From the Guidelines
Fatty changes in the erector spinae muscles are most commonly caused by acquired factors such as aging, disuse atrophy, chronic lower back pain, obesity, diabetes, and steroid use, rather than genetic abnormalities. When considering the etiology of erector spinae muscle fatty change, it's crucial to differentiate between acquired and genetic causes. Acquired causes, as mentioned, include a range of factors from lifestyle and metabolic conditions to the use of certain medications. On the other hand, genetic conditions that can lead to muscle fatty infiltration are less common and include muscular dystrophies, mitochondrial myopathies, and lipid storage diseases 1.
Key Causes and Considerations
- Aging: Natural aging process leads to muscle atrophy and fatty replacement.
- Disuse atrophy: Prolonged inactivity can cause muscle fibers to be replaced by fat.
- Chronic lower back pain: Leads to disuse of the erector spinae muscles, resulting in fatty infiltration.
- Obesity and diabetes: Metabolic changes associated with these conditions can lead to fatty deposition in muscles.
- Steroid use: Both medicinal and anabolic steroid use can cause muscle fatty infiltration.
- Genetic conditions: Though less common, conditions like muscular dystrophies and mitochondrial myopathies can lead to fatty changes in muscles. Given the information from the study on axial spondyloarthritis (axSpA) and the importance of MRI in diagnosing spinal changes, including fatty deposition in the context of inflammatory diseases 1, it's essential to approach the diagnosis and management of erector spinae muscle fatty changes with a comprehensive understanding of both acquired and genetic factors. Management should focus on addressing the underlying cause, with strategies including physical therapy, weight management, control of metabolic conditions, and, in genetic cases, management of the specific disorder. Regular exercise and maintaining muscle use are critical in preventing or reducing fatty infiltration in the erector spinae muscles.
From the Research
Erector Spine Muscle Fatty Change Causes
- Fatty infiltration of the erector spinae muscle is closely associated with low back pain, particularly at the upper lumbar levels 2
- Intervertebral disc degeneration (IVDD) and Modic changes are also possible causes of low back pain, but their association is more prominent at lower lumbar levels 2
- Fatty infiltration in the paraspinal muscles, including the erector spinae, can be a result of muscle degeneration and atrophy, which may be caused by disuse or sway-back posture 3
- The rate of decline in lumbar muscle quality, including fatty infiltration, can vary depending on ethnicity, muscle, and spinal level, with older Asian adults showing a faster decline in erector spinae muscle density 4
Genetic Abnormalities
- There is no direct evidence in the provided studies to suggest that genetic abnormalities are a cause of erector spine muscle fatty change
- However, the studies suggest that fatty infiltration in the erector spinae muscle can be influenced by various factors, including age, ethnicity, and spinal degeneration, which may have a genetic component 4, 3
Associated Factors
- Fatty infiltration in the erector spinae muscle has been correlated with dynamic sagittal spino-pelvic balance during gait in adult spinal deformity, suggesting that muscle quality can affect spinal compensation ability 5
- Spinal mobilization and manipulation, commonly used to treat low back pain, can also be associated with serious adverse events, including disc herniation and vertebral fracture, although the relationship between these events and erector spine muscle fatty change is not clear 6