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Schönnagel L, Zhu J, Camino-Willhuber G, Guven AE, Tani S, Caffard T, Haffer H, Muellner M, Chiapparelli E, Arzani A, Amoroso K, Moser M, Shue J, Tan ET, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Relationship between lumbar spinal stenosis and axial muscle wasting. Spine J 2024; 24:231-238. [PMID: 37788745 DOI: 10.1016/j.spinee.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND CONTEXT Although the effect of lumbar spinal stenosis (LSS) on the lower extremities is well documented, limited research exists on the effect of spinal stenosis on the posterior paraspinal musculature (PPM). Similar to neurogenic claudication, moderate to severe spinal canal compression can also interfere with the innervation of the PPM, which may result in atrophy and increased fatty infiltration (FI). PURPOSE This study aims to assess the association between LSS and atrophy of the PPM. STUDY DESIGN Retrospective cross-sectional study. PATIENT SAMPLE Patients undergoing MRI scans at a tertiary orthopedic center for low back pain or as part of a preoperative evaluation. OUTCOME MEASURES The functional cross-sectional area (fCSA) and percent fatty infiltration (FI) of the PPM at L4. METHODS Lumbar MRIs of patients at a tertiary orthopedic center indicated due to lower back pain (LBP) or as a presurgical workup were analyzed. Patients with previous spinal fusion surgery or scoliosis were excluded. LSS was assessed according to the Schizas classification at all lumbar levels. The cross-sectional area of the PPM was measured on a T2-weighted MRI sequence at the upper endplate of L4. The fCSA and fatty infiltration (FI) were calculated using custom software. Crude differences in FI and fCSA between patients with no stenosis and at least mild stenosis were tested with the Wilcoxon signed-rank test. To account for possible confounders, a multivariable linear regression model was used to adjust for age, sex, body mass index (BMI), and disc degeneration. A subgroup analysis according to MRI indication was performed. RESULTS A total of 522 (55.7% female) patients were included. The median age was 61 years (IQR: 51-71). The greatest degree of moderate and severe stenosis was found at L4/5, 15.7%, and 9.2%, respectively. Stenosis was the least severe at L5/S1 and was found to be 2% for moderate and 0.2% for severe stenosis. The Wilcoxon test showed significantly increased FI of the PPM with stenosis at any lumbar level (p<.001), although no significant decrease in fCSA was observed. The multivariable regression model showed a significant increase in FI with increased LSS at L1/2, L2/3, and L3/4 (p=.013, p<.01 and p=.003). The severity of LSS at L4/5 showed a positive association with the fCSA (p=.019). The subgroup analysis showed, the effect of LSS was more pronounced in nonsurgical patients than in patients undergoing surgery. CONCLUSIONS In this study, we demonstrated a significant and independent association between LSS and the composition of the PPM, which was dependent on the level of LSS relative to the PPM. In addition to neurogenic claudication, patients with LSS might be especially susceptible to axial muscle wasting, which could worsen LSS due to increased spinal instability, leading to a positive feedback loop.
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Affiliation(s)
- Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | | | - Ali E Guven
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA; Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA.
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Hou X, Hu H, Kong C, Zhang S, Wang W, Lu S. Psoas muscle index and psoas muscle density are associated with functional status in patients with degenerative lumbar spinal stenosis. J Back Musculoskelet Rehabil 2024:BMR230138. [PMID: 38306020 DOI: 10.3233/bmr-230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND The factors affecting lumbar spinal function in patients with degenerative lumbar spinal stenosis (DLSS) are still unclear. OBJECTIVE This study explored psoas major muscle morphology in patients with DLSS and its association with their functional status. METHODS A retrospective study was conducted on 288 patients with DLSS and 260 control subjects. Psoas major muscle evaluation included three morphometric parameters at the L3/4 disc level: psoas major index (PMI), muscle attenuation, and psoas major morphological changes (MPM). The association between psoas major morphology and functional status was assessed using the Oswestry disability index (ODI). RESULTS Both female and male patients with DLSS had a higher PMI and lower muscle attenuation. PMI and muscle attenuation were inversely correlated with age in the DLSS group. After multivariable analyses, the PMI and psoas major muscle attenuation were positively correlated with patients' functional status. CONCLUSION The PMI and muscle attenuation were positively correlated with functional status in patients with DLSS. These findings have important implications for physiotherapy programs of postoperative rehabilitation and conservative management of DLSS.
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Affiliation(s)
- Xiaofei Hou
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hailiang Hu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sitao Zhang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
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Corazzelli G, Capece M, Meglio V, Leonetti S, Pizzuti V, Ricciardi F, D'Elia A, Santilli M, Innocenzi G. Multiple univariate analysis of radiologic and clinical features on 168 patients with lumbar spinal stenosis: what is the role of the erector spinae in the development of a patient's disability? Acta Neurochir (Wien) 2023; 165:3947-3957. [PMID: 37932635 DOI: 10.1007/s00701-023-05863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The weakening of paraspinal muscles in the paravertebral area may play a role in developing central lumbar spinal stenosis, resulting in lower back discomfort. OBJECTIVE The study thoroughly examined the correlation between the Oswestry Disability Index, Dural Sac cross-sectional area, Schizas grading Scale, Body Mass Index, and the cross-sectional areas of Erector Spinae, Multifidus, and Psoas muscles. The findings were also compared between patients with central Lumbar Spinal Stenosis and healthy individuals. STUDY DESIGN Retrospective monocentric observational study. METHODS The study recruited 168 consecutive patients aged 60 or older diagnosed with central Lumbar Spinal Stenosis between January 2020 and July 2022. The patients' condition was evaluated by administering a preoperative Oswestry Disability Index questionnaire, measuring their Body Mass Index, and performing preoperative Magnetic Resonance Imaging. The analyzed parameters were the cross-sectional area of paraspinal muscles at the L4-L5 level, dural sac cross-sectional area, and Schizas grading Scale at the most stenotic level, using multiple linear univariate analyses. Two groups of healthy individuals were recruited: Group A (under 60 years old) and Group B (over 60 years old). The same data extrapolated from these groups were compared with those of patients with central lumbar stenosis using a two-tailed Mann-Whitney test. RESULTS As the Erector Spinae degenerates, the Oswestry Disability Index tends to increase. Similarly, an increase in Body Mass Index is often accompanied by a decrease in the cross-sectional area of the Erector Spinae. Low dural sac cross-sectional area is statistically linked to a reduced Multifidus cross-sectional area. Interestingly, the Schizas grading scale does not appear to correlate with changes in the cross-sectional area of the paraspinal muscles. Additionally, there is no significant difference in the cross-sectional area of the Psoas muscle between individuals with central lumbar spinal stenosis and healthy individuals. CONCLUSIONS Our study found that degeneration of the Erector Spinae plays a crucial role in the progression of perceived disability in Lumbar Spinal Stenosis. Prospective studies should investigate the long-term evolution of paraspinal muscles in decompressed patients.
