1
|
Soer R, Hofste A, Oosterveld FGJ, Hermens H, van Ravensberg R, Wolff AP, Groen GJ. A guide for standardized interpretation of lumbar multifidus ultrasonography; an observational study. BMC Musculoskelet Disord 2022; 23:680. [PMID: 35842637 PMCID: PMC9288015 DOI: 10.1186/s12891-022-05590-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background Inconsistent descriptions of Lumbar multifidus (LM) morphology were previously identified, especially in research applying ultrasonography (US), hampering its clinical applicability with regard to diagnosis and therapy. The aim of this study is to determine the LM-sonoanatomy by comparing high-resolution reconstructions from a 3-D digital spine compared to standard LM-ultrasonography. Methods An observational study was carried out. From three deeply frozen human tissue blocks of the lumbosacral spine, a large series of consecutive photographs at 78 μm interval were acquired and reformatted into 3-D blocks. This enabled the reconstruction of (semi-)oblique cross-sections that could match US-images obtained from a healthy volunteer. Transverse and oblique short-axis views were compared from the most caudal insertion of LM to L1. Results Based on the anatomical reconstructions, we could distinguish the LM from the adjacent erector spinae (ES) in the standard US imaging of the lower spine. At the lumbosacral junction, LM is the only dorsal muscle facing the surface. From L5 upwards, the ES progresses from lateral to medial. A clear distinction between deep and superficial LM could not be discerned. We were only able to identify five separate bands between every lumbar spinous processes and the dorsal part of the sacrum in the caudal anatomical cross-sections, but not in the standard US images. Conclusion The detailed cross-sectional LM-sonoanatomy and reconstructions facilitate the interpretations of standard LM US-imaging, the position of the separate LM-bands, the details of deep interspinal muscles, and demarcation of the LM versus the ES. Guidelines for electrode positioning in EMG studies should be refined to establish reliable and verifiable findings. For clinical practice, this study can serve as a guide for a better characterisation of LM compared to ES and for a more reliable placement of US-probe in biofeedback. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05590-5.
Collapse
Affiliation(s)
- Remko Soer
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, the Netherlands. .,University of Groningen, University Medical Center Groningen, Pain Center, Groningen, The Netherlands. .,University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands.
| | - Anke Hofste
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, the Netherlands.,University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands
| | - Frits G J Oosterveld
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, the Netherlands
| | - Hermie Hermens
- Roessingh Research and Development, Telemedicine Group, Enschede, the Netherlands.,Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Ricardo van Ravensberg
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, the Netherlands
| | - André P Wolff
- University of Groningen, University Medical Center Groningen, Pain Center, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands
| | - Gerbrand J Groen
- University of Groningen, University Medical Center Groningen, Pain Center, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands
| |
Collapse
|