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Yang F, Liu Z, Zhu Y, Zhu Q, Zhang B. Imaging of muscle and adipose tissue in the spine: A narrative review. Medicine (Baltimore) 2022; 101:e32051. [PMID: 36626484 PMCID: PMC9750571 DOI: 10.1097/md.0000000000032051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Interpretation of the morphology and characteristics of soft tissues, such as paravertebral muscles and fat, has always been a "relative blind spot" in the spine. The imaging features of the non-bony structures of the spine have been studied and reinterpreted, and changes in the non-bony structure are associated with spinal disease. Soft tissue parameters such as, the "paraspinal muscle cross-sectional area," "subcutaneous fat thickness," and the "paraspinal muscle fat infiltration rate" on computed tomography, magnetic resonance imaging and other imaging techniques are reproducible in the diagnosis, treatment and prognosis of spinal disorders and have the potential for clinical application. In addition, focus on the association between sarcopenia and spinal epidural lipomatosis with spinal disorders is increasing. Currently, there is no summary of studies on fat and muscle in the spinal region. Given this, within the context of recent research trends, this article provides a synthesis of research on adipose and muscle tissue in the spine, discusses advances in the study of the imaging manifestations of these structures in spinal disorders, and expands the perspectives.
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Affiliation(s)
- Fan Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhengang Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuhang Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qingsan Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Boyin Zhang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
- * Correspondence: Boyin Zhang, Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun 130033, China (e-mail: )
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Extra-Neural Metastases of Late Recurrent Myxopapillary Ependymoma to Left Lumbar Paravertebral Muscles: Case Report and Review of the Literature. Brain Sci 2022; 12:brainsci12091227. [PMID: 36138961 PMCID: PMC9497216 DOI: 10.3390/brainsci12091227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
Ependymomas are commonly classified as low-grade tumors, although they may harbor a malignant behavior characterized by distant neural dissemination and spinal drop metastasis. Extra-CNS ependymoma metastases are extremely rare and only few cases have been reported in the lung, lymph nodes, pleura, mediastinum, liver, bone, and diaphragmatic, abdominal, and pelvic muscles. A review of the literature yielded 14 other case reports metastasizing outside the central nervous system, but to our knowledge, no studies describe metastasis in the paravertebral muscles. Herein, we report the case of a 39-year-old patient with a paraspinal muscles metastasis from a myxopapillary ependymoma. The neoplasm was surgically excised and histologically and molecularly analyzed. Both the analyses were consistent with the diagnosis of muscle metastases of myxopapillary ependymoma. The here-presented case report is first case in the literature of a paraspinal muscles metastasis of myxopapillary ependymoma.
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Böning G, Hartwig T, Freyhardt P, de Bucourt M, Teichgräber U, Streitparth F. MR-guided lumbar facet radiofrequency denervation for treatment of patients with chronic low back pain in an open 1.0 Tesla MRI system. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1056. [PMID: 34422968 PMCID: PMC8339805 DOI: 10.21037/atm-21-633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/29/2021] [Indexed: 01/20/2023]
Abstract
Background To evaluate the feasibility, safety and efficacy of magnetic resonance imaging (MRI)-guided lumbar facet joint radiofrequency denervation (FRD) in patients with chronic low back pain. Methods The study consisted of two parts. First, a preclinical analysis using an ex vivo animal model was performed to define optimal technical parameters for ablation. Then, 17 patients with chronic lumbar facet joint pain syndrome were prospectively included and underwent MRI-guided FRD in an open 1.0-Tesla MRI. We analyzed technical feasibility and complications as well as clinical outcome in terms of subjective pain assessed on a numerical visual analogue scale (VAS) before and after 1 week/6 months after FRD. Clinical assessment was complemented by measurement of paravertebral muscle volume and fat content before the intervention and at 6-month follow-up. Results All interventions were technically successful without major complications. Initial VAS scores (median: 8, IQR: 1, range: 6-9, CI: 7.14-8.04) decreased significantly both after one week (median: 4, IQR: 5, range: 0-7, CI: 1.9-4.69, P=0.003) and after 6 months (median: 1, IQR: 6, range: 0-7, CI: 1.06-4.23, P<0.001). Mean multifidus muscle volume increased significantly in the patient population (from 366.8±130.8 cm3 before to 435.4±146.7 cm3 after FRD, P=0.031). Conclusions This proof of principle study shows MRI-guided FRD in an open 1.0-Tesla MRI system to be a potential therapy option for patients with chronic low back pain.