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Affiliation(s)
- Giuseppe Corazzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy.
| | - Mara Capece
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Vincenzo Meglio
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | | | | | | | | | - Marco Santilli
- Department of Neurology, IRCCS Neuromed, (IS), Pozzilli, Italy
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Muellner M, Haffer H, Chiapparelli E, Dodo Y, Shue J, Tan ET, Zhu J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine. BMC Musculoskelet Disord 2023; 24:846. [PMID: 37891498 PMCID: PMC10604445 DOI: 10.1186/s12891-023-06967-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The function of the paraspinal muscles and especially the psoas muscle in maintaining an upright posture is not fully understood. While usually considered solely as a hip flexor, the psoas muscle and its complex anatomy suggest that the muscle has other functions involved in stabilizing the lumbar spine. The aim of this study is to determine how the psoas muscle and the posterior paraspinal muscles (PPM; erector spinae and multifidus) interact with each other. METHODS A retrospective review including patients undergoing posterior lumbar fusion surgery between 2014 and 2021 at a tertiary care center was conducted. Patients with a preoperative lumbar magnetic resonance imaging (MRI) scan performed within 12 months prior to surgery were considered eligible. Exclusion criteria included previous spinal surgery at any level, lumbar scoliosis with a Cobb Angle > 20° and patients with incompatible MRIs. MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA) and the fat area (FAT) at L4 was conducted. The degree of fat infiltration (FI) was further calculated. FI thresholds for FIPPM were defined according to literature and patients were divided into two groups (< or ≥ 50% FIPPM). RESULTS One hundred ninetypatients (57.9% female) with a median age of 64.7 years and median BMI of 28.3 kg/m2 met the inclusion criteria and were analyzed. Patients with a FIPPM ≥ 50% had a significantly lower FI in the psoas muscle in both sexes. Furthermore, a significant inverse correlation was evident between FIPPM and FIPsoas for both sexes. A significant positive correlation between FATPPM and fCSAPsoas was also found for both sexes. No significant differences were found for both sexes in both FIPPM groups. CONCLUSION As the FIPPM increases, the FIPsoas decreases. Increased FI is a surrogate marker for a decrease in muscular strength. Since the psoas and the PPM both segmentally stabilize the lumbar spine, these results may be indicative of a potential compensatory mechanism. Due to the weakened PPM, the psoas may compensate for a loss in strength in order to stabilize the spine segmentally.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA.
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
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Qazi SA, Qazi RA, Ahmed T, Rehman L, Javeed F, Aziz HF. The diagnostic accuracy of straight leg raise test in patients more than 60 years of age suffering lumbar disk herniation with low back pain and sciatica. J Neurosci Rural Pract 2023; 14:610-614. [PMID: 38059256 PMCID: PMC10696343 DOI: 10.25259/jnrp_97_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/09/2023] [Indexed: 12/08/2023] Open
Abstract
Objective To determine the diagnostic accuracy of the SLR test in elderly patients suffering from lumbar disk herniation with sciatica and low back pain, using magnetic resonance imaging (MRI) as the gold standard. Materials and Methods A cross-sectional study was conducted at Jinnah Postgraduate Medical Center and a total of 120 patients, above 60 years of age, with symptomatic lumbar disk herniation were enrolled. SLR test was performed and the results recorded. MRI of the lumbar spine was undertaken for confirmation of disk herniation. Results The sensitivity of the SLR test in patients 60 years and older is 33.3%. A decrease in the diagnostic accuracy of the SLR test with an increment in age was also noted. Conclusion It was found that with an increment in age, there is a steady decline in the diagnostic accuracy of SLR Test.
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Affiliation(s)
- Sana Akbar Qazi
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Rabail Akbar Qazi
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Tanweer Ahmed
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Lal Rehman
- Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Farrukh Javeed
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Hafiza Fatima Aziz
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
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Suo M, Zhang J, Sun T, Wang J, Liu X, Huang H, Li Z. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med 2023; 55:2258922. [PMID: 37722876 PMCID: PMC10512810 DOI: 10.1080/07853890.2023.2258922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration. OBJECTIVES The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research. METHODS We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions. RESULTS The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice. CONCLUSION The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.
