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Shen M, Shen Z, Yang G, Tian X, Zhao H, Wang W, Yang H. The Differences on the Fatty Infiltration of Paraspinal Muscles between Single- and Multiple-level Intervertebral Disc Degeneration in Patients with Lumbar Disc Herniation. Orthop Surg 2024; 16:1999-2010. [PMID: 38952024 PMCID: PMC11293918 DOI: 10.1111/os.14101] [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: 01/20/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE Multiple-level Intervertebral disc degeneration (IDD) in patients with lumbar disc herniation (LDH) is related to postoperative re-herniation and low back pain. Although many investigators believed that there is an interdependence between paraspinal muscles degeneration and IDD, few studies focused on the fatty infiltration of paraspinal muscles on single- and multiple-level IDD in patients with LDH. This study aims to investigate the difference on the fatty infiltration of paraspinal muscles between single- and multiple-levels IDD in patients with LDH. and to explore in patients with LDH whether fatty infiltration is a potential risk factor for multiple-level IDD. METHODS This study was conducted as a retrospective observational analysis of 82 patients with LDH from January 1, 2020 to December 30, 2020 in our hospital were enrolled. Twenty-seven cases had single-level IDD (Group A), and 55 cases had multiple-level IDD (Group B). We measured the mean computed tomography (CT) density value of the paraspinal muscles, including multifidus (MF), erector spinae (ES) and psoas muscle (PM) at each disc from L1 to S1. Subgroups were set to further analyze the odds ratio (OR) of fatty infiltration of paraspinal muscles in different sex and BMI groups. We measured sagittal angles and analyzed the relationships between these angles and IDD. Finally, we use logistic regression, adjusted for other confounding factors, to investigate whether fatty infiltration is an independent risk factor for multi-level IDD. RESULTS The average age in multi-level IDD (51.40 ± 15.47 years) was significantly higher than single-level IDD (33.37 ± 7.10 years). The mean CT density value of MF, ES and PM in single-level IDD was significantly higher than multi-level IDD (all ps < 0.001). There was no significant difference of the mean value of angles between the two groups. No matter being fat (body mass index [BMI] > 24.0 kg/m2) or normal, patients with low mean muscle CT density value of MF and ES are significantly easier to suffer from multiple-level IDD. In the pure model, the average CT density value of the MF, ES and PM is all significantly associated with the occurrence of multi-IDD. However, after adjusting for various confounding factors, only the OR of the average CT density value for MF and ES remains statistically significant (OR = 0.810, 0.834, respectively). CONCLUSIONS In patients with LDH, patients with multiple-level IDD have more severe fatty infiltration of MF and ES than those with single-level IDD. Fatty infiltration of MF and ES are independent risk factors for multiple-level IDD in LDH patients.
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Affiliation(s)
- Minjie Shen
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zhijia Shen
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Suzhou Medical College of Soochow UniversitySuzhouChina
| | - Guanyu Yang
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Suzhou Medical College of Soochow UniversitySuzhouChina
| | - Xin Tian
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Suzhou Medical College of Soochow UniversitySuzhouChina
| | - Hongcheng Zhao
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
- Suzhou Medical College of Soochow UniversitySuzhouChina
| | - Wenhao Wang
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Huilin Yang
- Department of OrthopaedicsThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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Li Z, Chen J, Yang J, Wang R, Wang W. Relationship between paraspinal muscle properties and bone mineral density based on QCT in patients with lumbar disc herniation. BMC Musculoskelet Disord 2024; 25:360. [PMID: 38714980 PMCID: PMC11075372 DOI: 10.1186/s12891-024-07484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Increasing research suggests that paraspinal muscle fat infiltration may be a potential biological marker for the assessment of osteoporosis. Our aim was to investigate the relationship between lumbar paraspinal muscle properties on MRI and volumetric bone mineral density (vBMD) based on QCT in patients with lumbar disc herniation (LDH). METHODS A total of 383 patients (aged 24-76 years, 193 females) with clinically and