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Xu F, Zhou S, Sun Z, Jiang S, Han G, Li W. Relationship between the postoperative variations of paraspinal muscles and adjacent-segment degeneration in patients with degenerative lumbar spinal stenosis after posterior instrumented lumbar fusion. J Neurosurg Spine 2024; 40:551-561. [PMID: 38277656 DOI: 10.3171/2023.11.spine23750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/21/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE This study aimed to quantify pre- and postoperative paraspinal muscular variation following posterior lumbar interbody fusion (PLIF) in patients with degenerative lumbar spinal stenosis (DLSS) and measure the association of this variation with adjacent-segment degeneration (ASD). METHODS Data from 149 patients who underwent L4-S1 PLIF for DLSS were collected. Patients were divided into radiologically confirmed ASD and control groups according to follow-up radiological findings. MRI was performed before surgery and at the last follow-up. Muscular parameters including the relative cross-sectional area (rCSA), relative functional cross-sectional area (rFCSA), relative total cross-sectional area (rTCSA), and fatty infiltration (FI) of the multifidus (MF), erector spinae (ES), and psoas major (PM) muscles were measured on preoperative and follow-up L2-S1 MR images. Logistic regression was used to investigate risk factors for ASD. RESULTS The rate of radiological ASD was 42.3% at the final follow-up (mean 25.71 ± 8.35 months). At surgical levels, the rFCSA and rTCSA of the MF and ES muscles decreased. The FI of the MF from L2-3 to L5-S1 and ES muscles at L5-S1 significantly increased after surgery, while the rFCSA and rTCSA of the PM muscle increased and its FI decreased. At adjacent levels, the rFCSA and rTCSA of the MF muscle and rTCSA of the ES muscle decreased and the FI of the MF muscle increased postoperatively (p < 0.05), but the rFCSA and rTCSA of the PM muscle increased and its FI decreased (p < 0.05). The FIs of the MF, ES, and PM muscles at adjacent levels significantly differed between the ASD and control groups. Logistic regression analysis indicated that higher BMI (p = 0.002) and FI of the PM muscle at adjacent levels (p = 0.025) were significant risk factors for ASD. CONCLUSIONS The functional area decreased in the MF and ES muscles and increased in the PM muscle after L4-S1 PLIF. A compensatory postoperative decrease in FI of the PM muscle at the adjacent level was a protective factor for ASD in DLSS patients after PLIF.
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Affiliation(s)
- Fei Xu
- 1Orthopaedic Department, Peking University Third Hospital, Beijing, China
- 2Peking University Health Science Center, Beijing, China
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing, China; and
- 4Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Siyu Zhou
- 1Orthopaedic Department, Peking University Third Hospital, Beijing, China
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing, China; and
- 4Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuoran Sun
- 1Orthopaedic Department, Peking University Third Hospital, Beijing, China
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing, China; and
- 4Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shuai Jiang
- 1Orthopaedic Department, Peking University Third Hospital, Beijing, China
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing, China; and
- 4Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Gengyu Han
- 1Orthopaedic Department, Peking University Third Hospital, Beijing, China
- 2Peking University Health Science Center, Beijing, China
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing, China; and
- 4Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Weishi Li
- 1Orthopaedic Department, Peking University Third Hospital, Beijing, China
- 3Beijing Key Laboratory of Spinal Disease Research, Beijing, China; and
- 4Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
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Sanghani N, Claytor B, Li Y. Electrodiagnostic findings in amyotrophic lateral sclerosis: Variation with region of onset and utility of thoracic paraspinal muscle examination. Muscle Nerve 2024; 69:172-178. [PMID: 38038225 DOI: 10.1002/mus.28012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION/AIMS Limited data exist regarding variation of electrodiagnostic (EDX) findings in amyotrophic lateral sclerosis (ALS) patients with different onset regions and specificity of thoracic paraspinal muscle (TPSP) examination for confirming a diagnosis of ALS. We aimed to demonstrate the variation of EDX features and characterize the utility of TPSP muscle examination in the electrodiagnosis of ALS. METHODS This is a retrospective study of a large cohort of ALS patients who had a comprehensive EDX evaluation. RESULTS The study included 448 patients; all fulfilled the Gold Coast criteria for ALS. The average age at the time of EDX study was 64 years, and 41.1% were women. The onset region was identified as follows: bulbar (N = 149), cervical (N = 127), lumbosacral (N = 162), and other (N = 10). In contrast to limb onset, bulbar-onset patients more frequently demonstrated a pattern of normal or near normal needle electromyography (EMG) (p < .0001) and less frequently had abnormalities on EMG of TPSP (p = .002). Clinical or EDX diagnosis of sensory polyneuropathy was present in 12.6% patients, more frequently in the lumbosacral onset subgroup (p < .03). EMG showed active denervation in 9.6% and chronic denervation in 59% of craniobulbar muscles examined, without observed difference among different onset regions. TPSP showed higher frequencies of active and chronic denervation in ALS than a group of patients with non-ALS neuromuscular disorders. DISCUSSION EDX features may differ among ALS patients of different onset regions. TPSP EMG is highly useful in differentiating ALS from non-ALS neuromuscular disorders while the yield of craniobulbar muscles, especially for active denervation, is low.