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Affiliation(s)
- Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
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Muellner M, Haffer H, Moser M, Amoroso K, Wang Z, Arzani A, Tan ET, Chiapparelli E, Dodo Y, Shue J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Changes of the posterior paraspinal and psoas muscle in patients with low back pain: a 3-year longitudinal study. 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 2023; 32:3290-3299. [PMID: 37378708 DOI: 10.1007/s00586-023-07814-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time. METHODS Patients with LBP who had a repeat lumbar MRI with a minimum of 3-years apart at a tertiary referral center were analyzed. MRI-based quantitative assessments of the PPM and the psoas muscle were conducted for the baseline and follow-up MRI. The cross sectional area (CSA), the functional cross sectional area (fCSA) and the fat area (FAT) were calculated using a dedicated software program. The fatty infiltration (FI,%) of the regions of interest was calculated. Differences between the 1st and 2nd MRI were calculated for all assessed muscular parameters. RESULTS A total of 353 patients (54.4%female) with a median age of 60.1 years and BMI of 25.8 kg/m2 at baseline were analyzed. The mean time between the 1st and 2nd MRI was 3.6 years. The fCSAPPM declined in both sexes significantly from the 1st to the 2nd MRI, whereas the FATPPM increased. In line with this result, the FIPPM increased in both males (29.9%) and females (19.4%). Females had a higher FIPPM and FIPsoas than males in both MRIs. In females, no significant changes were found for the psoas muscle. The CSAPsoas and fCSAPsoas in males were significantly smaller in the 2nd MRI. With increasing age, a significant trend in a decrease in ∆FIPPM was observed for both sexes. CONCLUSION The study revealed significant quantitatively muscular changes in males and females, especially in the posterior paraspinal muscles in only three years' time.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Zhaorui Wang
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Artine Arzani
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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Naruse M, Fountain WA, Claiborne A, Finch WH, Trappe S, Trappe TA. Muscle group-specific skeletal muscle aging: a 5-yr longitudinal study in septuagenarians. J Appl Physiol (1985) 2023; 134:915-922. [PMID: 36892888 PMCID: PMC10069956 DOI: 10.1152/japplphysiol.00769.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
There is some evidence that the age-associated change in skeletal muscle mass is muscle specific, yet the number of specific muscles that have been studied to form our understanding in this area is limited. In addition, few aging investigations have examined multiple muscles in the same individuals. This longitudinal investigation compared changes in skeletal muscle size via computed tomography of the quadriceps (rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius), hamstrings (biceps femoris short and long heads, semitendinosus, and semimembranosus), psoas, rectus abdominis, lateral abdominals (obliques and transversus abdominis), and paraspinal muscles (erector spinae and multifidi) of older individuals from the Health, Aging, and Body Composition (Health ABC) study at baseline and 5.0 ± 0.1 years later (n = 469, 73 ± 3 yr and 78 ± 3 yr, 49% women, 33% black). Skeletal muscle size decreased (P < 0.05) in quadriceps (-3.3%), hamstrings (-5.9%), psoas (-0.4%), and rectus abdominis (-7.0%). The hamstrings and rectus abdominis atrophied approximately twice as much as the quadriceps (P < 0.05), whereas the quadriceps atrophied substantially more than the psoas (P < 0.05). The lateral abdominals (+5.9%) and paraspinals (+4.3%) hypertrophied (P < 0.05) to a similar degree (P > 0.05) over the 5 years. These data suggest that older individuals experience skeletal muscle atrophy and hypertrophy in a muscle group-specific fashion in the eighth decade, a critical time period in the aging process. A broader understanding of muscle group-specific skeletal muscle aging is needed to better guide exercise programs and other interventions that mitigate decrements in physical function with aging.NEW & NOTEWORTHY These longitudinal analyses of six muscle groups in septuagenarians provide novel information on the muscle group-specific aging process. Although the quadriceps, hamstrings, psoas, and rectus abdominis atrophied with different magnitudes, the lateral abdominals and paraspinals hypertrophied over the 5 years. These findings contribute to a better understanding of the skeletal muscle aging process and highlight the need to complete studies in this area with a muscle-specific focus.
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Affiliation(s)
- Masatoshi Naruse
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - William A Fountain
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Alex Claiborne
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - W Holmes Finch
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Todd A Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
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Abbas J, Yousef M, Peled N, Hershkovitz I, Hamoud K. Predictive factors for degenerative lumbar spinal stenosis: a model obtained from a machine learning algorithm technique. BMC Musculoskelet Disord 2023; 24:218. [PMID: 36949452 PMCID: PMC10035245 DOI: 10.1186/s12891-023-06330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Degenerative lumbar spinal stenosis (DLSS) is the most common spine disease in the elderly population. It is usually associated with lumbar spine joints/or ligaments degeneration. Machine learning technique is an exclusive method for handling big data analysis; however, the development of this method for spine pathology is rare. This study aims to detect the essential variables that predict the development of symptomatic DLSS using the random forest of machine learning (ML) algorithms technique. METHODS A retrospective study with two groups of individuals. The first included 165 with symptomatic DLSS (sex ratio 80 M/85F), and the second included 180 individuals from the general population (sex ratio: 90 M/90F) without lumbar spinal stenosis symptoms. Lumbar spine measurements such as vertebral or spinal canal diameters from L1 to S1 were conducted on computerized tomography (CT) images. Demographic and health data of all the participants (e.g., body mass index and diabetes mellitus) were also recorded. RESULTS The decision tree model of ML demonstrate that the anteroposterior diameter of the bony canal at L5 (males) and L4 (females) levels have the greatest stimulus for symptomatic DLSS (scores of 1 and 0.938). In addition, combination of these variables with other lumbar spine features is mandatory for developing the DLSS. CONCLUSIONS Our results indicate that combination of lumbar spine characteristics such as bony canal and vertebral body dimensions rather than the presence of a sole variable is highly associated with symptomatic DLSS onset.
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Affiliation(s)
- Janan Abbas
- Department of Physical Therapy, Zefat Academic College, 13206, Zefat, Israel.
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
| | - Malik Yousef
- Department of Information Systems, Zefat Academic College, Zefat, Israel
| | - Natan Peled
- Department of Radiology, Carmel Medical Center, 3436212, Haifa, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Kamal Hamoud
- Department of Physical Therapy, Zefat Academic College, 13206, Zefat, Israel
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10
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Hou X, Hu H, Kong C, Li Y, Zhang S, Wang W, Lu S. Correlation of psoas major muscle morphology with function and clinical symptoms in patients with symptomatic multilevel lumbar spinal stenosis. J Orthop Surg Res 2023; 18:111. [PMID: 36793071 PMCID: PMC9933294 DOI: 10.1186/s13018-023-03596-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE This study was performed to quantify the morphological characteristics of the psoas major muscle in patients with symptomatic multilevel degenerative lumbar spinal stenosis (SMLSS) and assess the correlations of these morphological characteristics with function and clinical symptoms. METHODS One hundred fourteen patients diagnosed with SMLSS (≥ 3 segments) were included. The patients' presenting symptoms were assessed with the Oswestry Disability Index (ODI), and visual analogue scale (VAS) scores were recorded. The morphology of the psoas major was evaluated at the L3/4 intervertebral disc level in three ways: by measuring (i) the psoas muscle mass index (PMI); (ii) the mean muscle attenuation (Hounsfield units, HU); and (iii) the morphologic change of the psoas major (mean ratios of the short axis to the long axis of the bilateral psoas major). RESULTS Men had a higher PMI than women (p = 0.001). Patients with severe disability had a significantly lower PMI (p = 0.002) and muscle attenuation (p = 0.001). The PMI and muscle attenuation were significantly higher in the patients with no or mild back pain (both p < 0.001). In the univariable and multivariable analyses, a greater HU value was associated with a higher functional status as assessed by the ODI (p = 0.002), and a higher PMI was associated with less severe back pain as measured by the VAS score (p < 0.001). CONCLUSION This study showed that muscle attenuation of psoas major positively correlated with the functional status and PMI negatively correlated with low back pain severity in patients diagnosed with SMLSS. Future prospective studies are needed to evaluate whether improvement in such muscle parameters through physiotherapy programs can alleviate the clinical symptoms and improve the functional status of patients with SMLSS.