radiologically diagnosed LDH were enrolled in this retrospective study. The muscle cross-sectional area (CSA) and the proton density fat fraction (PDFF) were measured for the multifidus (MF), erector spinae (ES) and psoas major (PS) at the central level of L3/4, L4/5 and L5/S1 on lumbar MRI. QCT was used to measure the vBMD of two vertebral bodies at L1 and L2 levels. Patients were divided into three groups based on their vBMD values: normal bone density group (> 120 mg/cm3), osteopenia group (80 to 120 mg/cm3) and osteoporosis group (< 80 mg/cm3). The differences in paraspinal muscle properties among three vBMD groups were tested by one-way ANOVA with post hoc analysis. The relationships between paraspinal muscle properties and vBMD were analyzed using Pearson correlation coefficients. Furthermore, the association between vBMD and paraspinal muscle properties was further evaluated using multiple linear regression analysis, with age and sex also included as predictors. RESULTS Among the 383 LDH patients, 191 had normal bone density, 129 had osteopenia and 63 had osteoporosis. In LDH patients, compared to normal and osteopenia group, paraspinal muscle PDFF was significantly greater in osteoporosis group, while paraspinal muscle CSA was lower (p < 0.001). After adjusting for age and sex, it was found that MF PDFF and PS CSA were found to be independent factors influencing vBMD (p < 0.05). CONCLUSION In patients with LDH, paraspinal muscle properties measured by IDEAL-IQ sequence and lumbar MR scan were found to be related to vBMD. There was a correlation between the degree of paraspinal muscle PDFF and decreasing vBMD, as well as a decrease paraspinal muscle CSA with decreasing vBMD. These findings suggest that clinical management should consider offering tailored treatment options for patients with LDH based on these associations.
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Affiliation(s)
- Ze Li
- School of Sports Medicine and Health, Chengdu Sport University, No.2, Tiyuan Road, Chengdu, Sichuan, China
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China
| | - Junrong Chen
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China.
| | - Jian Yang
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China
| | - Ran Wang
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China
| | - Wenbin Wang
- Department of radiology, Sichuan Province Orthopedic Hospital, No.132, West Section of 1st Ring Road, Chengdu, Sichuan, China
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Cooley JR, Jensen TS, Kjaer P, Jacques A, Theroux J, Hebert JJ. Spinal degeneration and lumbar multifidus muscle quality may independently affect clinical outcomes in patients conservatively managed for low back or leg pain. Sci Rep 2024; 14:9777. [PMID: 38684854 PMCID: PMC11059180 DOI: 10.1038/s41598-024-60570-0] [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: 08/17/2023] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
Few non-surgical, longitudinal studies have evaluated the relations between spinal degeneration, lumbar multifidus muscle (LMM) quality, and clinical outcomes. None have assessed the potential mediating role of the LMM between degenerative pathology and 12-month clinical outcomes. This prospective cohort study used baseline and 12-month follow-up data from 569 patients conservatively managed for low back or back-related leg pain to estimate the effects of aggregate degenerative lumbar MRI findings and LMM quality on 12-month low back and leg pain intensity (0-10) and disability (0-23) outcomes, and explored the mediating role of LMM quality between degenerative findings and 12-month clinical outcomes. Adjusted mixed effects generalized linear models separately estimated the effect of aggregate spinal pathology and LMM quality. Mediation models estimated the direct and indirect effects of pathology on leg pain, and pathology and LMM quality on leg pain, respectively. Multivariable analysis identified a leg pain rating change of 0.99 [0.14; 1.84] (unstandardized beta coefficients [95% CI]) in the presence of ≥ 4 pathologies, and a disability rating change of - 0.65 [- 0.14; - 1.16] for each 10% increase in muscle quality, but no effect on back pain intensity. Muscle quality had a non-significant mediating role (13.4%) between pathology and leg pain intensity. The number of different pathologies present demonstrated a small effect on 12-month leg pain intensity outcomes, while higher LMM quality had a direct effect on 12-month disability ratings but no mediating effect between pathology and leg pain. The relations between degenerative pathology, LMM quality, and pain-related outcomes appear complex and may include independent pathways.