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Affiliation(s)
- Nirav Sanghani
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Benjamin Claytor
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yuebing Li
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Ekşi MŞ, Özcan-Ekşi EE. Fatty infiltration of the erector spinae at the upper lumbar spine could be a landmark for low back pain. Pain Pract 2024; 24:278-287. [PMID: 37830410 DOI: 10.1111/papr.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/03/2023] [Accepted: 10/01/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end-plates, and fatty infiltration in their paraspinal muscles. METHODS Consecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age-, gender- and BMI-matched asymptomatic controls. RESULTS Low back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels. CONCLUSION Severe IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration.
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Affiliation(s)
- Murat Şakir Ekşi
- Neurosurgery Clinic, FSM Training and Research Hospital, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, Istanbul, Turkey
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Han G, Wang W, Yue L, Fan Z, Li Z, Li J, Sun Z, Li W. Age-Dependent Differences of Paraspinal Muscle Endurance and Morphology in Chinese Community Population Without Chronic Low Back Pain. Global Spine J 2024; 14:235-243. [PMID: 35584688 PMCID: PMC10676164 DOI: 10.1177/21925682221103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES Our aim was to describe age-dependent changes of lumbar paraspinal muscle endurance and morphology in Chinese healthy population. We also explored the relationship between paraspinals endurance and morphology. METHODS A total of 181 participants from Chinese community population without chronic low back pain were included. The participants were divided into three groups: young (20-39 years old, n = 29), middle (40-59 years old, n = 93), and elderly (≥ 60 years old, n = 59). The Ito test was performed to evaluate the isometric endurance of paraspinal muscles. The total cross-sectional area (TCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES) were measured at L1-L5 levels on magnetic resonance imaging. Physical activity level was evaluated using the physical activity index and comorbidities were assessed by the modified 5-item frailty index. RESULTS The elderly group had a shorter performance time of endurance test than the young group and middle-aged group. Correlation analysis showed that age had a significant correlation with endurance test, the average MF TCSA, MF FI, ES TCSA and ES FI of L1-5. In addition, PAI had a significant correlation with endurance test and MF FI. In multiple linear regression analysis, paraspinals endurance was associated with MF FI, ES FI, physical activity level and comorbidities. CONCLUSION Age-related decreases in paraspinals endurance and TCSA, and an increase in FI were revealed. Besides, paraspinal muscles FI, but not TCSA, was negatively associated with the endurance of paraspinals.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Tianjin Hospital, Beijing, China
| | - Lihao Yue
- Peking University Health Science Center, Beijing, China
| | - Zheyu Fan
- Peking University Health Science Center, Beijing, China
| | - Zonglin Li
- Peking University Health Science Center, Beijing, China
| | - Jiaming Li
- Peking University Health Science Center, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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You X, Wu D, Chen A, Zhou X, Fan H, Jiang Y. Asymmetric expression of PIEZO2 in paraspinal muscles of adolescent idiopathic scoliosis. J Back Musculoskelet Rehabil 2024; 37:137-146. [PMID: 37840481 DOI: 10.3233/bmr-220440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Muscle imbalance has long been recognized as one of the possible pathogeneses for adolescent idiopathic scoliosis (AIS). PIEZO2, the susceptibility gene of AIS, has been identified to play an important role in neuromuscular activities. OBJECTIVE This study aims to compare the mRNA expression of PIEZO2 between concave and convex paraspinal muscles of AIS patients and to identify the relationship between the ratio of PIEZO2 expression and curve magnitude. METHODS Twenty female AIS patients (right thoracic curve) who underwent spinal correction surgery were divided into moderate (n= 12) and severe (⩾ 70 degrees) curve groups (n= 8). The morphology of the paraspinal muscles was assessed with spinal MRI. Multifidus specimens were collected during surgical operations from the concave and convex sides of the apical