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Affiliation(s)
- Georg Böning
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tony Hartwig
- Department of Musculoskeletal Surgery, Vivantes Hospital Spandau, Berlin, Germany
| | - Patrick Freyhardt
- Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | - Maximilian de Bucourt
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulf Teichgräber
- Department of Radiology, Friedrich-Schiller-University, Jena, Germany
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3D analysis of fatty infiltration of the paravertebral lumbar muscles using T2 images-a new approach. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2570-2576. [PMID: 33740146 DOI: 10.1007/s00586-021-06810-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 02/07/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Factors influencing paraspinal muscle degeneration are still not well understood. Fatty infiltration is known to be one main feature of the degeneration cascade. The aim of this cross-sectional study was to illustrate the 3D cluster of paraspinal lumbar muscle degeneration on T2-weighted MRI images using our newly developed software application 'iSix'. METHODS Mono- (Mm. rotatores), multi- (Mm. multifidus) and pluri-segmental (M. erector spinae) lumbar muscles groups were segmented on T2-weighted MR sequences using a novel computer-assisted technique for quantitative muscle/fat discrimination. The degree of fatty infiltration of the three predefined muscle groups was compared on a 3-dimensional basis, with regard to segment involvement and age. General linear models were utilized for statistical comparison. RESULTS N = 120 segments (age: 52.7; range 16-87 years) could be included. The overall relative fatty infiltration of the mono-segmental muscles was higher (21.1 14.5%) compared to the multi-segmental (16.0 8.8% p = 0.049) and pluri-segmental muscles (8.5 8.0%; p = 0.03). Mono-segmental muscles on the levels L4/5 (22.9 ± 10.2 [CI 17.6-28.2] %) and L5/S1 (27.01 ± 15.1 [CI 21.4-32.7] %) showed a significant higher amount of fat compared to the levels L2/3 (8.2 ± 6.8 [CI 2.2-14.2] %; L4/5 vs. L2/3, p = 0.03; L5/S1 vs. L2/3, p = 0.02) and L3/4 (13.2 ± 5.4 [CI 8.6-17.7]%; L4/5 vs. L3/4, p = 0.02; L5/S1 vs. L3/4, p < 0.01). Multivariate linear regression analyses revealed age and Pfirrmann grade as independent factors for fatty muscle degeneration. CONCLUSIONS 3D analysis of fatty infiltration is an innovative tool to study lumbar muscle degeneration. Mono-segmental muscles are more severely affected by degeneration compared to multi-/pluri-segmental muscles, especially at the L4/5 and L5/S1 level. Age and disc degeneration independently correlate with muscle degeneration.
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Waheed W, Allison JB, Dewitt J, Hallman S, Tandan R. Axial muscle weakness. Pract Neurol 2020; 21:practneurol-2020-002736. [PMID: 33262222 DOI: 10.1136/practneurol-2020-002736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/04/2022]
Abstract
Axial myopathy is a rare neuromuscular disorder characterised by selective involvement of the paraspinal muscles, and presenting either as a bent spine and/or dropped head syndrome. The axial muscles can be involved in various conditions, including neuromuscular disease, movement disorders, spinal disease and metabolic disorders. There have been recent descriptions of disorders with selective axial muscle involvement, but overall axial myopathy remains under-recognised. Here, we review disorders of axial muscle function, provide guidance on interpreting axial muscles imaging and suggest a diagnostic algorithm to evaluate patients with axial muscles weakness.
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Affiliation(s)
- Waqar Waheed
- Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - John Dewitt
- Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Sharon Hallman
- Physical Therapy, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Rup Tandan
- Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
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Bahadir Ulger FE, Illeez OG. The Effect of Lumbosacral Transitional Vertebrae (LSTV) on Paraspinal Muscle Volume in Patients with Low Back Pain. Acad Radiol 2020; 27:944-950. [PMID: 31806558 DOI: 10.1016/j.acra.2019.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if psoas, multifidus, and erector spina muscle volume at intervertebral disc levels differ in patients with lumbosacral transitional vertebrae (LSTV) and low back pain (LBP), and in LBP patients without LSTV. MATERIALS AND METHODS This retrospective study included 101 patients that underwent lumbar spinal MRI due to LBP. The patients were divided into two groups according to the presence of LSTV, as those with LSTV (LSTV group) and those without LSTV (control group). Those in the LSTV group were classified according to Castellvi classification, and whether or not LSTV was bilateral or unilateral. The lumbar lordosis angle was measured using sagittal T2-weighted MR images. Axial T2-weighted images were used to bilaterally measure psoas, multifidus, and erector spina muscle volume at intervertebral disc levels. RESULTS Among the 101 participants, 33 were male (32.7%) and 68 were female (67.3%). Left multifidus muscle volume at the L4-5 level was significantly lower in the LSTV group than in the control group (p = 0.033). Right and left erector spina muscle volume at the L5-S1 level was significantly lower in the LSTV group than in the control group (right side: p = 0.010; left side: p = 0.003). The mean lumbar lordosis angle was 47.54 ± 12.69° in the LSTV group, versus 35.34 ± 11.53° in the control group (p < 0.001). There were not any significant differences in psoas, multifidus, or erector spina muscle volume between the patients with unilateral and bilateral LSTV (p > 0.05). CONCLUSION The present findings indicate that paraspinal muscle volume can be used to understand LSTV symptomatology.
