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Clinical value of body mass index and paraspinal muscle MRI proton density fat fraction in recurrence in patients with chronic low back pain
ZHONG Yuxuan  HE Bo  CHEN Jiaxin  LI Chunli  ZHANG Zhenguang  YANG Lei  HU Jiayao  YANG Juntao  LUO Mingbin  HUANG Yilong 

Cite this article as: ZHONG Y X, HE B, CHEN J X, et al. Clinical value of body mass index and paraspinal muscle MRI proton density fat fraction in recurrence in patients with chronic low back pain[J]. Chin J Magn Reson Imaging, 2026, 17(9): 34-41. DOI:10.12015/issn.1674-8034.2026.09.005.


[Abstract] Objective To investigate the relationship between body mass index (BMI) and lumbar paraspinal muscle imaging parameters with the recurrence of chronic low back pain (CLBP).Materials and Methods The patients with CLBP were prospectively recruited from the First Affiliated Hospital of Kunming Medical University, Baoshan People's Hospital, Dali Bai Autonomous Prefecture People's Hospital and The first People's Hospital of Honghe State. Clinical and imaging data were collected. Patients were divided into non-overweight (18.5 to 23.9 kg/m²) and overweight (≥ 24.0 kg/m2) groups based on BMI, and differences in paraspinal muscle parameters between groups were analyzed. Univariate and multivariate analyses were used to identify risk factors for CLBP recurrence. Receiver operating characteristic (ROC) curves were employed to evaluate the predictive performance of different models and to compare model performance after incorporating paraspinal muscle parameters and BMI.Results This study included a total of 317 patients with CLBP, consisting of 126 males (39.75%). Recurrence was observed in 116 patients (36.59%), and 110 patients (34.70%) were overweight. The multifidus muscle proton density fat fraction (MPDFF) was significantly higher in the recurrence group than in the non-recurrence group (P < 0.05). At the L4-L5 level, the multifidus muscle cross sectional area (MCSA) was significantly smaller in the recurrence group compared to the non-recurrence group (P < 0.05). Logistic regression analysis showed that elevated MPDFFL4-L5 (P = 0.008, OR = 1.04) and MCSAL4-L5 (P = 0.037, OR=0.84) were independent predictors of CLBP recurrence. The area under the receiver operating characteristic curve (AUC) for the model combining lumbar paraspinal parameters with clinical characteristics was superior to that of BMI (0.64 vs. 0.60, P < 0.05).Conclusions Lumbar paraspinal muscle PDFF is associated with CLBP recurrence and has a better predictive value than BMI.
[Keywords] chronic low back pain；body mass index；paraspinal muscle fatty infiltration；recurrence；body composition analysis；magnetic resonance imaging

ZHONG Yuxuan1   HE Bo1   CHEN Jiaxin1   LI Chunli1   ZHANG Zhenguang1   YANG Lei1   HU Jiayao2   YANG Juntao3   LUO Mingbin4   HUANG Yilong1*  

1 Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China

2 Department of Radiology, Baoshan People's Hospital, Baoshan 678000, China

3 Department of Radiology, Dali Bai Autonomous Prefecture People's Hospital, Dali 671000, China

4 Department of Radiology, The first People's Hospital of Honghe State, Mengzi 661199, China

Corresponding author: HUANG Y L, E-mail: kmhuangyilong@163.com

Conflicts of interest   None.

Received  2025-08-07
Accepted  2025-11-10
DOI: 10.12015/issn.1674-8034.2026.09.005
Cite this article as: ZHONG Y X, HE B, CHEN J X, et al. Clinical value of body mass index and paraspinal muscle MRI proton density fat fraction in recurrence in patients with chronic low back pain[J]. Chin J Magn Reson Imaging, 2026, 17(9): 34-41. DOI:10.12015/issn.1674-8034.2026.09.005.