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Affiliation(s)
- Xiaofei Hou
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053 People’s Republic of China ,grid.413259.80000 0004 0632 3337China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hailiang Hu
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053 People’s Republic of China
| | - Chao Kong
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053 People’s Republic of China ,grid.413259.80000 0004 0632 3337China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yongjin Li
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053 People’s Republic of China
| | - Sitao Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053 People’s Republic of China
| | - Wei Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053 People’s Republic of China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China. .,China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
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11
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Huang W, Cai XH, Li YR, Xu F, Jiang XH, Wang D, Tu M. The association between paraspinal muscle degeneration and osteoporotic vertebral compression fracture severity in postmenopausal women. J Back Musculoskelet Rehabil 2022; 36:323-329. [PMID: 36155499 PMCID: PMC10041424 DOI: 10.3233/bmr-220059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND According to reports in the literature, osteoporotic vertebral compression fracture (OVCF) is associated with paraspinal muscle degeneration; however, the association between the severity of OVCF and paraspinal muscle degeneration is not clear. OBJECTIVE The purpose of this study was to investigate the association between paraspinal muscle degeneration and OVCF severity in postmenopausal women. METHODS Three hundred and seventy-six MRI images from 47 patients were collected and analyzed. Sagittal and axial coronal T2-weighted images were used to measure the fractured vertebra sagittal cross-sectional area (FSCSA), the adjacent normal vertebral body sagittal cross-sectional area (NSCSA), paraspinal muscle cross-sectional area (CSA), and the fat cross-sectional area (FCSA). The ratio of fractured vertebra compressed sagittal cross-sectional area (RCSA) and fatty infiltration ratio (FIR) was subsequently calculated. The formulas for RCSA and FIR calculations are as follows: RCSA = (NSCSA-FSCSA)/NSCSA; FIR = FCSA/CSA. RCSA and FIR represent the severity of OVCF and paraspinal muscle degeneration, respectively. RESULTS The correlation between paraspinal muscle degeneration and OVCF severity was analyzed using the Pearson correlation, and multiple regression analysis was performed to explore related risk factors. OVCF severity was closely associated with paraspinal muscle degeneration (L3/4 FIR r= 0.704, P< 0.05; L4/5 FIR r= 0.578, P< 0.05; L5/S1 FIR r= 0.581, P< 0.05). Multiple regression analysis demonstrated that the risk factor for OVCF severity was L3/4 FIR (β= 0.421, P= 0.033). CONCLUSION OVCF severity was associated with the FIR of paraspinal muscles, and L3/4 FIR was a predictive factor for OVCF severity in postmenopausal women.
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Affiliation(s)
- Wei Huang
- Hubei University of Chinese Medicine, Wuhan, China.,Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China.,Department of Orthopedics, PLA Middle Military Command General Hospital, Wuhan, China
| | - Xian-Hua Cai
- Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopedics, PLA Middle Military Command General Hospital, Wuhan, China
| | - Yi-Rong Li
- Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China
| | - Feng Xu
- Department of Orthopedics, PLA Middle Military Command General Hospital, Wuhan, China
| | - Xin-Hao Jiang
- Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China
| | - Dan Wang
- Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China
| | - Min Tu
- Department of Spine Surgery, Jingmen No. 2 People's Hospital, Jingmen, Wuhan, China
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12
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Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Spine J 2022; 22:660-676. [PMID: 34718177 DOI: 10.1016/j.spinee.2021.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have proposed that there is a relationship between low back pain (LBP) and morphology and composition of paraspinal muscles. However, results have been conflicting, especially regarding fatty infiltration of muscles. PURPOSE The primary goal of this study was to review and analyze results from imaging studies which investigated morphological and composition changes in the multifidus, erector spinae and psoas major muscles in people with LBP. STUDY DESIGN/SETTING Systematic review with meta-analysis. PATIENT SAMPLE A patient sample was not required OUTCOME MEASURES: This review did not have outcome measures. METHODS PubMed, Scopus, Web of Sciences, EMBASE and ProQuest were searched for eligible studies up to 31st July 2020 (all languages). A systematic search of electronic databases was conducted to identify studies investigating the association between the morphology and fat content of lumbar muscles in people with LBP compared with a (no LBP) control group. 13,795 articles were identified. Based on the screening for inclusion/ exclusion, 25 were included. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. From the 25 articles, 20 were included in the meta-analysis. RESULTS Results showed that the total cross-sectional area of the multifidus was smaller in people with LBP (Standardized mean difference, SMD = -0.24, 95% CI = -0.5 to 0.03). Combined SMDs showed a medium effect of LBP on increasing multifidus muscle fat infiltration (SMD = 0.61, 95% CI = 0.30 to 0.91). There were no LBP related differences identified in the morphology or composition of the lumbar erector spine and psoas major muscles. CONCLUSIONS People with LBP were found to have somewhat smaller multifidus muscles with a significant amount of intramuscular fat infiltration. Varying sample size, age and BMI of participants, quality of studies and the procedures used to measure fat infiltration are possible reasons for inconsistencies in results of previous studies.