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Affiliation(s)
- Fatma Esra Bahadir Ulger
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, E5 Highway Icerenkoy-Atasehir, 34752 Istanbul, Turkey.
| | - Ozge Gulsum Illeez
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Soares CO, Pereira BF, Pereira Gomes MV, Marcondes LP, de Campos Gomes F, de Melo-Neto JS. Preventive factors against work-related musculoskeletal disorders: narrative review. Rev Bras Med Trab 2020; 17:415-430. [PMID: 32368676 DOI: 10.5327/z1679443520190360] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/05/2019] [Indexed: 11/05/2022] Open
Abstract
Musculoskeletal disorders (MSDs) are major causes of morbidity among workers. They comprise several signs and symptoms, as e.g. pain, paresthesia, fatigue and limited range of motion, which can be related to work tasks. Workplace-related factors include physical, psychological, social and biomechanical hazards. The main kinetic factors associated with MSDs include repetitive movements, exerting excessive force, awkward postures, compression and mechanical vibration. Accurate knowledge of epidemiological aspects, evaluation of ergonomic hazards and musculoskeletal symptoms, and workplace exercise may help reduce the occurrence of MSDs. The aim of the present review is to analyze the applicability of preventive strategies against MSDs among workers. We performed a narrative review based on a survey of databases PubMed and BIREME and included studies published in English, Spanish or Portuguese. We found that workplace exercise is beneficial for both employers and workers. Risk analysis of MSDs is essential for early identification of occupational hazards and to prevent health consequences and costs associated with absenteeism.
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Affiliation(s)
| | | | | | - Laís Passos Marcondes
- Physical Therapy, Centro Universitário de Rio Preto - São José do Rio Preto (SP), Brazil
| | - Fabiana de Campos Gomes
- Health Sciences, Faculdade de Medicina de São José do Rio Preto - São José do Rio Preto (SP), Brazil
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Slunsky P, Brunnberg M, Loderstedt S, Haake A, Brunnberg L. Effect of intraoperative positioning on postoperative neurological status in cats after perineal urethrostomy. J Feline Med Surg 2019; 21:931-937. [PMID: 30392433 PMCID: PMC11132246 DOI: 10.1177/1098612x18809188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate and quantify the changes in neurological status in cats after perineal urethrostomy performed in dorsal and ventral recumbency. METHODS This was a prospective, randomised study. Twenty male castrated cats with feline lower urinary tract disease presented for perineal urethrostomy were enrolled in this study. Surgery was performed in either dorsal recumbency (group A) or ventral recumbency (group B). Motor response of patellar tendon, gastrocnemius muscle, pelvic limb withdrawal and perineal reflexes, as well as the presence of spinal pain in the lumbosacral region, motor function of the tail and faecal continence, were examined before surgery, and 24 h and 14 days after surgery. RESULTS The animals had a mean weight of 5.07 ± 1.08 kg, with a mean age of 6.12 ± 1.85 years. Weight and age were not significantly different between groups A and B (both P = 0.897). All tested parameters of the neurological examination performed prior to surgery were considered normal in both groups (P = 1). The comparison between neurological examinations (perineal reflex and spinal pain) before and 24 h after surgery revealed a significantly decreased briskness of the perineal reflex and an increased occurrence of spinal pain 24 h after surgery (P = 0.043 and P = 0.031, respectively). However, the changes of aforementioned parameters were statistically insignificant (P = 0.249 and P = 0.141) between groups A and B. The other parameters (patellar tendon, pelvic limb withdrawal and gastrocnemius muscle reflexes, motor function of the tail and faecal continence) were statistically insignificant (P = 1) before surgery and 24 h after surgery, as well as between groups A and B 24 h after surgery. Results of all tested parameters were statistically insignificant (P = 1) before surgery and 14 days after surgery, as well as between groups A and B 14 days after surgery. CONCLUSIONS AND RELEVANCE The briskness of the perineal reflex was significantly decreased and the occurrence of spinal pain significantly increased 24 h after surgery. A parallel with a low-grade positioning-dependent nerve injury as described in human medicine may be drawn. However, no positioning method was proven to be superior to the other.