region, and mRNA expression of the PIEZO2 gene was compared between sides. The localization of PIEZO2 protein expression was confirmed with the markers PAX7 and PAX3, and the percentage of PIEZO2+ cells was also investigated. RESULTS In the moderate curve group, fatty infiltration in the deep paraspinal muscle was significantly higher on the concave side than on the convex side. There were no differences in deep muscle area, superficial muscle area, or fatty infiltration of superficial paraspinal muscle. The mRNA expression of PIEZO2 was significantly increased on the concave side, and the asymmetric expression predominantly occurred in moderate curves rather than severe ones. PIEZO2 was expressed on satellite cells instead of fibers of the muscle spindle. The percent of PIEZO2+PAX7+ cells in myofibers was significantly higher on the concave side in the moderate curve group, but not in the severe curve group. CONCLUSIONS Asymmetric morphological changes occur in the deep paraspinal muscles of AIS. The PIEZO2 is asymmetrically expressed in the multifidus muscle and is preferentially expressed in satellite cells.
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Affiliation(s)
- Xuanhe You
- Orthopedic Research Institute, Department of Orthopedic Surgery, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Diwei Wu
- Orthopedic Research Institute, Department of Orthopedic Surgery, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Anjing Chen
- Orthopedic Research Institute, Department of Orthopedic Surgery, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Xinran Zhou
- West China Biobanks, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Haiquan Fan
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, Sichuan, China
| | - Yang Jiang
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, Sichuan, China
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Liu Y, Yuan L, Zeng Y, Li W. Risk Factors for Distal Junctional Problems Following Long Instrumented Fusion for Degenerative Lumbar Scoliosis: Are they Related to the Paraspinal Muscles. Orthop Surg 2023; 15:3055-3064. [PMID: 37749777 PMCID: PMC10694019 DOI: 10.1111/os.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Although the incidence of distal junctional problems (DJPs) following long construct-based treatment for degenerative lumbar scoliosis (DLS) is lower, affected patients are more likely to require revision surgery when they occur. So the aim of this study is to identify risk factors associated with DJPs to avoid its occurrence by at least 1-year follow-up. METHODS A total of 182 DLS patients undergoing long instrumented fusion surgery (≥4 levels) between February 2011 and March 2022 were retrospectively analyzed. Patients were placed into the DJP group if a DJP occurred at the final follow-up; patients without mechanical complications were matched 1:2 according to age, sex and BMI as the control group. Patient characteristics, surgical variables, radiographic parameters, lumbar muscularity and fatty degeneration were analyzed statistically. The statistical differences in the results between the two groups (p values <0.05) and other variables selected by experts were entered into a multivariate logistic regression model, and the forwards likelihood ratio method was used to analyze the independent risk factors for DJPs. RESULTS Twenty-four (13.2%) patients suffered a DJP in the postoperative period and the reoperation rate was 8.8%. On univariate analysis, the lowest instrumented vertebra (LIV) CT value (p = 0.042); instrumented levels (p = 0.030); preoperative coronal vertical axis (CVA) (p = 0.046), thoracolumbar kyphosis (TLK) (p = 0.006), L4-S1 lordosis (p = 0.013), sacral slop (SS) (p = 0.030), pelvic tilt (PT) classification (p = 0.004), and sagittal vertical axis (SVA) (p = 0.021); TLK correction (p = 0.049); post-operative CVA (p = 0.029); Overall, There was no significant difference in the paraspinal muscle parameters between the two groups. On multivariate analysis, instrumented levels (OR = 1.595; p = 0.035), preoperative SVA (OR = 1.016; p = 0.022) and preoperative PT (OR = 0.873; p = 0.001) were identified as significant independent risk factors for DJP. CONCLUSION Longer instrumented levels, a greater preoperative SVA and a smaller PT were found to be strongly associated with the presence of DJPs in patients treated for DLS. The degeneration of the paraspinal muscles may not be related to the occurrence of DJPs. For DLS patients, the occurrence of DJP can be reduced by selecting reasonable fusion segments and evaluating the patient's sagittal balance and spino-pelvic parameters before operation.