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13
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Different degeneration patterns of paraspinal muscles in degenerative lumbar diseases: a MRI analysis of 154 patients. 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 2022; 31:764-773. [PMID: 34978601 DOI: 10.1007/s00586-021-07053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/20/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To evaluate the different degeneration patterns of paraspinal muscles in degenerative lumbar diseases and their correlation with lumbar spine degeneration severity. The degeneration characteristics of different paraspinal muscles in degenerative lumbar diseases remain unclear. METHODS 78 patients diagnosed with single-level degenerative lumbar spondylolisthesis (DLS) and 76 patients with degenerative lumbar kyphosis (DLK) were included as DLS and DLK groups. Paraspinal muscle parameters of psoas major (PS), erector spinae (ES) and multifidus muscle (MF) were measured, including fatty infiltration (FI) and relative cross-sectional area (rCSA), namely the ratio of the paraspinal muscle CSA to the CSA of the vertebrae of the same segment. Sagittal parameters including lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. The paraspinal muscle parameters and ES/MF rCSA ratio were compared between the two groups. Paraspinal muscles parameters including rCSA and FI were also compared between each segments from L1 to L5 in both DLS and DLK groups. In order to determine the influence of sagittal spinal alignment on paraspinal muscle parameters, correlation analysis was conducted between the MF, ES, PS rCSA and FI and the LL in DLS and DLK group. RESULT MF atrophy is more significant in DLS patients compared with DLK. Also, MF fatty infiltration in the lower lumbar spine of DLS patients was greater compared to DLK patients. DLK patients showed more significant atrophy of ES and heavier ES fatty infiltration. MF FI was significantly different between all adjacent segments in both DLS and DLK groups. In DLS group, ES FI was significantly different between L2/L3 to L3/L4 and L4/L5 to L5/S1, while in DLK group, the difference of ES FI between all adjacent segments was not significant, and ES FI was found negatively correlated with LL. CONCLUSIONS Paraspinal muscles show different degeneration patterns in degenerative lumbar diseases. MF degeneration is segmental in both DLS and DLK patients, while ES degenerated diffusely in DLK patients and correlated with the severity of kyphosis. MF degeneration is more significant in the DLS group, while ES degeneration is more significant in DLK patients. MF is the stabilizer of the lumbar spine segments, while the ES tends to maintain the spinal sagittal balance.
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Han G, Zou D, Liu Z, Zhou S, Li W, Gong C, Sun Z, Li W. Paraspinal muscle characteristics on MRI in degenerative lumbar spine with normal bone density, osteopenia and osteoporosis: a case-control study. BMC Musculoskelet Disord 2022; 23:73. [PMID: 35057764 PMCID: PMC8780389 DOI: 10.1186/s12891-022-05036-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background To investigate the difference of paraspinal muscles in patients with normal bone density, osteopenia and osteoporosis. Methods Patients undergoing surgery for lumbar spinal stenosis were included. Thirty-eight patients with osteoporosis were matched to patients with osteopenia and patients with normal bone density in a 1:1 manner according to WHO criteria. Dual-energy X-ray absorptiometry (DXA) scans and lumbar CT were performed preoperatively to measure the BMD of lumbar, femur and hip and HU values of L1-L4 respectively. The relative total cross-sectional area (rTCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured at L4–5 and L5-S level on preoperative MRI. Results Osteoporotic patients showed lower BMI, higher MF FI and higher ES FI when compared with normal bone density group (25.57 ± 3.71 vs 27.46 ± 3.11; 0.38 ± 0.1 vs 0.32 ± 0.08; 0.33 ± 0.1 vs 0.28 ± 0.08; all adjusted p < 0.05). Both the MF FI and ES FI were significantly correlated with lumbar T-score (r = − 0.223, p < 0.05; r = − 0.208, p < 0.05) and the averaged lumbar HU value (r = − 0.305, p < 0.01; r = − 0.239, p < 0.05). Conclusions Osteoporosis and paraspinal muscle degeneration might interact with each other and coexist in patients with degenerative lumbar diseases. It is recommended that the paraspinal muscle degeneration should be considered simultaneously when finding a patient with low bone mass before surgery.
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15
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Hodges PW, Bailey JF, Fortin M, Battié MC. Paraspinal muscle imaging measurements for common spinal disorders: review and consensus-based recommendations from the ISSLS degenerative spinal phenotypes group. 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; 30:3428-3441. [PMID: 34542672 DOI: 10.1007/s00586-021-06990-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Paraspinal muscle imaging is of growing interest related to improved phenotyping, prognosis, and treatment of common spinal disorders. We reviewed issues related to paraspinal muscle imaging measurement that contribute to inconsistent findings between studies and impede understanding. METHODS Three key contributors to inconsistencies among studies of paraspinal muscle imaging measurements were reviewed: failure to consider possible mechanisms underlying changes in paraspinal muscles, lack of control of confounding factors, and variations in spinal muscle imaging modalities and measurement protocols. Recommendations are provided to address these issues to improve the quality and coherence of future research. RESULTS Possible pathophysiological responses of paraspinal muscle to various common spinal disorders in acute or chronic phases are often overlooked, yet have important implications for the timing, distribution, and nature of changes in paraspinal muscle. These considerations, as well as adjustment for possible confounding factors, such as sex, age, and physical activity must be considered when planning and interpreting paraspinal muscle measurements in studies of spinal conditions. Adoption of standardised imaging measurement protocols for paraspinal muscle morphology and composition, considering the strengths and limitations of various imaging modalities, is critically important to interpretation and synthesis of research. CONCLUSION Study designs that consider physiological and pathophysiological responses of muscle, adjust for possible confounding factors, and use common, standardised measures are needed to advance knowledge of the determinants of variations or changes in paraspinal muscle and their influence on spinal health.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Jeannie F Bailey
- Department of Orthopedic Surgery, University of California, San Francisco, CA, USA
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, Western University, London, ON, Canada
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16