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Affiliation(s)
- Pavel Slunsky
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Mathias Brunnberg
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Shenja Loderstedt
- Small Animal Clinic, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Alexander Haake
- Justus Liebig University Giessen, Department of Veterinary Medicine, Giessen, Hesse, Germany
| | - Leo Brunnberg
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
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Wesselink E, de Raaij E, Pevenage P, van der Kaay N, Pool J. Fear-avoidance beliefs are associated with a high fat content in the erector spinae: a 1.5 tesla magnetic resonance imaging study. Chiropr Man Therap 2019; 27:14. [PMID: 30918625 PMCID: PMC6419476 DOI: 10.1186/s12998-019-0234-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Intramuscular adipose tissue (IMAT) is a feature of degenerative muscle composition and is a common feature in populations with chronic low back pain (CLBP). Avoidance behavior is a possible cause of morphological muscle composition due to disuse of the paraspinal muscles. Therefore it is of clinical interest to determine the association between fear-avoidance beliefs and IMAT of the paraspinal muscles in populations with CLBP. Methods In this cross-sectional study, we examined twenty-four adults, featuring a mean age of 48.63 years (SD ± 14.73), with CLBP. Axial T2-weighted Magnetic Resonance Imaging (MRI) images were selected on the same level as the intervertebral disc of segments L4-L5 and L5-S1. After determine the region of interest, the amount of IMAT was measured by an automatic-threshold method to distinguish fat from muscle tissue. Fear-avoidance beliefs were measured with the Fear-Avoidance Beliefs Questionnaire, with regard to Physical Activity (FABQ-PA). Bivariate correlation and multiple regression analysis were used to determine the association between IMAT of the paraspinal muscles and fear-avoidance beliefs. Results There is a significant bivariate association between the FABQ-PA and ES IMAT (r = 0.484, P = 0.017), but not for LMM (r = 0.228, P = 0.284). The association between the FABQ-PA and ES IMAT remained moderate after adjusting for covariates (β = 0.381, P = 0.028). Conclusion Fear-avoidance beliefs are moderately associated with ES IMAT and poorly associated with LMM IMAT in a population with CLBP. Results should be interpreted with caution due to a small and selected study population.
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Affiliation(s)
- Eddo Wesselink
- Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
- Paramedical Centre Fytac, Genemuiden, The Netherlands
| | - Edwin de Raaij
- Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
- the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | | | - Nick van der Kaay
- Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
- Physiotherapy van der Kaay, Leiden, The Netherlands
| | - Jan Pool
- Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
- the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Furtado ARR, Cherubini GB, Taeymans O. Low-field magnetic resonance changes in the paravertebral musculature of dogs with acute intervertebral disc extrusion. J Small Anim Pract 2019; 60:367-373. [PMID: 30701550 DOI: 10.1111/jsap.12979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/24/2018] [Accepted: 11/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the MRI features and prevalence of paravertebral muscle signal intensity changes in dogs with acute intervertebral disc extrusion and to search for associations between the signal changes and clinical history, signalment, neurological examination, serum creatine kinase activity and MRI characteristics of the disc herniation. MATERIALS AND METHODS Medical records and MRI examinations from 688 dogs with surgically confirmed acute intervertebral disc extrusion were reviewed retrospectively. T2-weighted and STIR MRI sequences were available for 276 cases and were examined for paravertebral muscle signal intensity changes. When present, extension, lateralisation and signal characteristics of these changes were recorded. Exclusion criteria were muscle injections 24 hours before MRI scan, trauma and previous spinal surgery. RESULTS Nineteen dogs met the inclusion criteria. There were signal changes in the multifidus muscle, mostly in the thoracolumbar region and often extending caudally from the level of the intervertebral disc herniation. Two cases had paravertebral muscle signal intensity changes in the cervical region. MRI signal changes were seen more frequently in the muscles of non-ambulatory dogs. Clinical history and neuro-examination did not allow differentiation between dogs with and without paravertebral muscle signal intensity changes. CLINICAL SIGNIFICANCE Paravertebral muscle signal intensity changes were observed infrequently in the epaxial musculature of 6.9% dogs with acute intervertebral disc extrusion in both the thoracolumbar and cervical regions. The pathophysiological processes responsible for these MRI changes remain unknown.
