Vol.:(0123456789) 1 3
European Spine Journal
https://doi.org/10.1007/s00586-018-5567-3
ORIGINAL ARTICLE
Intervertebral disc status is associated with vertebral marrow adipose
tissue and muscular endurance
Matthew Quittner
1,2
· Timo Rantalainen
1,2
· Nicola D. Ridgers
1,2
· Guy Trudel
3
· Adnan Sheikh
4
· David Connell
5
·
Daniel L. Belavý
1,2
Received: 13 November 2017 / Accepted: 26 March 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Purpose Low back pain is a major public health issue. Identifying factors associated with better intervertebral disc (IVD)
characteristics gives insight into IVD metabolism and highlights intervention targets for improvement of IVD health. This
cross-sectional study investigates whether IVD T2-relaxation time on magnetic resonance imaging (MRI) is associated with
vertebral fat fraction (VFF; to quantify marrow adipose tissue), trunk muscle cross-sectional area (CSA), muscle function
and physical activity (PA).
Methods Seventy-nine healthy subjects (35 males, 44 females) without history of spinal disease were included. Lumbar
IVDs T2-relaxation time, lumbar VFF and CSA of multifdus, erector spinae, quadratus lumborum, and psoas muscles were
quantifed via MRI. Isometric trunk fexion and extension endurance times as well as habitual PA levels and exposure to
occupational spine risk factors were documented. Pearson-partial correlations adjusted for anthropometric diferences by
controlling for vertebral body height.
Results Higher IVD T2-time correlated with: (a) lower VFF (r = − 0.27, p < 0.05), (b) greater trunk extensor muscle endur-
ance (r = 0.37, p < 0.01), and (c) greater trunk fexor muscle endurance (r = 0.30, p < 0.01) but not with muscle CSA. Lower
VFF also correlated with greater extensor muscle endurance (r = − 0.26, p < 0.05) and habitual PA (MET-mins per week)
(r = − 0.24, p < 0.05).
Conclusion This is the frst study to show that better IVD hydration is associated with lower VFF and that greater physi-
cal activity is associated with favourable levels of vertebral marrow adipose tissue in young healthy individuals. Reduced
vertebral marrow adipose tissue may specifcally improve IVD hydration via improved nutrient supply.
Graphical abstract These slides can be retrieved under Electronic Supplementary Material.
Key points
intervertebral disc, exercise, marrow adipose tissue, magnetic resonance imaging,
muscular endurance
1. Healthy intervertebral discs (IVDs) bear the physical loads required for everyday
activities. Only when an IVD is sufficiently hydrated can it function properly.
2. This study investigated the association between lumbar IVD hydration and variables
including vertebral fat fraction (VFF), muscular endurance, muscular size and physical
activity.
3. We found that greater IVD hydration was associated with lower VFF and greater
muscular endurance, but not with muscle size. Greater physical activity (MET -
mins/week) was also associated with lower VFF.
Annulus
T2-me
1
Nucleus
T2-me
1
VFF
2
Bodymass (kg)
Height (cm)
Extensor
duraon (secs)
Flexor duraon
(secs)
Weekly Physical
Acvity
Erector
Spinae
3
Mulfidus
3
Psoas
3
Quadratus
Lumborum
3
Spine Risk
Acvies (Years)
Whole IVD
T2-me
.76†
.73†
.87†
.87†
-.24*
-.27*
.07
-.06
.24*
.11
.26*
.37†
.23*
.30†
.19
.17
.09
-.05
.03
-.12
.26*
.15
.13
-.01
-.10
-.02
Annulus
T2-me
.46†
.41†
-.23*
-.22
.26*
.24
.25*
.20
.12
.28*
.14
.16
.07
.05
.20
.13
.12
.05
.31†
.26*
.25*
.22
.00
.05
Nucleus
T2-me
-.16
-.20
-.05
-.19
.14
-.01
.25*
.35†
.23*
.30†
.22*
.21
.01
-.06
-.02
-.09
.16
.13
.03
.01
-.11
-.05
VFF
.26*
.15
.28*
.14
-.33†
-.26*
-.24*
-.15
-.20
-.24*
.25*
-.14
.22*
-.16
.22*
-.05
.23*
-.11
.09
-.09
Bodymass
.71†
.57†
-.47†
-.36†
-.32†
-.20
-.13
-.22
.69†
.58†
.63†
.50†
.63†
.50†
.78†
.69†
.22
.24*
Height
-.31†
-.10
-.28*
-.11
-.10
-.16
.69†
.54†
.65†
.49†
.66†
.50†
.68†
.50†
.16
.21
Extensor
Duraon
.49†
.43†
.20
.25
-.33†
-.19
-.42†
-.30†
-.26*
-.09
-.40†
-.27*
.10
.12
Flexor
Duraon
.27*
.32†
-.17
-.02
-.24*
-.12
-.09
-.07
-.35†
-.23*
.10
.13
Weekly
Physical
Acvity
.02
-.03
-.02
-.08
.11
.07
-.02
-.09
.20
.20
Erector
Spinae
.75†
.66†
.77†
.69†
.83†
.76†
.23*
.27*
Mulfidus
.71†
.61†
.74†
.64†
.03
.03
Psoas
.83†
.76†
.29*
.34†
Quadratus
Lumborum
.20
.23*
Table 2: IVD correlations: Sexes pooled
Take Home Messages
1. This is the first study to show that better IVD hydration is associated with
lower VFF in young healthy individuals. Reduced VFF may specifically improve
IVD hydration via improved nutrient supply.
2. Physical activity may prove an appropriate intervention for reducing VFF
with a potentially favourable impact on preserving IVD nutrition and
hydration.
3. Muscular function may be more relevant to IVD health than muscular size in
young healthy individuals.
Keywords Intervertebral disc · Exercise · Marrow adipose tissue · Magnetic resonance imaging · Muscular endurance
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s00586-018-5567-3) contains
supplementary material, which is available to authorized users.
Extended author information available on the last page of the article