undergone high-resolution CT scan of the lumbar spine in the same position. FT and FO were measured at L1-2 to L5-S1. Significant sagittal FO was noted in the stenosis males (L2-3 to L4-5) and females (L2-3 to L5-S1) compared to the controls. The prevalence of FT was remarkably greater in the stenosis males (L4-5, L5-S1) and females (L3-4, L5-S1) compared to their counterparts in the control group. Our results also showed that FT (L3-4 to L5-S1) increases approximately 2.9 times the likelihood for DLSS development. This study indicates that FO and FT in the lower lumbar spine are significantly associated with DLSS.
International Journal of Legal Medicine, 2017
Introduction The effect of impact tool geometry and soft material covering on bone fracture patte... more Introduction The effect of impact tool geometry and soft material covering on bone fracture patterns plays a major role in fracture patterns. However, the literature is nearly void of such studies and only general correlations between the fracture pattern and the mechanism underlying the insult were reported. Purpose The aim of this study is to reveal the association between the geometry of the impact tool and the presence of soft material covering on bone fracture patterns. The Dynatup Model POE 2000 (Instron Co.) low energy pendulum impact machine was utilized to apply impact loading on fresh pig femoral bones (n = 50). The bone clamp shaft was adjusted to position the bone for three-point bending with additional bone compression simulating a situation occurring in pedestrian road traffic accidents. Five different tests using varying impact tool sizes with and without soft interface covering were carried out. Results A significant positive correlation was found between the fracture features and the impact tool's geometry. Only bones that were damaged by a rounded impact body result in a Bfalseb utterfly fragment; in all other cases where the impact body is flat and wide, double trapezoid fragments are observed in the area of impact. The impacted aspect is the most affected. All fracture line features were significantly greater in bones subjected to an impact by tools without soft covering. With an impact with soft covering, the impacted aspect exhibits numerous unique fracture lines and a fragmented pattern. Our study clearly shows that impact tool geometry and soft material covering markedly affect the fracture pattern.
Bulletins et mémoires de la Société d’Anthropologie de Paris, 2017
The time range between 60 ka and 50 ka is one of the most dramatic phases in human biological evo... more The time range between 60 ka and 50 ka is one of the most dramatic phases in human biological evolution. In this period, the western part of Eurasia (Europe and the Near East) was populated by Neanderthals, whereas the eastern part (Central Asia and Siberia) was populated by Deniso-vans. However, by 30 ka, these two populations were replaced by anatomically modern humans (AMH). When did these newcomers arrive and from where? There is accumulating archaeological and genetic evidence suggesting that this demographic shift occurred at the end of MIS 4 [1-3]. Moreover, it is quite clear that a major dispersal of AMH out of Africa was the source of the new populations [4-7]. In this study, we examined specific morphological characteristics of Manot 1 (e.g., suprainiac fossa), and assessed their similarities to the corresponding traits found among Neanderthals. We will show that although the terminology is similar, the traits in each hominin group are of different entities. We also show that Manot 1 and Early Upper Palaeolithic skulls of Europe have many traits in common (e.g., suprainiac fossa, bunning), although Manot 1 is much more gracile. Finally, some of the archaic traits (e.g., suprainiac fossa) seen in Manot 1 can be traced to the Late Pleistocene Aduma skull (~79-105 ka) from Ethiopia or even Eyasi 1 (~200-400 ka) from Tanzania. Keywords Manot Cave · Human evolution · Upper Palaeolithic · Neanderthals · Modern human · Out of Africa origin Résumé La période comprise entre 60 000 et 50 000 ans BP est l'une des phases les plus importantes de l'évolution biolo-gique humaine. Au cours de celle-ci, la partie occidentale de l'Eurasie (l'Europe et le Proche-Orient) a été peuplée par les Néandertaliens, tandis que la partie orientale (Asie centrale et Sibérie) l'a été par les Dénisoviens. Cependant, il y a plus de 30 000 ans, ces deux populations ont été remplacées par des Hommes anatomiquement modernes. Quand sont apparus ces nouveaux arrivants, et d'où venaient-ils ? Des données arché-ologiques et génétiques suggèrent que ce changement démo-graphique a eu lieu à la fin du stade isotopique marin 4 [1-3]. Une dispersion importante d'Hommes anatomiquement mod-ernes en dehors du continent africain serait à la source de ces nouvelles populations [4-7]. Dans cette étude, nous exami-nons la possibilité que Manot 1 appartienne à la population de base qui a donné lieu à l'Homme moderne. En outre, les relations entre Manot 1 et la population du Paléolithique supérieur d'Europe et les Néandertaliens levantins contem-porains sont abordées. Dans cette étude, nous avons examiné les caractéristiques morphologiques particulières de Manot 1 (e.g. la fosse sus-iniaque) et évalué leurs similitudes avec les caractères homologues présents chez les Néanderta-liens. Nous avons montré que, bien que la terminologie soit identique, les caractères de chaque groupe d'homininés I. Hershkovitz (*) The