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Affiliation(s)
- Jeffrey R Cooley
- College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia.
| | - Tue S Jensen
- Department of Diagnostic Imaging, Regional Hospital Silkeborg, Silkeborg, Denmark
- Spine Centre of Southern Denmark, Middelfart, Denmark
- Chiropractic Knowledge Hub, Odense M, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Health Sciences Research Centre, UCL University College, Odense M, Denmark
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Jean Theroux
- College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - Jeffrey J Hebert
- College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
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Pranata A, Farragher J, Perraton L, El-Ansary D, Clark R, Meyer D, Han J, Mentiplay B, Bryant AL. Impaired Lumbar Extensor Force Control Is Associated with Increased Lifting Knee Velocity in People with Chronic Low-Back Pain. SENSORS (BASEL, SWITZERLAND) 2023; 23:8855. [PMID: 37960555 PMCID: PMC10647238 DOI: 10.3390/s23218855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
The ability of the lumbar extensor muscles to accurately control static and dynamic forces is important during daily activities such as lifting. Lumbar extensor force control is impaired in low-back pain patients and may therefore explain the variances in lifting kinematics. Thirty-three chronic low-back pain participants were instructed to lift weight using a self-selected technique. Participants also performed an isometric lumbar extension task where they increased and decreased their lumbar extensor force output to match a variable target force within 20-50% lumbar extensor maximal voluntary contraction. Lifting trunk and lower limb range of motion and angular velocity variables derived from phase plane analysis in all planes were calculated. Lumbar extensor force control was analyzed by calculating the Root-Mean-Square Error (RMSE) between the participants' force and the target force during the increasing (RMSEA), decreasing (RMSED) force portions and for the overall force error (RMSET) of the test. The relationship between lifting kinematics and RMSE variables was analyzed using multiple linear regression. Knee angular velocity in the sagittal and coronal planes were positively associated with RMSEA (R2 = 0.10, β = 0.35, p = 0.046 and R2 = 0.21, β = 0.48, p = 0.004, respectively). Impaired lumbar extensor force control is associated with increased multiplanar knee movement velocity during lifting. The study findings suggest a potential relationship between lumbar and lower limb neuromuscular function in people with chronic low-back pain.
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Affiliation(s)
- Adrian Pranata
- School of Health and Biomedical Science, RMIT University, Mill Park 3082, Australia; (J.F.); (D.E.-A.)
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn 3122, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China;
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Joshua Farragher
- School of Health and Biomedical Science, RMIT University, Mill Park 3082, Australia; (J.F.); (D.E.-A.)
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Parkville 3052, Australia;
| | - Luke Perraton
- Department of Physiotherapy, Monash University, Frankston 3199, Australia;
| | - Doa El-Ansary
- School of Health and Biomedical Science, RMIT University, Mill Park 3082, Australia; (J.F.); (D.E.-A.)