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Affiliation(s)
- Yinhao Liu
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina
- Peking University Health Science CenterBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
| | - Lei Yuan
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
| | - Yan Zeng
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
| | - Weishi Li
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
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Shrestha A, Shrestha AK, Deo A, Sharma GR. Intramuscular hydatid cyst of paraspinal muscle: A diagnostic challenge. Clin Case Rep 2023; 11:e8105. [PMID: 37900715 PMCID: PMC10600356 DOI: 10.1002/ccr3.8105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023] Open
Abstract
Hydatid cyst is a zoonosis caused by ingestion of eggs of Echinococcus-a tapeworm. Following ingestion of the eggs, oncosphere larvae are released which penetrate the intestinal wall to invade various organs of the body including liver, lungs, and skeletal muscles via. blood vessels. Due to their contractile nature and high lactic acid content, skeletal muscles are typically not a suitable site for attachment of hydatid cyst. In our case report presented below, we report a rare case of an isolated hydatid cyst of paraspinal muscle presenting as a slow-growing asymptomatic mass in the back, posing a clinical diagnostic dilemma.
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Affiliation(s)
- Anisha Shrestha
- Neurosurgery, Dirghayu Guru Hospital Pvt. Ltd.KathmanduNepal
| | | | - Alok Deo
- Neurological Surgery, Dirghayu Guru Hospital Pvt. LtdKathmanduNepal
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Guo C, Xu S, Liang Y, Zheng B, Zhu Z, Liu H. Correlation between Degenerative Thoracolumbar Kyphosis and Lumbar Posterior Muscle. J Pers Med 2023; 13:1503. [PMID: 37888114 PMCID: PMC10608706 DOI: 10.3390/jpm13101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
The relationship between spinal alignment, particularly degenerative thoracolumbar kyphosis (DTLK) combined with lumbar spine stenosis (LSS), and paraspinal muscle content remains underexplored. This study aimed to elucidate the characteristics of paraspinal muscle distribution in DTLK patients and its association with lumbar lordosis (LL) and body mass index (BMI). METHODS A case-control study was conducted comparing 126 patients with DTLK and LSS against 87 control patients. The lumbar crossing indentation value (LCIV) was introduced as a novel measurement for paraspinal muscle content, and its relationship with thoracolumbar kyphosis (TLK), BMI, and LL was assessed. RESULTS LCIV in DTLK patients was found to be lower than in the control group, with a progressive increase from the upper to lower lumbar spine. In the control group, paraspinal muscle content was observed to increase with age and BMI, and LCIV was higher in males. However, the DTLK group showed no gender difference. LCIV in the DTLK group was more pronounced in patients with increased LL. The degree of TLK was not influenced by BMI but was associated with the content of the paravertebral muscle. CONCLUSIONS Paraspinal muscle content, as measured by LCIV, is significantly associated with DTLK and LSS. The study emphasizes the importance of considering paraspinal muscle health in DTLK patients and offers valuable insights for diagnosis and therapeutic interventions.
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Affiliation(s)
| | | | | | | | | | - Haiying Liu
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing 100044, China; (C.G.); (S.X.); (Y.L.); (B.Z.); (Z.Z.)