BMC Musculoskeletal Disorders, 2017
Background: Degenerative lumbar spinal stenosis (DLSS) is a common health problem in the elderly ... more Background: Degenerative lumbar spinal stenosis (DLSS) is a common health problem in the elderly and usually associated with three-joint complex degeneration. Schmorl's nodes (SNs) are described as vertical herniation of the disc into the vertebral body through a weakened part of the end plate that can lead to disc degeneration. Since SNs can harm the spine unit stability, the association between DLSS and SNs is expected. The aim of this study is to shed light on the relationship between degenerative lumbar spinal stenosis and SNs. Methods: Two groups of individuals were studied: the first included 165 individuals with DLSS (age range: 40-88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms (age range: 40-99, sex ratio: 90 M/90 F). The presence or absence of SNs on the cranial and caudal end plate surfaces at the lumbosacral region (from L1 to S1 vertebra) was recorded, using CT images (Brilliance 64 Philips Medical System, Cleveland Ohio, thickness of the sections was 1-3 mm and MAS, 80-250). Chi-Square test was taken to compare the prevalence of SNs between the study groups (control and stenosis) by lumbar disc level, for each gender separately. Multivariable logistic regression analysis was also used to determine the association between DLSS and SNs. Results: The prevalence rate of SNs was significantly greater in the stenosis males (L1-2 to L5-S1) and females (L4-5 and L4-S1) compared to their counterparts in the control (P < 0.001). In addition, the presence of SNs in both males and females was found to increase the likelihood for DLSS. Conclusions: Our results indicate that SNs prevalence is significantly greater in the DLSS group compared to the control. Furthermore, SNs are strongly associated with DLSS.
To date, the earliest modern human fossils found outside of Africa are dated to around 90,000 to ... more To date, the earliest modern human fossils found outside of Africa are dated to around 90,000 to 120,000 years ago at the Levantine sites of Skhul and Qafzeh. A maxilla and associated dentition recently discovered at Misliya Cave, Israel, was dated to 177,000 to 194,000 years ago, suggesting that members of the Homo sapiens clade left Africa earlier than previously thought. This finding changes our view on modern human dispersal and is consistent with recent genetic studies, which have posited the possibility of an earlier dispersal of Homo sapiens around 220,000 years ago. The Misliya maxilla is associated with full-fledged Levallois technology in the Levant, suggesting that the emergence of this technology is linked to the appearance of Homo sapiens in the region, as has been documented in Africa.
Clinical Anatomy, 2019
The ratio between the sagittal diameter of the spinal canal and the sagittal diameter of the vert... more The ratio between the sagittal diameter of the spinal canal and the sagittal diameter of the vertebral body, known as the "Torg ratio", is often used to test for spinal canal narrowing. Here, we investigate this ratio in a large population, consisting of two ethnicities, both sexes and three age groups. Measurements were taken on the dry cervical verterbrae (C3-C7) of 277 individuals using a digital apparatus allowing for the recording of 3D coordinates of a set of landmarks on the vertebral body. Vertebral body and vertebral foramen lengths were compared across the different subgroups. Vertebral body and vertebral foramen lengths differ significantly between males and females and between African Americans and European Ameri-cans. With age, the vertebral body length increases while the foramen length does not undergo significant changes. These anatomical differences are reflected in differences in the Torg ratio calculated for the different subgroups. In conclusion, our findings suggest that a hard cutoff on the Torg ratio used to define a pathological narrowing of the cervical spine should be adapted to the population the patients come from. Clin. Anat. 32:84-89, 2019.