- Department of Surgery, Royal Melbourne Hospital, Parkville 3052, Australia
| | - Ross Clark
- School of Health, University of Sunshine Coast, Sippy Downs 4556, Australia;
| | - Denny Meyer
- School of Health Sciences, Swinburne University of Technology, Hawthorn 3122, Australia;
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China;
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
- Research Institute for Sports and Exercise, University of Canberra, Bruce 2617, Australia
| | - Benjamin Mentiplay
- LaTrobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora 3086, Australia;
| | - Adam L. Bryant
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Parkville 3052, Australia;
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Liu Z, Dai G, Cao Y, Duan C. Analysis of Degenerative and Isthmic Lumbar Spondylolisthesis from the Difference of Pelvic Parameters and the Degree of Degeneration through Imaging Data. J Pers Med 2023; 13:1420. [PMID: 37763187 PMCID: PMC10532549 DOI: 10.3390/jpm13091420] [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: 07/26/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In previous studies, many imaging analyses have been conducted to explore the changes in the intervertebral disc degeneration (DD), facet joint osteoarthritis (FJOA), L4 inclination angle (L4IA), pelvis-related parameters, lumbar lordosis (LL), and paravertebral muscle (PVM) in the occurrence and development of degenerative spinal diseases via measuring the X-ray, CT, and MRI data of clinical patients. However, few studies have quantitatively investigated the pelvic parameters and the degree of spine degeneration in patients with degenerative lumbar spondylolisthesis (DLS) and isthmic lumbar spondylolisthesis (ILS). This study discusses the changes in the imaging parameters of DLS, ILS, and a control group; explores the correlation between different measurement parameters; and discusses their risk factors. METHODS We evaluated 164 patients with single L4-L5 grade 1 level degenerative lumbar spondylolisthesis (DLS group), 161 patients with single L4-L5 grade 1 level isthmic lumbar spondylolisthesis (ILS group), and 164 patients with non-specific back pain (control group). The grades of DD and FJOA as well as the percentage of the fat infiltration area (%FIA) of multifidus muscle (MM) at the L4-L5 level were measured via CT and MRI. Lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), the L4 inclination angle (L4IA), and sacral slope (SS) were measured via X-ray film, and the differences among the DLS group, ILS group, and control group were analyzed. Furthermore, the risk factors related to the incidences of the DLS and ILS groups were discussed. RESULTS First, the pelvis-related parameters of DLS and ILS patients were 51.91 ± 12.23 and 53.28 ± 11.12, respectively, while those of the control group were 40.13 ± 8.72 (p1 < 0.001, p2 < 0.001). Lumbar lordosis (LL) in DLS patients (39.34 ± 8.57) was significantly lower than in the control group (44.40 ± 11.79, p < 0.001). On the contrary, lumbar lordosis (LL) in the ILS group (55.16 ± 12.31) was significantly higher than in the control group (44.40 ± 11.79, p < 0.001). Secondly, the three groups of patients were characterized by significant variations in the L4 inclination angle (L4IA), disc degeneration (DD), facet joint osteoarthritis (FJOA), pelvis-related parameters, and paravertebral muscle (PVM) (p < 0.05). Finally, logistic regression suggests that the L4IA, FJOA, and PT may be risk factors for the occurrence of DLS, and the occurrence of ILS is correlated with the L4IA, FJOA, DD, PT, and LL. CONCLUSIONS Compared with the control group, there are changes in pelvic parameters, the L4IA, LL, DD, FJOA, and PVM in DLS and ILS patients, and the degree is different. The parameters within the same group are related to each other, and DLS and ILS have different risk factors. The mechanical stability of the spine is affected by the parameter and angle changes, which may be of great significance for explaining the cause of spondylolisthesis, evaluating the health of the lumbar spine, and guiding the lifestyles of patients.
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Affiliation(s)
- Zhide Liu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China (G.D.)
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha 410008, China
| | - Guoyu Dai
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China (G.D.)
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha 410008, China
| | - Yong Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China (G.D.)
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha 410008, China
| | - Chunyue Duan
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China (G.D.)