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Uno K, Yoshikawa N, Kitami K, Mori S, Shibata T, Iyoshi S, Fujimoto H, Mogi K, Yoshihara M, Tamauchi S, Ikeda Y, Yokoi A, Kato K, Hoshiba T, Oguchi H, Kajiyama H. The sarcopenia index measured using the lumbar paraspinal muscle is associated with prognosis in endometrial cancer. Jpn J Clin Oncol 2023; 53:942-949. [PMID: 37519058 DOI: 10.1093/jjco/hyad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE The number of type-II endometrial cancer patients has been increasing and the prognosis is not favorable. We aim to investigate whether sarcopenia index in any of several different muscles could serve as a novel biomarker of prognosis in patients with type-II endometrial cancer. METHODS We retrospectively investigated a total of 194 patients at four hospitals. Ninety patients were treated as derivation set and the other 104 patients as validation set. Using preoperative computed tomography images, we measured the horizontal cross-sectional area at the third lumbar spine level: the (i) psoas major, (ii) iliac and (iii) paraspinal muscle. The clinical information including recurrence-free survival and overall survival were retrospectively collected. These results were validated with external data sets of three hospitals. RESULTS The median values of the sarcopenia index (cm2/m2) ± standard deviation with the first data of 90 patients using the psoas, iliac and paraspinal muscle were 3.4 ± 1.0, 1.7 ± 0.6 and 12.6 ± 3.2, respectively. In univariate analyses, the sarcopenia indexes measured using the psoas or paraspinal muscle were associated with recurrence-free survival and overall survival. On the other hand, in multivariate analyses, only the sarcopenia index using paraspinal muscle was significantly related to recurrence-free survival (hazard ratio = 3.78, 95% confidence intervals = 1.29-5.97, P = 0.009) and overall survival (hazard ratio = 3.13, 95% confidence interval = 1.18-8.26, P = 0.022). Paraspinal sarcopenia index was also related to overall survival (hazard ratio = 3.74, 95% confidence interval = 1.31-10.72, P = 0.014) even in patients with advanced stage. Serum albumin was significantly correlated with the sarcopenia index (P = 0.012). Within the analysis of the validation set, sarcopenia index using paraspinal muscle was related to recurrence-free survival (hazard ratio = 2.06, P = 0.045) in multivariate analysis and recurrence-free survival (P = 0.009) in patients with advanced stage. CONCLUSIONS The sarcopenia index using the paraspinal muscle, not psoas, could be a suitable index to predict recurrence-free survival and overall survival in patients with type-II endometrial cancer even in advanced stage.
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Affiliation(s)
- Kaname Uno
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhisa Kitami
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Sho Mori
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
| | - Takahiro Shibata
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shohei Iyoshi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany
| | - Hiroki Fujimoto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Discipline of Obstetrics and Gynecology, Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Kazumasa Mogi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Yokoi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kato
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsutomu Hoshiba
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hidenori Oguchi
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Blagec P, Sara S, Tripalo Batoš A, Trivić Mažuranić I, Močić Pavić A, Mišak Z, Hojsak I. Magnetic Resonance Imaging Can Be Used to Assess Sarcopenia in Children with Newly Diagnosed Crohn's Disease. Nutrients 2023; 15:3838. [PMID: 37686870 PMCID: PMC10490346 DOI: 10.3390/nu15173838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND This study aimed to determine the proportion of patients with sarcopenia diagnosed by MRI and compare these results to bioelectrical impedance analysis (BIA). METHODS Children with newly diagnosed Crohn's disease (CD) who had MRI enterography (MRE) and BIA and had at least 12 months of follow-up were included. Total psoas muscle area (TPMA) and total paravertebral muscle (TPVM) were measured and compared to subjects' lean mass and the lean mass body index (LMBI) was assessed by BIA. RESULTS 30 newly diagnosed children with CD were included (mean age 14.2 years, 53% male). Sarcopenia was found in 13 (43%) children; mean TPMA was 15.2 (1.1 SD) cm2 and TPVM 30.95 (1.7 SD) cm2. A highly positive correlation was shown for lean mass assessed by BIA and TPMA (0.706, p < 0.001) and TPVM (0.75, p < 0.001). Sarcopenia was more prevalent in boys (77% vs. 24%, p = 0.004), patients with the perianal disease (69% vs. 29%, p = 0.03), and children with sarcopenia were likely to receive anti-TNF (77% vs. 41%, p = 0.05). During the follow-up period, 16 (53%) children experienced a relapse. TPMA (HR 0.99, p = 0.018) and TPVM (HR 0.99, p = 0.031) values were statistically significant risk factors for relapse. CONCLUSION A high proportion of patients with CD have sarcopenia at the time of the diagnosis. There is a good correlation between muscle mass assessed by MRI and BIA. Because MRI is performed in a great proportion of newly diagnosed CD patients it can also be used to assess the presence of sarcopenia.