THE ANATOMICAL RECORD, 2018
Vertebral osteophytes are an age-dependent manifestation of degenerative changes in the spine. We... more Vertebral osteophytes are an age-dependent manifestation of degenerative changes in the spine. We aimed to determine the prevalence and severity of cervical osteophytosis in a large study population. To do so, we developed a grading system for osteophytosis, enabling the assessment of their presence and severity in the cervical spine, and applied it to the analysis of dried cer-vical vertebral bodies (C3-C7) from 273 individuals. Statistical analyses were carried out per motion segment, while testing for the effect of age, sex, and ethnicity. The highest prevalence of osteophytes was found in motion segment C5/C6 (48.2%), followed by C4/C5 (44.1%), and last C6/C7 and C3/C4 (40.5%). Severe osteophytes are most commonly seen in motion segment C5/C6. In all motion segments, the inferior discal surface of the upper vertebra manifests more osteophytes than the superior discal surface of the lower one. Osteophytes prevalence is sex-dependent only in the upper cervi-cal vertebrae (C3-C4), and age-and ethnicity-dependent for all vertebrae.
BioMed Research International, 2018
The aim of this study was to reveal whether demographic aspect, vertebral morphometry, and spine ... more The aim of this study was to reveal whether demographic aspect, vertebral morphometry, and spine degeneration are associated with lumbar Schmorl's nodes (SNs). A retrospective cross-sectional study was performed using data from the Department of Radiology (Carmel, Medical Center, Israel) for 180 individuals: age range between 40 and 99 years; 90 males and 90 females. All participants had undergone high-resolution CT scans for abdominal diagnostic purposes in the same supine position prior to our study, which enabled the processing of the scans in all planes and allowed a 3D reconstruction of the lower lumbar region. Eighty individuals (44.4%) had at least one SN along the lumbar spine, particularly at L3-4 level (30%). Vertebral body length (L1 to L3) and width (L1 and L4) were significantly greater in the SNs group compared to non-SNs group. On contrast, disc height (L3-4 and L4-5) was significantly lesser in SNs group than non-SNs group. SNs was significantly associated with smoking (X 2 = 4.436, P=0.02) and degenerative lumbar spinal stenosis (X 2 = 5.197, P=0.038). Moreover, the prevalence of SN was significantly greater in individuals with vacuum phenomenon and osteophytes formation (L1-2 to L4-5 levels). This study indicates that vacuum phenomenon on L3-4 (OR: 4.7, P=0.034), smoking habit (OR: 3.2, P=0.003), disc height loss of L4-5 (OR: 0.798, P=0.008), vertebral body length of L1 (OR: 1.37, P<0.001), and age (OR: 1.05, P=0.002) increase the probability of developing lumbar SNs.
BioMed research international, 2019
The aim of this study was to shed light on the association between lumbosacral transitional verte... more The aim of this study was to shed light on the association between lumbosacral transitional vertebra (LSTV) and degenerative lumbar spinal stenosis (DLSS). A cross-sectional retrospective study was performed on 165 individuals that were diagnosed with clinical picture of DLSS (age range: 40-88 years; sex ratio: 80M/85F) and 180 individuals without DLSS related symptoms (age range: 40-99 years; sex ratio: 90M/90F). All participants had undergone high-resolution CT scan for the lumbar region in the same position. We also used the volume rendering method to obtain three-dimensional CT images of the lumbosacral area. Both males and females in the stenosis group manifest greater prevalence of LSTV than their counterparts in the control group (P<0.001). Furthermore, the presence of LSTV increases the likelihood of degenerative spinal stenosis (odds ratio= 3.741, P<0.001). In the control group, LSTV was more common in males, and sacral slope angle of males was significantly greater in LSTV group compared to non-LSTV. This study indicates that LSTV was significantly associated with symptomatic DLSS.
