Association of Dorsal Subcutaneous Fat Thickness, Paraspinal Muscle Fat Infiltration, Modic Changes, and Demographic Factors with Lumbar Disc Degeneration on Magnetic Resonance Imaging
DOI:
https://doi.org/10.19166/med.v15i3.11621Keywords:
lumbar disc degeneration, dorsal subcutaneous fat thickness, paraspinal muscle, Modic changes, MRIAbstract
Background:
Lumbar disc degeneration is a common contributor to chronic low back pain. Magnetic resonance imaging enables assessment of disc degeneration and related factors, including dorsal subcutaneous fat thickness, paraspinal muscle fat infiltration, Modic changes, age, and sex.
Methods:
This quantitative cross-sectional study used consecutive sampling of patients who underwent non-contrast lumbar MRI at Royal Prima General Hospital, Medan, from September to November 2025. A total of 253 samples were analyzed. Lumbar disc degeneration was graded using the modified Pfirrmann system, paraspinal fat infiltration using the Goutallier classification, and Modic changes using standard MRI criteria. Statistical analysis was performed using SPSS.
Result:
Lumbar disc degeneration tended to be more severe in the lower lumbar levels, particularly L4-L5 and L5-S1. Paraspinal muscle fat infiltration, Modic changes, and age showed significant associations with lumbar disc degeneration. Dorsal subcutaneous fat thickness and sex did not show significant associations with degeneration across the analyzed levels.
Conclusions:
Paraspinal muscle fat infiltration, Modic changes, and age were significantly associated with lumbar disc degeneration on MRI, whereas dorsal subcutaneous fat thickness and sex were not. These findings support careful MRI evaluation of paraspinal muscle quality and endplate changes in patients with lumbar degeneration.
References
1. Oichi T, Taniguchi Y, Oshima Y, et al. Pathomechanism of intervertebral disc degeneration. JOR Spine. 2020;3(1):e1076. doi:10.1002/jsp2.1076.
2. Wen DJ, Tavakoli J, Tipper JL. Lumbar total disc replacements for degenerative disc disease: a systematic review of outcomes with a minimum of 5 years follow-up. Global Spine J. 2024;14:1827-1837. doi:10.1177/21925682241228756.
3. Wu PH, Kim HS, Jang IT. Intervertebral disc diseases part 2: a review of the current diagnostic and treatment strategies for intervertebral disc disease. Int J Mol Sci. 2020;21(6):2135. doi:10.3390/ijms21062135.
4. Makkiyah FA, Sinaga TA, Khairunnisa N. A study from a highly populated country: risk factors associated with lower back pain in middle-aged adults. J Korean Neurosurg Soc. 2023;66(2):190-198. doi:10.3340/jkns.2021.0278.
5. Susanto H, et al. Low back pain prevalence in Indonesian older adults: systematic review and meta-analysis. Pain Manag Nurs. 2025. doi:10.1016/j.pmn.2025.07.004.
6. Hutchins TA, et al. ACR Appropriateness Criteria low back pain: 2021 update. J Am Coll Radiol. 2021;18(11):S361-S379. doi:10.1016/j.jacr.2021.08.002.
7. Cao Z, et al. Incidence and risk factors for Modic changes in the lumbar spine: a systematic review and meta-analysis. Front Endocrinol. 2025;16. doi:10.3389/fendo.2025.1585552.
8. Kirnaz S, et al. Fundamentals of intervertebral disc degeneration. World Neurosurg. 2022;157:264-273. doi:10.1016/j.wneu.2021.09.066.
9. Shi L, et al. Correlation between the fatty infiltration of paraspinal muscles and disc degeneration and the underlying mechanism. BMC Musculoskelet Disord. 2022;23(1). doi:10.1186/s12891-022-05466-8.
10. Kanbayti IH, et al. Lumbar disc degeneration is linked to dorsal subcutaneous fat thickness at the L1-L2 intervertebral disc level measured by MRI. Tomography. 2024;10(1):159-168. doi:10.3390/tomography10010012.
11. Li GQ, et al. Study and analysis of the correlation between lumbar spondylolisthesis and Modic changes. Front Surg. 2024;11. doi:10.3389/fsurg.2024.1296275.
12. Ravikanth R. Magnetic resonance evaluation of lumbar disc degenerative disease as an implication of low back pain: a prospective analysis. Neurol India. 2020;68:1378-1384. doi:10.4103/0028-3886.304091.
13. Griffith JF, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine. 2007;32:E708-E712.
14. Özcan-Ekşi EE, Ekşi MŞ, Akçal MA. Severe lumbar intervertebral disc degeneration is associated with Modic changes and fatty infiltration in the paraspinal muscles at all lumbar levels, except for L1-L2. World Neurosurg. 2019;122:e1069-e1077. doi:10.1016/j.wneu.2018.10.229.
15. Zhang Y, et al. Association between fatty infiltration of paraspinal muscle, sagittal spinopelvic alignment and stenosis grade in patients with degenerative lumbar spinal stenosis. N Am Spine Soc J. 2021;5. doi:10.1016/j.xnsj.2021.100054.
16. Berikol G, et al. Subcutaneous fat index: a reliable tool for lumbar spine studies. Eur Radiol. 2022;32(9):6504-6513. doi:10.1007/s00330-022-08775-7.
17. Hong C, Lee CG, Song H. Characteristics of lumbar disc degeneration and risk factors for collapsed lumbar disc in Korean farmers and fishers. Ann Occup Environ Med. 2021;33(1). doi:10.35371/aoem.2021.33.e16.
18. Liyew WA. Clinical presentations of lumbar disc degeneration and lumbosacral nerve lesions. Int J Rheumatol. 2020;2020. doi:10.1155/2020/2919625.
19. Scarcia L, et al. Degenerative disc disease of the spine: from anatomy to pathophysiology and radiological appearance, with morphological and functional considerations. J Pers Med. 2022;12(11):1810. doi:10.3390/jpm12111810.
20. Faur C, et al. Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain. BMC Musculoskelet Disord. 2019;20(1):414. doi:10.1186/s12891-019-2786-7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Audrina Ernes, Inda Kania M, Nyi Raden Siti Vissy Puspa Dewi Muharam

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website). The final published PDF should be used and bibliographic details that credit the publication in this journal should be included.


