Systematic Review of Paraspinal Muscle Changes in Lumbar Spondylolisthesis: MRI and CT Insights

Valerio D'Andrea; Caterina Bernetti; Federico Greco; Claudia Volterrani; Carlo C. Quattrocchi; Paul M. Parizel; Johan Van Goethem; Gianfranco Di Gennaro; Bruno Beomonte Zobel; Carlo A. Mallio

doi:10.1111/os.70362

Orthopaedic Surgery ›› 2026, Vol. 18 ›› Issue (8) :1563 -1573. DOI: 10.1111/os.70362

REVIEW ARTICLE

Systematic Review of Paraspinal Muscle Changes in Lumbar Spondylolisthesis: MRI and CT Insights

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Abstract

Background: Spondylolisthesis is a frequently encountered condition in orthopedics, requiring dynamic stability maintained primarily by the paraspinal muscles. This systematic review evaluates the cross-sectional area (CSA) and fat infiltration (FI) of paraspinal muscles—specifically the multifidus, erector spinae, and psoas major—in lumbar spondylolisthesis (LS) to understand their roles in spinal stability and progression in degenerative and isthmic forms.

Methods: Following PRISMA guidelines, PubMed, Cochrane, and Scopus were searched as of September 2024. Fourteen retrospective studies using MRI/CT imaging met inclusion criteria, focusing on CSA and FI in LS. Data were extracted from studies that assessed spinal instability through vertebral slippage measurements or comparisons with asymptomatic controls.

Results: The findings indicate that reduced CSA and increased FI in paraspinal muscles, especially the multifidus, are associated with spinal instability and progressive vertebral slippage. Several studies reported reductions in CSA and increases in FI in patients with spondylolisthesis, although methods and anatomical levels varied across studies. Compensatory hypertrophy of the erector spinae and psoas major was observed, particularly in isthmic cases.

Conclusions: These findings support the potential role of muscle health in maintaining spinal stability and suggest that targeted rehabilitation strategies addressing paraspinal muscle alterations may improve clinical outcomes in patients with LS.

Keywords

cross-sectional area / CT / MRI / paraspinal muscles / spondylolisthesis

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Valerio D'Andrea, Caterina Bernetti, Federico Greco, Claudia Volterrani, Carlo C. Quattrocchi, Paul M. Parizel, Johan Van Goethem, Gianfranco Di Gennaro, Bruno Beomonte Zobel, Carlo A. Mallio. Systematic Review of Paraspinal Muscle Changes in Lumbar Spondylolisthesis: MRI and CT Insights. Orthopaedic Surgery, 2026, 18 (8) : 1563-1573 DOI:10.1111/os.70362

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