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Ragurajaprakash K. Vertical spinal instability – Advanced neuromuscular therapy protocol. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Sheldon BL, DiMarzio M, Chung SH, Tram J, Khazen O, Staudt MD, Bondoc M, Pilitsis JG. Association of Outcomes of Spinal Cord Stimulation for Chronic Low Back Pain and Psoas Measurements Based on Size of Iliopsoas Muscles. Neuromodulation 2021; 25:121-127. [PMID: 33616289 DOI: 10.1111/ner.13375] [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] [Received: 11/16/2020] [Revised: 01/02/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients experience variable long-term improvement in chronic back pain despite successful spinal cord stimulation (SCS) trials. Iliopsoas (IP) size has been shown to differ between patients with low back pain and healthy controls. In this study, we examine whether IP muscle cross-sectional area (CSA) is associated with SCS outcomes. MATERIALS AND METHODS We examined patients for whom we had lumbar MRIs 6.3 years prior to SCS and had baseline and one-year outcome data. Percent change from baseline to one year was calculated for Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ). Correlations between IP muscle CSA, ratio of iliopsoas muscle size to the vertebral body area (P/VBA), and the ratio of iliopsoas muscle size to BMI (P/BMI) were examined. Sex differences were considered. RESULTS A total of 73 subjects were included in this study including 30 females and 43 males. Males had significantly larger IP (males 15.70 ± 0.58, females 9.72 ± 0.43; p < 0.001), P/VBA (males 1.00 ± 0.04, females 0.76 ± 0.03, p < 0.001) and P/BMI ratio (males 0.51 ± 0.02, females 0.32 ± 0.01; p < 0.001) than females. In females, P/VBA predicted NRS worst pain scores (β = 0.82, p = 0.004, r2 = 0.55) and BDI (β = 0.59, p = 0.02, r2 = 0.24). In males, P/BMI was a significant predictor of BDI outcomes scores (β = 0.45, p = 0.03, r2 = 0.16). Males who had more muscle mass measured by iliopsoas size had more depression as measured using BDI (p = 0.03, r = 0.61). Females with less muscle mass measured by P/VBA also experienced more depression (p = 0.02, r = 0.74). CONCLUSIONS Our study showed that psoas measurements correlated with various pain outcomes specifically. P/VBA was most predictive in females and P/BMI in males. Depression correlated with P/BMI, reinforcing the complex relationship between depression and constant chronic pain. Tertile analyses further showed a relationship between iliopsoas CSA and depression in males and females. We provide preliminary data of sex-specific psoas measurements as a risk factor for worse SCS outcomes.
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Affiliation(s)
- Breanna L Sheldon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Sung Hwan Chung
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Justin Tram
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Melanie Bondoc
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical College, Albany, NY, USA
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18
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Hofste A, Soer R, Hermens HJ, Wagner H, Oosterveld FGJ, Wolff AP, Groen GJ. Inconsistent descriptions of lumbar multifidus morphology: A scoping review. BMC Musculoskelet Disord 2020; 21:312. [PMID: 32429944 PMCID: PMC7236939 DOI: 10.1186/s12891-020-03257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
Background Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature. Methods Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system. Results In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings – particularly for levels L4–S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases. Discussion Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas. Conclusions We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology.
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Affiliation(s)
- Anke Hofste
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands. .,Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands.
| | - Remko Soer
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands.,Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.,Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
| | - Heiko Wagner
- Department of Movement Science, Institute of Sport and Exercise Sciences, Münster, Germany
| | - Frits G J Oosterveld
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - André P Wolff
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands
| | - Gerbrand J Groen
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands
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Longitudinal Analysis of Paraspinal Muscle Cross-Sectional Area During Early Adulthood - A 10-Year Follow-Up MRI Study. Sci Rep 2019; 9:19497. [PMID: 31862980 PMCID: PMC6925288 DOI: 10.1038/s41598-019-56186-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022] Open
Abstract
Only a few previous studies have investigated paraspinal musculature (i.e., multifidus (MF), psoas major (PSM), erector spinae (ES)) in longitudinal, population-based settings. This study aimed to evaluate changes in the cross-sectional area (CSA) of the paraspinal muscles between the ages of 20 and 30 years. The study population consisted of a sub-cohort from the Northern Finland Birth Cohort 1986 (n = 298; 156 men, 142 women). Baseline magnetic resonance imaging was performed at a mean age of 21.3 years and follow-up imaging at 30.6 years. The CSA measurements were performed by tracing the paraspinal muscle outlines individually (MF, ES, PM) and all combined (total muscle area (TMA)) at the L4 cranial endplate level. The longitudinal data analysis was performed using generalized estimating equations modelling. The CSA of MF and ES increased during the follow-up among both sexes (men: MF + 5.7%, p < 0.001; ES + 2.7%, p = 0.001; and women: MF + 10.5%, p < 0.001; ES 9.2%, p = 0.001). The CSA of PM decreased among men (PM −4.0%, p < 0.001) but not among women (PM + 0.5%, p = 0.553). TMA increased significantly only among women (men: +0.5%, p = 0.425; women: +6.5%, p < 0.001). The increases in ES and TMA were more distinct among women than men (p < 0.001). Our study demonstrated clear age- and sex-related changes in paraspinal muscle size in early adulthood.
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Heo JY, Park JH, Lim SA, Shim SW, Choi YS. Feasibility of Using Fat Degeneration of Lumbar Extensor Muscle as an Alternative Diagnostic Criterion for Sarcopenia in Patients with Osteoporotic Vertebral Fractures. Asian Spine J 2019; 14:320-326. [PMID: 31711061 PMCID: PMC7280914 DOI: 10.31616/asj.2019.0044] [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: 02/08/2019] [Accepted: 04/17/2019] [Indexed: 12/04/2022] Open
Abstract
Study Design Feasibility study. Purpose To investigate the feasibility of using fat degeneration of lumbar extensor muscle (LEM) as an alternative diagnostic criterion for sarcopenia in patients with osteoporotic vertebral fractures. Overview of Literature Although sarcopenia has been gaining increased attention among researchers and healthcare practitioners, there is uncertainty about the association between sarcopenia and fat degeneration of LEM. Methods In this study, 33 patients with osteoporotic vertebral fractures (group 1) and 29 patients without such fractures (group 2) were enrolled. Sarcopenia was diagnosed in accordance with the Asian Working Group for Sarcopenia (AWGS) criteria, including assessment of extremity muscle mass using dual-energy X-ray absorptiometry, grip strength, and gait speed. The bone mineral density and fat degeneration of LEM were investigated using magnetic resonance imaging. Results The mean rates of fat degeneration of LEM and the skeletal muscle index were 38.3% and 5.5 kg/m2 in group 1 and 28.9% and 6.3 kg/m2 in group 2, respectively. The fat degeneration of LEM was negatively correlated with gait speed (r=−0.44, p=0.01) and handgrip strength (r=−0.37, p=0.01). The fat degeneration of LEM also demonstrated a significant relationship with osteoporotic vertebral fractures (p=0.01). Receiver operating characteristic curve analysis between fat degeneration of LEM and osteoporotic vertebral fractures showed that the cut-off value of fat degeneration was 31.9% (sensitivity=0.67, specificity=0.66). There was a positive correlation between sarcopenia defined by the AWGS and that defined by the 31.90% cut-off value of fat degeneration of LEM instead of extremity muscle mass (r=0.46, p=0.01). Conclusions These results suggest the feasibility of using fat degeneration of LEM as an alternative diagnostic criterion for sarcopenia in patients with osteoporotic vertebral fractures. A cut-off value of fat degeneration of LEM of 31.9% was shown to be useful for diagnosing osteoporotic vertebral fractures.