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Affiliation(s)
- A R R Furtado
- Dick White Referrals, Six Mile Bottom, Cambridge CB80UH, UK
| | - G B Cherubini
- Dick White Referrals, Six Mile Bottom, Cambridge CB80UH, UK
| | - O Taeymans
- Dick White Referrals, Six Mile Bottom, Cambridge CB80UH, UK
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Creze M, Soubeyrand M, Yue JL, Gagey O, Maître X, Bellin MF. Magnetic resonance elastography of the lumbar back muscles: A preliminary study. Clin Anat 2018; 31:514-520. [DOI: 10.1002/ca.23065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Maud Creze
- Radiology Department; Bicêtre Hospital; APHP France
- Imagerie par Résonance Magnétique Médicale et Multi-Modalités, IR4M, CNRS, Univ Paris-Sud, Université Paris-Saclay; Orsay France
| | | | - Jin Long Yue
- Imagerie par Résonance Magnétique Médicale et Multi-Modalités, IR4M, CNRS, Univ Paris-Sud, Université Paris-Saclay; Orsay France
- Imagerie Moléculaire In Vivo, IMIV, Inserm, CEA, CNRS, Univ Paris-Sud, Université Paris-Saclay; Orsay France
| | - Olivier Gagey
- Orthopedic Department; Bicêtre Hospital; APHP France
| | - Xavier Maître
- Imagerie par Résonance Magnétique Médicale et Multi-Modalités, IR4M, CNRS, Univ Paris-Sud, Université Paris-Saclay; Orsay France
| | - Marie-France Bellin
- Radiology Department; Bicêtre Hospital; APHP France
- Imagerie par Résonance Magnétique Médicale et Multi-Modalités, IR4M, CNRS, Univ Paris-Sud, Université Paris-Saclay; Orsay France
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Muscle Atrophy Measurement as Assessment Method for Low Back Pain Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:437-461. [PMID: 30390264 DOI: 10.1007/978-981-13-1435-3_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Low back pain is one of the most common pain disorders defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, sometimes with accompanying leg pain. The meaning of the symptomatic atrophy of paraspinal muscles and some pelvic muscles has been proved. Nowadays, a need for new diagnostic tools for specific examination of low back pain patients is posited, and it has been proposed that magnetic resonance imaging assessment toward muscle atrophy may provide some additional information enabling the subclassification of that group of patients.
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Phan K, Wang N, Kim JS, Kothari P, Lee NJ, Xu J, Cho SK. Effect of Preoperative Anemia on the Outcomes of Anterior Cervical Discectomy and Fusion. Global Spine J 2017; 7:441-447. [PMID: 28811988 PMCID: PMC5544160 DOI: 10.1177/2192568217699404] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Preoperative anemia has been associated with an increased need for blood transfusions and postoperative complications. The effects of anemia on the outcomes of anterior cervical discectomy and fusion (ACDF) have not been explored. The present study aimed to evaluate the association between preoperative anemia and 30-day complications following ACDF surgery. METHODS Data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2012) was used. Preoperative anemia was defined as hematocrit <39% for males and <36% for females. A bivariate analysis was performed on demographic and perioperative variables. Multivariable logistic regression models were employed, adjusting for patient variables, to identify independent risk factors for complications. RESULTS A total of 3500 patients were included of which 444 (12.7%) were anemic patients. Multivariate analysis was used to quantify the predictive power of anemia on key postoperative outcomes, while controlling for the other statistically significant. Preoperative anemia was found to be a statistically significant predictor of any complication (odds ratio [OR] = 1.853; 95% confidence interval [CI] = 1.17-2.934; P = .0086), pulmonary complications (OR = 3.269; 95% CI = 1.745-6.126; P = .0002), intraoperative blood transfusion (OR = 4.364; 95% CI = 1.48-12.866; P = 0.0076), return to operating theatre (OR = 2.655; 95% CI = 1.539-4.582; P = .0005), and length of hospital stay more than 5 days (OR = 2.151; 95% CI = 1.499-3.085; P < .0001). CONCLUSION Preoperative anemia appears to be a significant predictor of perioperative complications, reoperation, and extended length of hospital stay in patients undergoing elective ACDF. Future studies should explore outcomes of treatment of preoperative anemia prior to surgery to determine the optimal management strategy.