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Affiliation(s)
- Paola Blagec
- Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, 10000 Zagreb, Croatia; (P.B.); (S.S.); (I.T.M.); (A.M.P.); (Z.M.)
| | - Sila Sara
- Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, 10000 Zagreb, Croatia; (P.B.); (S.S.); (I.T.M.); (A.M.P.); (Z.M.)
| | - Ana Tripalo Batoš
- Department of Pediatric Radiology, Children’s Hospital Zagreb, 10000 Zagreb, Croatia;
| | - Ivana Trivić Mažuranić
- Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, 10000 Zagreb, Croatia; (P.B.); (S.S.); (I.T.M.); (A.M.P.); (Z.M.)
| | - Ana Močić Pavić
- Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, 10000 Zagreb, Croatia; (P.B.); (S.S.); (I.T.M.); (A.M.P.); (Z.M.)
| | - Zrinjka Mišak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, 10000 Zagreb, Croatia; (P.B.); (S.S.); (I.T.M.); (A.M.P.); (Z.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, 10000 Zagreb, Croatia; (P.B.); (S.S.); (I.T.M.); (A.M.P.); (Z.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University Josip Juraj Strossmayer Osijek, 31000 Osijek, Croatia
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Shahidi B, Padwal JA, Su JJ, Regev G, Zlomislic V, Allen RT, Garfin SR, Kim C, Lieber RL, Ward SR. The effect of fatty infiltration, revision surgery, and sex on lumbar multifidus passive mechanical properties. JOR Spine 2023; 6:e1266. [PMID: 37780825 PMCID: PMC10540820 DOI: 10.1002/jsp2.1266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/10/2023] [Accepted: 05/28/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose Previous research has demonstrated increased stiffness in the multifidus muscle compared to other paraspinal muscles at the fiber bundle level. We aimed to compare single fiber and fiber bundle passive mechanical properties of multifidus muscle: (1) in 40 patients undergoing primary versus revision surgery and (2) in muscle with mild versus severe fatty infiltration. Methods The degree of muscle fatty infiltration was graded using the patients' spine magnetic resonance images. Average single fiber and fiber bundle passive mechanical properties across three tests were compared between primary (N = 30) and revision (N = 10) surgery status, between mild and severe fatty infiltration levels, between sexes, and with age from passive stress-strain tests of excised multifidus muscle intraoperative biopsies. Results At the single fiber level, elastic modulus was unaffected by degree of fatty infiltration or surgery status. Female sex (p = 0.001) and younger age (p = 0.04) were associated with lower multifidus fiber elastic modulus. At the fiber bundle level, which includes connective tissue around fibers, severe fatty infiltration (p = 0.01) and younger age (p = 0.06) were associated with lower elastic modulus. Primary surgery also demonstrated a moderate, but non-significant effect for lower elastic modulus (p = 0.10). Conclusions Our results demonstrate that female sex is the primary driver for reduced single fiber elastic modulus of the multifidus, while severity of fatty infiltration is the primary driver for reduced elastic modulus at the level of the fiber bundle in individuals with lumbar spine pathology.