Quaternary International, 2020
Genetic and archaeological models predict that African modern humans successfully colonized Euras... more Genetic and archaeological models predict that African modern humans successfully colonized Eurasia between 60,000 and 40,000 years before present (ka), replacing all other forms of hominins. While there is good evidence for the first arrival in Eurasia around 50-45ka, the fossil record is extremely scarce with regard to earlier representatives. A partial calvaria discovered at Manot Cave (Western Galilee, Israel) dated to >55 ka by uranium–thorium dating was recently described. Since then, other findings indicated an early dispersal of modern humans out-of-Africa between 194 and 177ka (Misliya-1) or possibly even earlier at 210ka (Apidima 1), and a quite long existence of Homo sapiens in Africa (Jebel Irhoud, ~300ka). While the faces of these early Homo sapiens appear quite modern, the shape of the braincase seems to lack behind, reaching the modern state only around after 35ka. Here, new data and approaches were applied to the Manot 1 calvaria. The ecto- and endocranial shape analyses based on micro-computed tomography data and a landmark-semilandmark approach using multiple reconstructions of the incomplete calvaria confirm that Manot 1 is unequivocally modern human. Its endocranial shape is markedly different from the earliest known Homo sapiens and close to the Levantine Qafzeh/Skhul assemblage (120-90ka) as well as modern humans, but still shows some deviations from both groups. The absence of other Homo sapiens fossils in the Levant between the Qafzeh/Skhul and Manot populations is not supportive for the hypothesis of a continuous occupation or the local evolution of modern humans. It suggests that Manot 1 represents a population migrating out-of-Africa and reaching the Levantine corridor during warmer and wetter climatic conditions over the Northern Sahara and the Mediterranean. Manot 1 shows that both modern humans and Neanderthals (e.g. Kebara, Amud) contemporaneously inhabited the Levant during the Middle to Upper Paleolithic interface. The endocranial shape of Manot 1 might indicate that this population had not yet fully reached the brainshape of modern humans evident after 35ka.
BioMed Research International, 2020
The aim of this study was to compare pedicle dimensions in degenerative lumbar spinal stenosis (D... more The aim of this study was to compare pedicle dimensions in degenerative lumbar spinal stenosis (DLSS) with those in the general population. A retrospective computerized tomography (CT) study for lumbar vertebrae (L1 to L5) from two sample populations was used. The first included 165 participants with symptomatic DLSS (age range: 40-88 years, sex ratio: 80 M/85 F), and the second had 180 individuals from the general population (age range: 40-99 years, sex ratio: 90 M/90 F). Both males and females in the stenosis group manifested significantly greater pedicle width than the control group at all lumbar levels (P < 0:05). In addition, pedicle heights for stenosis females were remarkably smaller on L4 and L5 levels compared to their counterparts in the control group (P < 0:001). Males have larger pedicles than females for all lumbar levels (P < 0:001). Age and BMI did not demonstrate significant association with pedicle dimensions. Our outcomes indicate that individuals with DLSS have larger pedicle widths than the control group. More so, pedicle dimensions are gender-dependent but independent of age and BMI.