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Affiliation(s)
- Kevin Phan
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia,University of New South Wales, Sydney, New South Wales, Australia
| | - Nelson Wang
- University of Sydney, Sydney, New South Wales, Australia
| | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parth Kothari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathan J. Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Xu
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Samuel K. Cho, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
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Anterior Lumbar Interbody Fusion With and Without an "Access Surgeon": A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2017; 42:E592-E601. [PMID: 27669042 DOI: 10.1097/brs.0000000000001905] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The aim of this study was to investigate the outcomes of anterior lumber interbody fusion (ALIF) with and without an "access surgeon." SUMMARY OF BACKGROUND DATA Anterior approaches for spine operations have become increasingly popular but may often involve unfamiliar anatomy and territory for spine surgeons, potentially placing the patient at risk to a greater proportion of approach-related complications. Thus, many spine surgeons require or prefer the assistance of an "access surgeon" to perform the exposure. However, there has been much debate about the necessity of an "access surgeon." METHODS A systematic search of six databases from inception to April 2016 was performed by two independent reviewers. Meta-analysis was used to pool overall rates, and compare the outcomes of ALIF with an access surgeon and without. RESULTS A total of 58 (8028 patients) studies were included in this meta-analysis. The overall intraoperative complications were similar with and without an "access surgeon." The overall pooled rate of arterial injuries [no access 0.44% vs. access 1.16%, odds ratio (OR) 2.67, P < 0.001], retrograde ejaculation (0.41% vs. 0.96%, OR 2.34, P = 0.005), and ileus (1.93% vs. 2.26%, OR 2.45, P < 0.001) was higher with an "access surgeon." However, the overall pooled rates of peritoneal injury (0.44% vs. 0.16%, OR 0.36, P = 0.034) and neurological injury (0.99% vs. 0.11%, OR 0.11, P < 0.001) were lower with an "access surgeon." Total postoperative complications (5.95% vs. 4.08%, OR 0.67, P < 0.001) were lower with an "access surgeon" along with prosthesis complications (1.59% vs. 0.89%, OR 0.56, P < 0.001) and reoperation rates (2.28% vs. 1.31%, OR 0.57, P < 0.001). CONCLUSION Compared with no access surgeon, the use of an access surgeon was associated with similar intraoperative complication rates, higher arterial injuries, retrograde ejaculation, ileus, and lower prosthesis complications, reoperation rates, and postoperative complications. In cases wherein exposure may be difficult, support from an "access surgeon" should be available. LEVEL OF EVIDENCE 1.
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Salah El-din Mahmoud W, Yousef A, Manssor E, Ahmed S. The relationship between pain and functional disability with morphological changes of psoas major in discogenic low back pain patients. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.8.363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ahmed Yousef
- Chief, Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdul Aziz University, Al-Kharj, KSA, Physics Department, Faculty of Science, South Valley University, Qena, Egypt
| | - E Manssor
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdul Aziz University, Al-Kharj, KSA
| | - Sameh Ahmed
- Lecturer Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Egypt
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Musculoskeletal imaging in preventive medicine. Wien Med Wochenschr 2016; 166:9-14. [PMID: 26819215 DOI: 10.1007/s10354-016-0431-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
The aim is to review the modalities in musculoskeletal imaging with view on the prognostic impact for the patient's and for social outcome and with view on three major fields of preventive medicine: nutrition and metabolism, sports, and patient education. The added value provided by preventive imaging is (1) to monitor bone health and body composition with a broad spectrum of biomarkers, (2) to detect and quantify variants or abnormalities of nerves, muscles, tendons, bones, and joints with a risk of overuse, rupture, or fracture, and (3) to develop radiology reports from the widely used narrative format to structured text and multimedia datasets. The awareness problem is a term for describing the underreporting and the underdiagnosis of fragility fractures in osteoporosis.