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Affiliation(s)
- Bahar Shahidi
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
- Departments of RadiologyUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Jennifer A. Padwal
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Jeannie J. Su
- Departments of RadiologyUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Gilad Regev
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Vinko Zlomislic
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - R. Todd Allen
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Steven R. Garfin
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Choll Kim
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Richard L. Lieber
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
- Departments of BioengineeringUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Samuel R. Ward
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
- Departments of RadiologyUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
- Departments of BioengineeringUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
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Oh CH, Shin DE, Yoon S, Oh J, Lee Y, Lee S. Comparison of whole trunk muscle mass between healthy and lumbar herniated nucleus pulposus patients using abdominal pelvic computed tomography. Front Med (Lausanne) 2023; 10:1190021. [PMID: 37593402 PMCID: PMC10428013 DOI: 10.3389/fmed.2023.1190021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023] Open
Abstract
Background Paraspinal muscle asymmetry is associated with low back pain (LBP) problems. This study aimed to analyze skeletal muscle areas around the lumbar vertebra and compare the ratio of anterior and posterior muscles between patients with lumbar herniated nucleus pulposus (HNP) and healthy individuals using abdominal pelvic computed tomography (APCT). Methods After propensity score matching, 122 HNP patients and 122 non-HNP individuals were finally used for analyses. In APCT, axial cut images were collected at the level of the third lumbar vertebra lower end plate and only the muscle structure was obtained. After obtaining the muscular portion of their image, we measured the skeletal muscle area (SMA). Second, for analysis relation of sarcopenia and HNP, the status of low skeletal muscle mass was determined using a previously reported criteria based on APCT scans in the Republic of Korea. Results From the analysis of the anterior-posterior muscles, the ratio of anterior SMA was statistically significantly larger in the HNP group than in the non-HNP group. Regarding the anatomical classification of trunk muscles, a statistically significant left-right imbalance to peripheral muscle in HNP men was observed. Regarding the status of low skeletal muscle mass, no statistical difference in prevalence between the two groups were observed. Moreover, no statistical difference in the prevalence of low skeletal muscle mass obesity was observed. Conclusion The lumbar flexor muscle was larger in HNP than others, showing trunk muscle imbalance. However, low skeletal muscle mass is not associated with HNP.
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Affiliation(s)
| | | | | | | | | | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
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Zhu WP, Huang Y, Hu P, Lin W. Lumbar Extensor and Flexor Muscle Structural Changes in Young Female Nurses with Chronic Bilateral Non-Specific Low Back Pain: A Case-Control Study. Discov Med 2023; 35:444-450. [PMID: 37272111 DOI: 10.24976/discov.med.202335176.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Muscle structural studies on non-specific low back pain in young female nurses are rare. This study aimed to investigate the changes of lumbar extensor and flexor muscle cross-sectional area and fatty infiltration in young female nurses with chronic bilateral non-specific low back pain by lumbar spine magnetic resonance imaging to speculate on the possible pathogenesis. METHODS The magnetic resonance imaging (MRI) data of 58 female nurses with chronic bilateral non-specific low back pain and 60 healthy female controls were analyzed retrospectively. The lumbar extensor and flexor muscle cross-sectional area/intervertebral disc cross-sectional area ratio, as well as magnetic resonance imaging signal intensity of lumbar extensor (erector spinae; multifidus) and flexor muscles (psoas muscle) were measured, calculated and compared between nurses and healthy controls by independent samples t-test. In addition, each mean MRI signal intensity of lumbar extensor or flexor muscles in nurses at different anatomical segments from lumbar vertebrae 2 (L2)-L3 to L5-sacral vertebrae 1 (S1) was also compared, and one-way Analysis of Variance (ANOVA) analyzed the mean MRI signal intensity between muscles in nurses with multiple comparisons. RESULTS There was no significant difference in lumbar extensor and flexor muscle cross-sectional area/intervertebral disc cross-sectional area ratio between nurses with chronic bilateral non-specific low back pain and healthy controls, p > 0.01. The magnetic resonance imaging signal intensity in lumbar extensor and flexor muscle was significantly higher in nurses with chronic bilateral non-specific low back pain than in healthy controls, p < 0.01. The MRI signal intensity of lumbar extensor muscle at the lower lumbar segments was higher than at the upper ones. The magnetic resonance imaging signal intensity of the extensor muscle (erector spinae; multifidus) was significantly higher than that of the flexor muscle (psoas muscle), p < 0.01. CONCLUSIONS This study showed that young nurses with chronic bilateral non-specific low back pain have lumbar extensor and flexor muscle fatty infiltration without muscle atrophy. We hypothesized that muscle fatty infiltration may occur prior to muscle atrophy. Therefore, the high fatty infiltration of the lumbar extensor and flexor muscle may be a cause or a result of chronic bilateral non-specific low back pain in young nurses.