[1]
HO E K, CHEN L X, SIMIC M, et al. Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis[J/OL]. BMJ, 2022, 376: e067718 [2025-10-25]. https://pmc.ncbi.nlm.nih.gov/articles/PMC8965745/. DOI: 10.1136/bmj-2021-067718.
[2]
GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and toprojections 2050: a systematic analysis of the Global Burden of Disease Study 2021[J/OL]. Lancet Rheumatol, 2023, 5(6): e316-e329 [2025-10-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC10234592/. DOI: 10.1016/s2665-9913(23)00098-x.
[3]
SILVA T DA, MACASKILL P, KONGSTED A, et al. Predicting pain recovery in patients with acute low back pain: Updating and validation of a clinical prediction model[J]. Eur J Pain, 2019, 23(2): 341-353. DOI: 10.1002/ejp.1308.
[4]
KNEZEVIC N N, CANDIDO K D, VLAEYEN J W S, et al. Low back pain[J]. Lancet, 2021, 398(10294): 78-92. DOI: 10.1016/S0140-6736(21)00733-9.
[5]
CHIAROTTO A, KOES B W. Nonspecific low back pain[J/OL]. N Engl J Med, 2021, 38618 [2025-10-24]. https://pubmed.ncbi.nlm.nih.gov/35507483/. DOI: 10.1056/NEJMcp2032396.
[6]
LUCHA-LÓPEZ M O, HIDALGO-GARCÍA C, MONTI-BALLANO S, et al. Body mass index and its influence on chronic low back pain in the Spanish population: A secondary analysis from the European health survey (2020)[J/OL]. Biomedicines, 2023, 11(8): 2175 [2025-10-24]. https://pubmed.ncbi.nlm.nih.gov/37626672/. DOI: 10.3390/biomedicines11082175.
[7]
MAINOUS A G, YIN L, WU V, et al. Body mass index vs body fat percentage as a predictor of mortality in adults aged 20-49 years[J]. Ann Fam Med, 2025, 23(4): 337-343. DOI: 10.1370/afm.240330.
[8]
AILY J B, DE NORONHA M, FERRARI R J, et al. Differences in fatty infiltration in thigh muscles and physical function between people with and without knee osteoarthritis and similar body mass index: a cross-sectional study[J/OL]. BMC Musculoskelet Disord, 2025, 26(1): 109 [2025-10-24]. https://pubmed.ncbi.nlm.nih.gov/39901175/. DOI: 10.1186/s12891-025-08347-y.
[9]
ZHANG J, WANG B, ZOU C, et al. Low back pain trends attributable to high body mass index over the period 1990-2021 and projections up to 2036[J/OL]. Front Nutr, 2024, 11: 1521567 [2025-10-25]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11790459/. DOI: 10.3389/fnut.2024.1521567.
[10]
NGUYEN H S, DOAN N, SHABANI S, et al. Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy[J]. J Craniovertebr Junction Spine, 2016, 7(1): 31-37. DOI: 10.4103/0974-8237.176619.
[11]
HAN G Y, JIANG Y, ZHANG B, et al. Imaging evaluation of fat infiltration in paraspinal muscles on MRI: a systematic review with a focus on methodology[J]. Orthop Surg, 2021, 13(4): 1141-1148. DOI: 10.1111/os.12962.
[12]
KANG J, ZHA Y F, LI L, et al. MR texture analysis of paravertebral fat infiltration in patients with chronic low back pain based on IDEAL-IQ sequence[J]. Chin J Magn Reson Imag, 2021, 12(10): 6-11. DOI: 10.12015/issn.1674-8034.2024.09.039.
[13]
WIANGKHAM T, PHUNGWATTANAKUL N, THONGBAI N, et al. Translation, cross-cultural adaptation and psychometric validation of the Thai version of the STarT Back Screening Tool in patients with non-specific low back pain[J/OL]. BMC Musculoskelet Disord, 2021, 22(1): 454 [2025-10-25]. https://pubmed.ncbi.nlm.nih.gov/34006259/. DOI: 10.1186/s12891-021-04347-w.
[14]
RUBINO F, CUMMINGS D E, ECKEL R H, et al. Definition and diagnostic criteria of clinical obesity[J]. Lancet Diabetes Endocrinol, 2025, 13(3): 221-262. DOI: 10.1016/S2213-8587(24)00316-4.
[15]
STANTON T R, LATIMER J, MAHER C G, et al. A modified Delphi approach to standardize low back pain recurrence terminology[J]. Eur Spine J, 2011, 20(5): 744-752. DOI: 10.1007/s00586-010-1671-8.
[16]