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha 410008, China
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Wang K, Deng Z, Chen X, Shao J, Qiu L, Jiang C, Niu W. The Role of Multifidus in the Biomechanics of Lumbar Spine: A Musculoskeletal Modeling Study. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010067. [PMID: 36671639 PMCID: PMC9854514 DOI: 10.3390/bioengineering10010067] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/07/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The role of multifidus in the biomechanics of lumbar spine remained unclear. PURPOSE This study aimed to investigate the role of multifidus in the modeling of lumbar spine and the influence of asymmetric multifidus atrophy on the biomechanics of lumbar spine. METHODS This study considered five different multifidus conditions in the trunk musculoskeletal models: group 1 (with entire multifidus), group 2 (without multifidus), group 3 (multifidus with half of maximum isometric force), group 4 (asymmetric multifidus atrophy on L5/S1 level), and group 5 (asymmetric multifidus atrophy on L4/L5 level). In order to test how different multifidus situations would affect the lumbar spine, four trunk flexional angles (0°, 30°, 60°, and 90°) were simulated. The calculation of muscle activation and muscle force was done using static optimization function in OpenSim. Then, joint reaction forces of L5/S1 and L4/L5 levels were calculated and compared among the groups. RESULTS The models without multifidus had the highest normalized compressive forces on the L4/L5 level in trunk flexion tasks. In extreme cases produced by group 2 models, the normalized compressive forces on L4/L5 level were 444% (30° flexion), 568% (60° flexion), and 576% (90° flexion) of upper body weight, which were 1.82 times, 1.63 times, and 1.13 times as large as the values computed by the corresponding models in group 1. In 90° flexion, the success rate of simulation in group 2 was 49.6%, followed by group 3 (84.4%), group 4 (89.6%), group 5 (92.8%), and group 1 (92.8%). CONCLUSIONS The results demonstrate that incorporating multifidus in the musculoskeletal model is important for increasing the success rate of simulation and decreasing the incidence of overestimation of compressive load on the lumbar spine. Asymmetric multifidus atrophy has negligible effect on the lower lumbar spine in the trunk flexion posture. The results highlighted the fine-tuning ability of multifidus in equilibrating the loads on the lower back and the necessity of incorporating multifidus in trunk musculoskeletal modeling.
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Affiliation(s)
- Kuan Wang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Zhen Deng
- Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China
| | - Xinpeng Chen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Jiang Shao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Lulu Qiu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Chenghua Jiang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Wenxin Niu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
- Laboratory of Rehabilitation Engineering and Biomechanics, Department of Rehabilitation Sciences, School of Medicine, Tongji University, Shanghai 200092, China
- Correspondence: ; Tel.: +86-021-65982856
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Libda NI, Bessar AA, Fahmy H, El Sammak AAEA, Tantawy HF. A new equation for correlation of clinical and radiological factors affecting multifidus muscle degeneration in magnetic resonance imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00792-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Multifidus muscle (MF) is one of the back muscles of the spine that is involved in the pathogenesis of low back pain. Its role as a stabilizer of the spine continues to present diagnostic and therapeutic challenges. The degree of MF degeneration is dependent on multiple clinical and radiological factors. We proposed a new equation to predict MF degeneration based upon clinical and radiological changes in magnetic resonance imaging.
Methods
Clinical factors associated with MF degeneration include visual analogue scale (VAS) for pain, body mass index, duration of complaint, age of the patients and the presence of sciatica. Other radiological factors include the number of disc pathologies, neural canal stenosis and facet joint arthropathies, by building a module of a univariate and multivariate linear regression analysis for the parameters affecting MF degeneration score as a dependent variable.
Results
Regarding the univariate and multivariate linear regression for factors affecting MF degeneration, the most common factors associated with increased multifidus score were the duration in years and VAS score in the multivariate analysis model with B value equal to 0.184 according to duration in years and equal to 0.287 with VAS score according to 95% confidence interval.
Conclusion
The equation for multifidus score is a helpful method to predict the degree of MF degeneration in relation to clinical variable.
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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.