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Affiliation(s)
- Ju-Yeong Heo
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Ji-Hun Park
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sung-An Lim
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Seung-Woo Shim
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Yong-Soo Choi
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Pourahmadi M, Asadi M, Dommerholt J, Yeganeh A. Changes in the macroscopic morphology of hip muscles in low back pain. J Anat 2019; 236:3-20. [PMID: 31475359 DOI: 10.1111/joa.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2019] [Indexed: 01/11/2023] Open
Abstract
Low back pain is a major health issue affecting the lumbopelvic muscles. Morphological changes in hip muscles, such as alterations in the muscle cross-sectional area and muscle volume, may occur in patients with low back pain. This systematic review was conducted to investigate whether patients with low back pain have macroscopic changes in their hip muscle morphology compared with asymptomatic, healthy individuals, based on current evidence. The electronic databases of PubMed/Medline, Ovid, Scopus, Embase® , and Google Scholar were searched from the inception to August 31, 2018. We only included full texts of original studies regarding macroscopic morphological alterations, including atrophy and fat infiltration, in hip muscles of patients with low back pain compared with asymptomatic controls. The quality of the included studies was determined using an assessment tool based on the Newcastle-Ottawa Scale. The scale was modified for the purposes of this study. Sixteen comparative observational studies were found eligible to be included in this review. Eleven were classified as high quality and four as moderate quality. The morphological changes in the psoas major, gluteus maximus, gluteus medius, gluteus minimus, and piriformis muscles were assessed in the primary studies. All selected studies were considered B level of evidence studies. The strength of conclusions for the psoas major, gluteal, and piriformis muscles was moderate. The results revealed that there is substantial controversy about the morphological changes in hip muscles in patients with low back pain; however, the majority of high-quality studies concluded that atrophy of hip muscles is evident in patients with low back pain. The psoas major muscle was the most commonly investigated hip muscle for morphological changes. Major methodological limitations of the included studies were identified and discussed. The present systematic review does not include a formal meta-analysis because of very significant differences in the primary studies in terms of study populations and methodologies. Finally, in clinical practice, it is recommended that physical therapists develop exercise programs to improve hip muscle function in patients with low back pain.
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Affiliation(s)
- Mohammadreza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Asadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Yeganeh
- Trauma and Injury Research Center, Rasoul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Eguchi Y, Toyoguchi T, Inage K, Fujimoto K, Orita S, Suzuki M, Kanamoto H, Abe K, Norimoto M, Umimura T, Sato T, Koda M, Furuya T, Aoki Y, Nakamura J, Akazawa T, Takahashi K, Ohtori S. Analysis of skeletal muscle mass in women over 40 with degenerative lumbar scoliosis. 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 2018; 28:1618-1625. [DOI: 10.1007/s00586-018-5845-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 11/17/2018] [Accepted: 11/27/2018] [Indexed: 01/06/2023]
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Cooley JR, Walker BF, M Ardakani E, Kjaer P, Jensen TS, Hebert JJ. Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis. BMC Musculoskelet Disord 2018; 19:351. [PMID: 30261870 PMCID: PMC6161433 DOI: 10.1186/s12891-018-2266-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/18/2018] [Indexed: 12/26/2022] Open
Abstract
Background Individual study results have demonstrated unclear relationships between neurocompressive disorders and paraspinal muscle morphology. This systematic review aimed to synthesize current evidence regarding the relationship lumbar neurocompressive disorders may have with lumbar paraspinal muscle morphology. Methods Searches were conducted in seven databases from inception through October 2017. Observational studies with control or comparison groups comparing herniations, facet degeneration, or canal stenosis to changes in imaging or biopsy-identified lumbar paraspinal muscle morphology were included. Data extraction and risk of bias assessment were performed by review author pairs independent of one another. Morphological differences between individuals with and without neurocompressive disorders were compared qualitatively, and where possible, standardised mean differences were obtained. Results Twenty-eight studies were included. Lumbar multifidus fiber diameter was smaller on the side of and below herniation for type I [SMD: −0.40 (95% CI = −0.70, −0.09) and type II fibers [SMD: −0.38 (95% CI = −0.69, −0.06)] compared to the unaffected side. The distribution of type I fibers was greater on the herniation side [SMD: 0.43 (95% CI = 0.03, 0.82)]. Qualitatively, two studies assessing small angular fiber frequency and fiber type groupings demonstrated increases in these parameters below the herniation level. For diagnostic imaging meta-analyses, there were no consistent differences across the various assessment types for any paraspinal muscle groups when patients with herniation served as their own control. However, qualitative synthesis of between-group comparisons reported greater multifidus and erector spinae muscle atrophy or fat infiltration among patients with disc herniation and radiculopathy in four of six studies, and increased fatty infiltration in paraspinal muscles with higher grades of facet joint degeneration in four of five studies. Conflicting outcomes and variations in study methodology precluded a clear conclusion for canal stenosis. Conclusions Based on mixed levels of risk of bias data, in patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level. As the variability of study quality and heterogeneous approaches utilized to assess muscle morphology challenged comparison across studies, we provide recommendations to promote uniform measurement techniques for future studies. Trial registration PROSPERO 2015: CRD42015012985 Electronic supplementary material The online version of this article (10.1186/s12891-018-2266-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey R Cooley
- School of Health Professions, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia.
