Correlation of Dorsal Subcutaneous Fat Thickness, Paraspinal Muscle Fat Infiltration, Modic Changes, and Demographic Factors with Spinal Canal Stenosis, with Lumbar Disc Degeneration as a Mediating Variable, Using Magnetic Resonance Imaging
DOI:
https://doi.org/10.54832/phj.v8i2.1596Keywords:
lumbar spinal stenosis, lumbar disc degeneration, paraspinal muscle fat infiltration, MRIAbstract
Background: Lumbar spinal stenosis is a common degenerative condition, but the joint relationships among paraspinal muscle fat infiltration, endplate changes, regional adiposity, disc degeneration, and MRI-defined canal narrowing are incompletely described. This study examined the level-specific associations of these MRI features with lumbar disc degeneration and MRI-defined central canal stenosis in a selected MRI-referral cohort, with disc degeneration examined as a hypothesized intermediate variable.
Methods: This retrospective cross-sectional study reviewed archived lumbar MRI examinations of 100 consecutive adults with degenerative findings at Royal Prima Hospital, Medan (acquired September–November 2025). At each level from L1-L2 to L5-S1, the dural sac cross-sectional area (graded 0–3), dorsal subcutaneous fat thickness, paraspinal muscle fat infiltration (Goutallier classification), Modic changes, and disc degeneration (modified Pfirrmann grading) were assessed. Level-specific Spearman correlation coefficients (ρ) with 95% confidence intervals were calculated, and the Benjamini–Hochberg false discovery rate (FDR) was applied across all 65 tests.
Results: Mean age was 48.87 ± 15.24 years, and 68% of participants were women. Age correlated with disc degeneration at all levels (ρ = 0.444–0.747), as did the Modic score (ρ = 0.275–0.541); multifidus fat infiltration correlated with disc degeneration from L1-L2 to L4-L5 (ρ = 0.280–0.632). Correlations with stenosis grade were weaker and level-specific: age at L3-L4 and L4-L5 (ρ = 0.361 and 0.405), Modic score from L2-L3 to L4-L5 (ρ = 0.254–0.490), and psoas and erector spinae fat infiltration at selected mid-lumbar levels (ρ = 0.256–0.392). Disc degeneration correlated with stenosis from L1-L2 to L4-L5 (ρ = 0.242–0.464) but not at L5-S1 (ρ = −0.035). Dorsal subcutaneous fat thickness was not significantly correlated with either outcome at any level.
Conclusion: In this MRI-referral cohort, age, Modic changes, and paraspinal muscle fat infiltration were associated with disc degeneration and, less consistently, with central canal stenosis. This pattern is consistent with, but does not demonstrate, an intermediate role of disc degeneration; longitudinal, multilevel studies with formal mediation analysis are needed.
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