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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
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Wilford KF, Mena-Iturriaga MJ, Vugrin M, Wainer M, Sizer PS, Seeber GH. International perspective on healthcare provider gender bias in musculoskeletal pain management: a scoping review protocol. BMJ Open 2022; 12:e059233. [PMID: 35715190 PMCID: PMC9207904 DOI: 10.1136/bmjopen-2021-059233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Chronic pain affects millions of individuals worldwide. Healthcare provider gender bias in the management of these individuals has societal and individual ramifications. Yet, a thorough and comprehensive literature summary on this topic is lacking. Therefore, this study aims to systematically: (1) identify and map the available scientific and grey literature as it relates to healthcare provider gender bias in the assessment, diagnosis and management of (chronic) musculoskeletal pain and (2) identify current gaps that necessitate further research. METHODS AND ANALYSIS This scoping review will be conducted in accordance with recent guidelines, and the results will be reported via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The following databases will be searched: PubMed (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier), CINAHL Complete (Ovid), Academic Search Complete (Ebscohost), Pre-Prints Database (National Library of Medicine) and Rehabilitation Reference Center from inception to August 2022. Additionally, relevant grey literature will be identified. All screening will be done by two independent reviewers during two stages: first title/abstract screening followed by full-text screening. Data will be extracted from the bibliometric, study characteristics, and pain science families of variables. Results will be descriptively mapped, and the frequency of concepts, population, characteristics and other details will be narratively reported. Additionally, results will be presented in tabular and graphical form. ETHICS AND DISSEMINATION As this study will neither involve human subject participation nor utilisation of protected data, ethical approval is not required. This study's methodological approach follows current recommendations. Study findings will be disseminated through conference presentations and international peer-review journal publication. In addition, infographics available in English, Spanish and German will be disseminated. REGISTRATION DETAILS This project will be registered in Open Science Framework prior to data collection.
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Affiliation(s)
- Katherine Fisher Wilford
- College of Rehabilitative Sciences Physical Therapy, University of Saint Augustine - Austin Campus, Austin, Texas, USA
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Maria Jesus Mena-Iturriaga
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Margaret Vugrin
- Preston Smith Library, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Macarena Wainer
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Phillip S Sizer
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Gesine Hendrijke Seeber
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Xiao Y, Fortin M, Ahn J, Rivaz H, Peters TM, Battié MC. Statistical morphological analysis reveals characteristic paraspinal muscle asymmetry in unilateral lumbar disc herniation. Sci Rep 2021; 11:15576. [PMID: 34341427 PMCID: PMC8329062 DOI: 10.1038/s41598-021-95149-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/21/2021] [Indexed: 12/19/2022] Open
Abstract
Growing evidence suggests an association of lumbar paraspinal muscle morphology with low back pain (LBP) and lumbar pathologies. Unilateral spinal disorders provide unique models to study this association, with implications for diagnosis, prognosis, and management. Statistical shape analysis is a technique that can identify signature shape variations related to phenotypes but has never been employed in studying paraspinal muscle morphology. We present the first investigation using this technique to reveal disease-related paraspinal muscle asymmetry, using MRIs of patients with a single posterolateral disc herniation at the L5-S1 spinal level and unilateral leg pain. Statistical shape analysis was conducted to reveal disease- and phenotype-related morphological variations in the multifidus and erector spinae muscles at the level of herniation and the one below. With the analysis, shape variations associated with disc herniation were identified in the multifidus on the painful side at the level below the pathology while no pathology-related asymmetry in cross-sectional area (CSA) and fatty infiltration was found in either muscle. The results demonstrate higher sensitivity and spatial specificity for the technique than typical CSA and fatty infiltration measures. Statistical shape analysis holds promise in studying paraspinal muscle morphology to improve our understanding of LBP and various lumbar pathologies.
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Affiliation(s)
- Yiming Xiao
- Department of Computer Science and Software Engineering, Concordia University, Montreal, Canada. .,PERFORM Centre, Concordia University, Montreal, Canada.
| | - Maryse Fortin
- PERFORM Centre, Concordia University, Montreal, Canada.,Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Joshua Ahn
- Department of Kinesiology, Western University, London, Canada
| | - Hassan Rivaz
- PERFORM Centre, Concordia University, Montreal, Canada.,Department of Electrical and Computer Engineering, Concordia University, Montreal, Canada
| | - Terry M Peters
- Robarts Research Institute, Western University, London, Canada
| | - Michele C Battié
- School of Physical Therapy and Western's Bone and Joint Institute, Western University, London, Canada
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