Sex-specific differences in paraspinal muscle composition and clinical outcomes after non-surgical spinal decompression

Jacob A. Connolly, Kenneth A. Weber II, Eddo O Wesselink, Adriana Baez, Anthony Sun and Nathan D. Schilaty

Table 1

Iraq research ' table

Table 2

Iraq research ' table

Table 3

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Sex-specific differences in paraspinal muscle composition and clinical outcomes after non-surgical spinal decompression

Please see the full study here.

Abstract

Background: Low back pain (LBP) is a leading cause of disability worldwide. Lumbar paraspinal muscle dysfunction is strongly associated with LBP, yet conservative treatments may not fully address underlying pathology. Non-surgical spinal decompression (NSSD) has emerged as a potential treatment option, though objective evidence supporting its effectiveness remains limited.

Methods: Study Start: 1/1/2025, Study End: 12/31/2025. The objective of this study was to evaluate the longitudinal changes in paraspinal muscle morphology after NSSD treatment. Twenty-one participants (11 females, 10 males) with pre- and post-treatment MRIs treated at the USF Health Chiropractic Clinic, Department of Neurosurgery, Brain & Spine. Participants received NSSD using the DRX9000® targeting L4 (n = 12) or L5 (n = 9), with a median of 20 sessions (range: 19–26). The main outcome measures were Pain (0–10), Oswestry Disability Index (ODI, 0–50), and MRI-derived paraspinal muscle metrics obtained using the MuscleMap Toolbox. Associations between MRI metrics and patient-reported outcomes were assessed using Spearman correlations.

Results: Pain improved by 3.23 ± 1.51 points from a baseline of 5.43 ± 1.33 (p < 0.001). ODI improved by 10.83 ± 8.86 points (n = 12) from 15.22 ± 7.49 (p = 0.001). No significant group-level changes were observed in MRI-derived muscle morphology following NSSD. In females, ΔODI was strongly correlated with ΔPain (ρ = 0.79, p = 0.019). Across all participants, there were no correlations between ΔODI or ΔPain with muscle cross-sectional area. Female-only analyses revealed significant associations between improvements in patient-reported outcomes and reductions in intramuscular fat in the erector spinae, multifidus, and quadratus lumborum.

Conclusion: Pain and disability improved following NSSD treatment but there were no group-level changes in paraspinal muscle morphology. However, female participants who experienced greater functional improvement demonstrated reductions in intramuscular fat, suggesting potential sex-specific muscle-quality adaptations that may serve as markers of treatment responsiveness.

Keywords: non-surgical spinal decompression; magnetic resonance imaging; SpineReport; low back pain

Acknowledgements

We would like to thank Dr. Susan Welsh, Dr. Jessie Bexley, and Jamie Pirone from the USF Chiropractic clinic, Dr. Peter Wakeman, Dr. Josh Hassmann, and Dr. Cindy Le from Wakeman Chiropractic, and Dr. Kevin Van Nostrand from Spinal Health and Rehab Integrative Medicine for providing us with the MRIs needed for this study. We would also like to acknowledge Excite Medical, the Florida Department of State Center for Neuromusculoskeletal Research, and the Florida High-Tech Corridor for funding this work.

Funding

This work was funded by the Florida Department of State Center for Neuromusculoskeletal Research and matched funding through the Florida High Tech Corridor and Excite Medical (FHT 24 − 19).

Author information

Authors and Affiliations

Neurosurgery, Brain & Spine, University of South Florida, Tampa, FL, USA

Jacob A Connolly & Nathan D Schilaty

Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA

Jacob A Connolly & Nathan D Schilaty

Perioperative and Pain Medicine, Stanford University School of Medicine, CA, Palo Alto, USA

Kenneth A Weber II & Eddo O Wesselink

Morsani College of Medicine, University of South Florida, Tampa, FL, USA

Adriana Baez & Anthony Sun

Corresponding author

Correspondence to Nathan D Schilaty.

Ethics declarations

Ethics approval statement

This study was performed in accordance with the Declaration of Helsinki and all relevant institutional and national guidelines and regulations. The protocol was reviewed and approved for retrospective record review by the University of South Florida Institutional Review Board (STUDY004354). Because all MRI images obtained from the USF Neurosurgery, Brain & Spine Chiropractic Division (Tampa, FL), Wakeman Chiropractic (Daytona Beach, FL), and Spinal Health & Rehab (Punta Gorda, FL) were fully de-identified before analysis, the requirement for informed consent was waived by the University of South Florida Institutional Review Board.

Consent for publication

Not Applicable.

Competing interests

This work was funded by Excite Medical, the manufacturer of the DRX9000, with matched funding via the Florida High-Tech Corridor (Schilaty ND). Excite Medical recognizes that under University policy the results of sponsored research must be publishable and agrees that the University Project Director or other University employees engaged in the project are permitted to present at symposia and professional meetings and to publish in journals, theses or dissertations, or otherwise of their own choosing, the data, methods, and results of the project either positive or negative. All other authors (Connolly JA, Weber KA II, Wesselink EO, Baez A, Sun A) have no competing interests to declare.

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