American Journal of Physical Anthropology, 1999
Diploic veins (Canales diploicae), which were identified in dogs by Dupuytren more than 200 years... more Diploic veins (Canales diploicae), which were identified in dogs by Dupuytren more than 200 years ago (Hecker [1845] Die anatomische Verhaltnisse und Krankheiten der Venae diploicae und Vasa emissaria. Erfahrungen und Abhandlungen im Gebiete der Chirurgie und Augenheilkunde. Erlangen), have remained inadequately understood and scantily referenced in the anatomical and anthropological literature. The tunnels formed by diploic veins are among the few known skeletal markers of soft tissue alteration. Protected by two bony laminae, diploic vein tunnels often resist postdepositional destruction and may provide a new way to assess living and extinct hominid populations. This basic research was carried out to enable future utilization of the diploic venous channels in anthropologic research. In the present study, diploic venous channels were observed radiographically in 108 human adults aged 19 years and above, 18 infants and children aged 1-18 years (Hamann-Todd Osteological Collection), eight fetuses aged 7-9 months (the Johns Hopkins Collection), and seven nonhuman primates (Hamann-Todd Osteological Collection). In addition, seven documented cases of parents and children were radiographed for genetic evaluation (Osteological Collection of The Hungarian Natural History Museum). Five distinct diploic distribution patterns were identified and described in this study. This was at variance with the impressions reported in dissection-based studies. Independence of diploic vein pattern from demographic (gender and age) and size factors and their tendency to be symmetrical make them amenable and reliable traits for skeletal population study. Diploic vein patterns appeared to be more complicated in humans than in nonhuman primates, raising the possibility of future phylogenetic applications.
American Journal of Physical Anthropology, 1997
The controversy over the reliability of ectocranial suture status (open vs. closed) as an age est... more The controversy over the reliability of ectocranial suture status (open vs. closed) as an age estimation stimulated the pursuit of Meindl and Lovejoy&#39;s suggestion (Meindl and Lovejoy [1985] Am. J. Phys. Anthropol. 68:57-66) for large scale analysis. The extent of the sagittal suture closure was assessed in 3,636 skulls from the Hamann-Todd and Terry collections. The debate over whether cranial suture ossification represents a pathologic or an age-predictable pathologic process also stimulated a comparison with age and two stress markers, hyperostosis frontalis interna and tuberculosis. Sagittal suture closure was found to be age-independent and sexually biased. The wide confidence intervals (for age) appear to preclude meaningful application of suture status for age determination. No correlation was found with the tested biological stressors.
American Journal of Physical Anthropology, 1997
The present study discusses in detail the osteological changes associated with sickle cell anemia... more The present study discusses in detail the osteological changes associated with sickle cell anemia in children and their importance in differential diagnosis. Posterior calcaneal and specific articular surface disruptive metacarpal lesions are diagnostic for sickle cell anemia. Calvarial thickening, tibial and femoral cortical bone thickening, and bowing are of more limited utility in differential diagnosis. Granular osteoporosis, pelvic demineralization and rib broadening are nonspecific. Localized calvarial &quot;ballooning,&quot; previously not described, may have diagnostic significance. Bone marrow hyperplastic response (porotic hyperostosis) in sickle cell anemia produces minimal radiologic changes contrasted with that observed in thalassemia and blood loss/hemolytic phenomenon. Two other issues, the osteological criteria for discriminating among the anemias and the purported relationship between porotic hyperostosis and iron deficiency anemia, are also discussed. There is sufficient information to properly diagnose the four major groups of anemias, and further, to establish that iron deficiency is only indirectly associated with porotic hyperostosis. The hyperproliferative bone marrow response (manifest as porotic hyperostosis) to blood loss or hemolysis exhausts iron stores, resulting in secondary iron deficiency.
Comptes Rendus de l'Académie des Sciences - Series III - Sciences de la Vie, 1997
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Papers by Israel Hershkovitz
Methods: Two sample populations were studied. The first included 165 individuals with DLSS (age range: 40–88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40–99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2 circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS.
Results: Individuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS.
Conclusions: Our results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.
Keywords: Degenerative lumbar spinal stenosis, Paraspinal muscles density, Muscle cross-sectional area size,
Computerized tomography (CT)
Methods: Two sample populations were studied. The first included 165 individuals with DLSS (age range: 40–88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40–99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2 circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS.
Results: Individuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS.
Conclusions: Our results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.
Keywords: Degenerative lumbar spinal stenosis, Paraspinal muscles density, Muscle cross-sectional area size,
Computerized tomography (CT)