HEUCH I, HEUCH I, HAGEN K, et al. Overweight and obesity as risk factors for chronic low back pain: a new follow-up in the HUNT Study[J/OL]. BMC Public Health, 2024, 24(1): 2618 [2025-10-25]. https://pubmed.ncbi.nlm.nih.gov/39334024/. DOI: 10.1186/s12889-024-20011-z.
[17]
NIU S B, YANG H, WU J H, et al. Diagnosis and treatment of chronic low back pain: research progress[J]. Acad J Nav Med Univ, 2023, 44(6): 726-732. DOI: 10.16781/j.cn31-2187/r.20211177.
[18]
HUANG Y L, WANG L, LUO B F, et al. Associations of lumber disc degeneration with paraspinal muscles myosteatosis in discogenic low back pain[J]. Front Endocrinol (Lausanne), 2022, 13: 891088. DOI: 10.3389/fendo.2022.891088.
[19]
JIANG J Q, HUANG Y L, HE B. Advances in the interaction between lumbar intervertebral disc degeneration and fat infiltration of paraspinal muscles: critical summarization, classification, and perspectives[J/OL]. Front Endocrinol (Lausanne), 2024, 15: 1353087 [2025-10-25]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11228240/. DOI: 10.3389/fendo.2024.1353087.
[20]
TEICHTAHL A J, URQUHART D M, WANG Y Y, et al. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults[J]. Spine J, 2015, 15(7): 1593-1601. DOI: 10.1016/j.spinee.2015.03.039.
[21]
HEGAZI R, HALPERN B. Looking beyond fat in obesity: the frequently overlooked importance of muscle mass[J]. Rev Endocr Metab Disord, 2025, 26(5): 719-721. DOI: 10.1007/s11154-025-09986-1.
[22]
SUO M, ZHANG J, SUN T, et al. The association between morphological characteristics of paraspinal muscle and spinal disorders[J/OL]. Ann Med, 2023, 55(2): 2258922 [2025-10-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC10512810/. DOI: 10.1080/07853890.2023.2258922.
[23]
CHEN J X, HUANG Y L, YANG Y J, et al. Vertebral bone quality score was associated with paraspinal muscles fat infiltration, but not modic classification in patients with chronic low back pain: a prospective cross-sectional study[J/OL]. BMC Musculoskelet Disord, 2024, 25(1): 509 [2025-10-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11221129/. DOI: 10.1186/s12891-024-07626-4.
[24]
WANG Z, ZHAO Z, HAN S, et al. Advances in research on fat infiltration and lumbar intervertebral disc degeneration[J/OL]. Front Endocrinol (Lausanne), 2022, 13: 1067373 [2025-10-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC9768030/. DOI: 10.3389/fendo.2022.1067373.
[25]
LEE S H, PARK S W, KIM Y B, et al. The fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level[J]. Spine J, 2017, 17(1): 81-87. DOI: 10.1016/j.spinee.2016.08.001.
[26]
JUNG M, ROSPLESZCZ S, LÖFFLER M T, et al. Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study[J]. Eur Radiol, 2023, 33(3): 1501-1512. DOI: 10.1007/s00330-022-09140-4.
[27]
ZHANG T W, FIROUZABADI A, BECKER L, et al. Association between lumbar paraspinal muscle activities and quality in chronic low back pain: a cross-sectional analysis[J]. Eur Spine J, 2025, 34(4): 1348-1358. DOI: 10.1007/s00586-025-08727-x.
[28]
LI Y, WANG R L, LI J J, et al. Different degeneration patterns of paraspinal muscles between double-level and single-level lumbar spondylolisthesis: an magnetic resonance imaging analysis of 140 patients[J]. Neurospine, 2024, 21(3): 1029-1039. DOI: 10.14245/ns.2448576.288.
[29]
ZIEGELMAYER S, HÄNTZE H, MERTENS C, et al. Intermuscular adipose tissue and lean muscle mass assessed with MRI in people with chronic back pain in Germany: a retrospective observational study[J/OL]. Lancet Reg Health Eur, 2025, 54: 101323 [2025-10-24]. https://pmc.ncbi.nlm.nih.gov/articles/PMC12141060/. DOI: 10.1016/j.lanepe.2025.101323.
[30]
MOSER I, SOMMER I, GARTLEHNER G. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings [Internet[J/OL]. 2024: 715-722. DOI: 10.1055/a-2375-3671.

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