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Comparison of location, depth, quality, and intensity of experimentally induced pain in 6 low back muscles. Clin J Pain 2015; 30:800-8. [PMID: 25098553 DOI: 10.1097/ajp.0000000000000026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The pattern of pain originating from experimentally induced low back pain appears diffuse. This may be because sensory information from low back muscles converges, sensory innervation extends over multiple vertebral levels, or people have difficulty accurately representing the painful location on standardized pain maps. OBJECTIVE The aim of this study was to provide insight into the perception of pain from noxious stimulation of a range of low back muscles using novel depth and location measures. METHODS Hypertonic saline (1 mL, 7% NaCl) was injected into bellies of longissimus (LO), quadratus lumborum (QL), superficial multifidus (SM), and deep multifidus (DM) at the level of the fourth lumbar vertebrae (L4) and in SM and DM at L5 using ultrasound guidance over 6 sessions. Fifteen participants reported depth, location, intensity, size, and descriptive quality of pain throughout the painful period (∼14 min). RESULTS Pain was reported deeper (P<0.04) for DML4/L5 compared with SML4/L5, LO and QL; more cranial for LO compared with DML4 and QL (P<0.01); more lateral for LO compared with DML4 (P<0.02); and more lateral for QL compared with all other muscles at L4 (P<0.0001). Pain intensity was higher in DML4/L5 than all other muscles (P<0.04) for ∼3 minutes. Descriptive qualities varied slightly between muscles. DISCUSSION Depth and lateral position may be the most critical descriptors to determine the source of acute lumbar muscular pain. Overlapping regions of pain may be explained by convergence of receptive fields, innervation of multifidus fascicles at multiple lumbar segments, and convergence of sensory input from different muscles to the same sensory cell bodies as demonstrated in the lumbar spine of animal preparations.
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Zimmermann C, Kalepu R, Ponfick M, Reichel H, Cakir B, Zierz S, Gdynia HJ, Kassubek J, Ludolph AC, Rosenbohm A. Histological characterization and biochemical analysis of paraspinal muscles in neuromuscularly healthy subjects. Muscle Nerve 2015; 52:45-54. [PMID: 25307884 DOI: 10.1002/mus.24490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2014] [Indexed: 01/07/2023]
Abstract
INTRODUCTION There are no generally accepted histopathological reference values in paraspinal skeletal muscle biopsies. METHODS We examined multifidii muscle biopsies from 20 neuromuscularly healthy subjects using routine histological stains and biochemical analyses of respiratory chain enzymes. RESULTS Staining showed incomplete myopathic features, such as increased variability in fiber size, type 1 hypertrophy, rounded fiber shape, endomysial fibrosis, and replacement by adipose tissue. Acid phosphatase reaction was positive in up to 35% of the selected muscle fibers. Mitochondrial changes were obvious but revealed no selective age dependence. Reduced complex I, cytochrome c oxidase (COX), and citrate synthase (CS) could be observed. CONCLUSIONS Because the increased variability in morphological details can easily be misinterpreted as myopathic changes, analysis of paraspinal muscles should take into consideration that incomplete myopathic features and reduced oxidative enzyme activities for complex I, COX, and CS are normal variations at this location.
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Affiliation(s)
- Claudia Zimmermann
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Rajakiran Kalepu
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Matthias Ponfick
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Balkan Cakir
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Stephan Zierz
- Department of Neurology, University of Halle, Halle (Saale), Germany
| | - Hans-Jürgen Gdynia
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Angela Rosenbohm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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Heidari P, Farahbakhsh F, Rostami M, Noormohammadpour P, Kordi R. The role of ultrasound in diagnosis of the causes of low back pain: a review of the literature. Asian J Sports Med 2015; 6:e23803. [PMID: 25883773 PMCID: PMC4393543 DOI: 10.5812/asjsm.23803] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 08/01/2014] [Indexed: 11/16/2022] Open
Abstract
Context: Low back pain (LBP) is among the most prevalent musculoskeletal conditions in the developed countries. It is a common problem causing disability and imposing a huge economic burden to individuals and state organizations. Imaging plays an important role in diagnosis of the etiology of LBP. Evidence Acquisition: The electronic databases included: PubMed (1950 to present), Ovid SP Medline (1950 to present) and ISI (1982 to present) and Google Scholar. In every search engine another search was performed using various permutations of the following keywords: ultrasonography, ultrasound imaging, low back pain, back muscles, paraspinal muscles, multifidus, transverse abdominis, muscle size, spinal canal, sacroiliac joint and spondylolisthesis. Results: Magnetic resonance imaging (MRI) is widely used in evaluation of patients with LBP; however, high costs, limited availability and contraindications for its use have restricted MRI utilization. In a quest for a less expensive and readily available tool to investigate LBP, clinicians and researchers found ultrasonography (US) as an alternative. In this review we discuss the US application in diagnosis of some common causes of non-specific chronic LBP. Discussed topics include evaluation of spinal canal diameter, paraspinal and transabdominal muscles, sacroiliac joint laxity, pregnancy related LBP, sacroiliitis, and spondylolisthesis using US in patients with LBP. Conclusions: While the first researches on employing ultrasound in diagnosis of patients with LBP had been focused on spinal canal diameter, recent studies have been mostly performed to evaluate the role of transabdominal and paraspinal muscles on core stability and thereby LBP occurrence. On the other side, Doppler ultrasonography has recently played an important role in objective measurement of joint laxity as a common etiology for LBP. Doppler imaging also in pregnant patients with LBP has been recommended as a safe and sensitive method. As conclusion, according to recent and most prestigious studies, focusing more on transabdominal muscle thickness can be considered as future approach in investigations.