| | - Bruce F Walker
- School of Health Professions, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - Emad M Ardakani
- School of Health Professions, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, DK, Denmark
| | - Tue S Jensen
- Spine Centre of Southern Denmark, Ostre Hougvej 55, 5500, Middelfart, DK, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230, Odense M, DK, Denmark.,Department of Diagnostic Imaging, Regional Hospital Silkeborg, Falkevej 1-3, 8600, Silkeborg, DK, Denmark
| | - Jeffrey J Hebert
- Faculty of Kinesiology, University of New Brunswick, 3 Bailey Drive, Fredericton, New Brunswick, E3B 5A3, Canada.,School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
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Seo YG, Park WH, Lee CS, Kang KC. Lumbar Extensor Muscle Size and Isometric Muscle Strength in Women with Symptomatic Lumbar Degenerative Diseases. Asian Spine J 2018; 12:943-950. [PMID: 30213179 PMCID: PMC6147876 DOI: 10.31616/asj.2018.12.5.943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/05/2018] [Indexed: 11/25/2022] Open
Abstract
Study Design A cross-sectional design. Purpose To determine the characteristics of lumbar extensor muscle (LEM) size and isometric muscle strength and examine their correlations in women with lumbar degenerative diseases (LDDs). Overview of Literature Many studies have evaluated the relationship between muscle size and strength, but the results have been controversial. Methods Seventy-four female patients (mean age, 66 years) who consecutively underwent posterior lumbar interbody fusion (L1–S1) were recruited. The cross-sectional area (CSA) of the back extensor muscles was measured between L1–2 to L5–S1, and the total sum of the CSAs at each disc level was calculated. Back extensor muscle strength was evaluated using a MedX lumbar extension machine. The Oswestry Disability Index (ODI, 0–100) and Visual Analog Scale (VAS, 0–10) of lower back pain were determined. Results The mean CSAs of the LEM at each level (L1/2–L5/S1) and the total sum were 34.3, 36.3, 35.1, 31.4, 21.9, and 156.2 cm2, respectively. The mean isometric strength at each angle (range, 0°–72°) was 32.5, 50.1, 72.0, 88.7, 100.7, 112.2, and 126.2 ft-lb, respectively. The mean ODI and VAS scores were 54.6 and 6.6, and the mean body weight and body mass index (BMI) were 59.9 kg and 24.9 kg/m2, respectively. The CSAs of the upper lumbar level (L1–4) and the total sum of the CSAs were associated with isometric strength, which was negatively correlated with patients’ age and ODI and positively associated with body weight and BMI, mainly at higher lumbar flexion angles (48°–72°). Conclusions In women with LDD, LEM sizes of the upper lumbar levels (L1–4) were larger than those of the lower levels (L4–S1) and were positively associated with muscle strength. The upper lumbar levels in patients with LDDs appear to play a compensatory role when degenerative lesions are present in the lower lumbar levels.
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Affiliation(s)
- Yong Gon Seo
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Hah Park
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Suh Lee
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Chung Kang
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Correlation of texture analysis of paraspinal musculature on MRI with different clinical endpoints: Lumbar Stenosis Outcome Study (LSOS). Eur Radiol 2018; 29:22-30. [DOI: 10.1007/s00330-018-5552-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/09/2018] [Accepted: 05/21/2018] [Indexed: 01/03/2023]
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Jiang J, Wang H, Wang L, Zhang B, Guo Q, Yuan W, Lu X. Multifidus Degeneration, A New Risk Factor for Lumbar Spinal Stenosis: A Case-Control Study. World Neurosurg 2016; 99:226-231. [PMID: 27931946 DOI: 10.1016/j.wneu.2016.11.142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/26/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To analyze whether multifidus degeneration has a relationship with degenerative lumbar spinal stenosis (LSS). MATERIALS AND METHODS Clinical data of 40 patients with LSS were analyzed retrospectively. Moreover, 40 healthy people were selected as controls. Subjects of both groups underwent a 1.5-T lumbar spinal magnetic resonance imaging scan in our hospital, and then the multifidus muscularity, fatty infiltration ratio, and bilateral asymmetry at L4/5 level on magnetic resonance imaging were measured with ImageJ software to analyze and compare the multifidus parameters between the 2 groups. RESULTS Compared with the control group, the multifidus muscularity was lower, fatty infiltration ratio was greater, and muscle asymmetry was more significant at the L4/5 level in patients with LSS, and the difference between the 2 groups was statistically significant. CONCLUSIONS Multifidus degeneration, including reduced volume, increased fatty infiltration, and bilateral muscle asymmetry, has an association with LSS.
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Affiliation(s)
- Jiayao Jiang
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Haibin Wang
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Liang Wang
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Bangke Zhang
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Qunfeng Guo
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Wen Yuan
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China.
| | - Xuhua Lu
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China.
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Nasrala Neto E, Bittencourt WS, Nasrala MLS, Oliveira ALLD, Souza ACGD, Nascimento JFD. Correlations between low back pain and functional capacity among the elderly. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1981-22562016019.150227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To investigate the association between low back pain and functional capacity among non-institutionalized elderly persons. Method: A cross-sectional observational study of non-institutionalized elderly persons was performed. The Timed Up and Go (TUG) and Sitting-Rising Test (SRT) functional tests were used, together with the Roland Morris Disability Questionnaire (RMDQ). Result: A total of 99 elderly persons of both genders were included. Kendall’s Correlation analysis showed a significant correlation between the RMDQ and the SRT scores for the act of sitting (p=0.001) and the act of lifting (p=0.028). Despite the statistical significance, these two variables were weakly correlated (r=-239;r=-163). The results also identified a statistically significant correlation between the TUG and SRT tests for the act of sitting (r=-222; p=0.003) and the act of lifting (r=-206; p=0.006). Conclusion: It was observed that most of the non-institutionalized elderly persons had good functional capacity. It is also possible to affirm that there is an association between low back pain and functional capacity.
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