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Affiliation(s)
- Pedram Heidari
- Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Farzin Farahbakhsh
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Departement of Spine, Noorafshar Rehabilitation and Sports Medicine Hospital, Tehran, IR Iran
| | - Mohsen Rostami
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Ramin Kordi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Ramin Kordi, Sports Medicine Research Center, Tehran University of Medical Sciences, P.O.Box: 14395-578, Tehran, IR Iran. Tel: +98-2188630227-8, E-mail:
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Fortin M, Gibbons LE, Videman T, Battié MC. Do variations in paraspinal muscle morphology and composition predict low back pain in men? Scand J Med Sci Sports 2014; 25:880-7. [PMID: 25134643 DOI: 10.1111/sms.12301] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 11/27/2022]
Abstract
This longitudinal study aimed to clarify the longstanding controversy over whether variations in paraspinal muscle morphology (e.g., size, composition and asymmetry) are predictors of low back pain (LBP). A sample of 99 Finnish men were included in this population-based longitudinal study. Data were collected through a structured interview, physical examination and magnetic resonance imaging (MRI). Baseline measurements of the lumbar multifidus and erector spinae muscles were obtained from T2-weighted axial images at L3-L4 and L5-S1, and interview data were obtained at baseline, 1- and 15-year follow-ups. Few of the paraspinal muscle parameters investigated were predictors of change in LBP frequency, intensity or sciatica at 1- and 15-year follow-ups in the population-based sample, and findings were not consistent across muscles and spinal levels. However, greater multifidus and erector spinae fatty infiltration at L5-S1 was associated with a higher risk of having continued, frequent, persistent LBP at 1-year follow-up. None of the relationships observed was confounded by body mass index or the amount of physical activity at work or leisure. This longitudinal study provided evidence that variations in paraspinal muscle morphology on MRI have a limited, if not uncertain, role in the short- and long-term predictions of LBP in men.
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Affiliation(s)
- M Fortin
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - L E Gibbons
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - T Videman
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - M C Battié
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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[Computed tomography and magnetic resonance imaging for painful spinal column: contributions and controversies]. RADIOLOGIA 2011; 53:116-33. [PMID: 21353687 DOI: 10.1016/j.rx.2010.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 10/17/2010] [Accepted: 10/22/2010] [Indexed: 02/05/2023]
Abstract
The use of tomographic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI), to complement or replace plain-film radiography in the study of spine pain is becoming more and more common. The aim of this paper is to provide a general review of the CT and MRI manifestations of the wide spectrum of lesions that can cause pain in the spinal column. This spectrum includes degenerative disease, malalignment, tumors, inflammatory processes, and infectious processes. Precise knowledge and accurate reporting of the findings at CT and MRI are fundamental for clinical decision making in patients with spine pain.
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Ruiz Santiago F, Castellano García M, Guzmán Álvarez L, Tello Moreno M. Computed tomography and magnetic resonance imaging for painful spinal column: contributions and controversies. RADIOLOGIA 2011. [DOI: 10.1016/s2173-5107(11)70006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Jordan B, Eger K, Koesling S, Zierz S. Camptocormia phenotype of FSHD: a clinical and MRI study on six patients. J Neurol 2010; 258:866-73. [PMID: 21165637 DOI: 10.1007/s00415-010-5858-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 11/27/2010] [Accepted: 11/30/2010] [Indexed: 01/05/2023]
Abstract
Recently it has been postulated that there is an atypical facioscapulohumeral muscular dystrophy (FSHD) phenotype with isolated axial myopathy. Involvement of paraspinal and limb muscles was evaluated in six patients with molecularly proven FSHD and a predominant bent spine phenotype. Consistent with the camptocormia phenotype, the most severely affected muscles in all six patients were the thoracic and lumbar spinal tract together with hamstrings. MRI disclosed severe axial muscle degeneration but mostly subclinical involvement of limb muscles. The involvement of hip extensor muscles in FSHD might considerably contribute to the clinical phenotype of camptocormia due to axial muscle involvement.
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Affiliation(s)
- Berit Jordan
- Department of Neurology, Martin-Luther University Halle-Wittenberg, Halle/Saale, Germany.
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