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Affiliation(s)
- Wan-Ping Zhu
- Post Anesthesia Care Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016 Hangzhou, China
| | - Yue Huang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016 Hangzhou, China
| | - Peng Hu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016 Hangzhou, China
| | - Wei Lin
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016 Hangzhou, China
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Shen X, Xu C, Wang R, Zhang Z, Qi M, Zhang Y, Wu H, Liu Y, Chen H, Yuan W. Evaluation of Haplo-Paraspinal-Muscle-Preserving Technique to Prevent Postoperative Axial Pain in Cervical Laminoplasty. Int J Spine Surg 2023; 17:281-291. [PMID: 36635065 PMCID: PMC10165665 DOI: 10.14444/8416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The present study aimed to assess the efficacy of a new haplo-paraspinal-muscle-preserving (HMP) laminoplasty technique in the treatment of cervical myelopathy. METHODS The medical records of 68 patients diagnosed with multisegmental cervical myelopathy were retrospectively reviewed. Of these, 22 patients who underwent HMP laminoplasty were defined as the muscle-preserved group (MP), and 46 patients who underwent traditional open-door laminoplasty were enrolled and defined as the traditional open-door laminoplasty group (LP). Patient demographic data and surgical parameters like clinical and radiological parameters, operation duration, blood loss, and spinal canal expansion distance were compared. RESULTS Average surgical time and blood loss were significantly reduced in the MP group when compared with the LP group (P < 0.05). Both groups demonstrated significant improvements in neurological function and spinal canal expansion (P > 0.05). However, the visual analog scale score in the MP group was significantly lower compared with the LP group at the 6-month follow-up (P < 0.05), but no differences were found at the 1-year follow-up. The loss of lordosis was more prominent in the LP group when compared with the MP group at 1-year follow-up (P < 0.05). Lower events of persistent axial pain were found in the MP group but with no statistical significance. More hinge side laminae fractures could be found in the MP group, but more hinge side displacements were found in the LP group. CONCLUSIONS The HMP laminoplasty technique is relatively safe, effective, easier to perform, and better for lordosis maintenance and complication control compared with the traditional open-door technique. CLINICAL RELEVANCE Although traditional open-door laminoplasty is an efficient approach in treating multisegmental cervical myelopathy, the complications could significantly affect the clinical outcome. Our new HMP laminoplasty technique has a lower complication rate and a better lordosis maintenance ability; therefore, it could be a better choice in treating multisegmental cervical myelopathy. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- XiaoLong Shen
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Chen Xu
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ruizhe Wang
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zifan Zhang
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Min Qi
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yizhi Zhang
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Huiqiao Wu
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yang Liu
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Huajiang Chen
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wen Yuan
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
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Wang A, Wang T, Zang L, Fan N, Yuan S, Si F, Du P. Identification of preoperative radiological risk factors for reoperation following percutaneous endoscopic lumbar decompression to treat degenerative lumbar spinal stenosis. Front Surg 2023; 9:1054760. [PMID: 36684204 PMCID: PMC9852717 DOI: 10.3389/fsurg.2022.1054760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/24/2022] [Indexed: 01/07/2023] Open
Abstract
Background This study aimed to identify radiological risk factors associated with reoperation after percutaneous transforaminal endoscopic decompression (PTED) for degenerative lumbar spinal stenosis (DLSS). Methods The preoperative clinical data of 527 consecutive patients with DLSS who underwent PTED were retrospectively reviewed. Overall, 44 patients who underwent reoperation were matched for age, sex, body mass index, and surgical segment to 132 control patients with excellent or good clinical outcomes. Radiological characteristics were compared between the groups using independent sample t-tests and Pearson's chi-square tests. A predictive model was established based on multivariate logistic regression analysis. Results The analyses revealed significant differences in the presence of lumbosacral transitional vertebra (LSTV, 43.2% vs. 17.4%, p = 0.001), the number of levels with senior-grade disc degeneration (2.57 vs. 1.96, p = 0.018) and facet degeneration (1.91 vs. 1.25 p = 0.002), and the skeletal muscle index (SMI, 849.7 mm2/m2 vs. 1008.7 mm2/m2, p < 0.001) between patients in the reoperation and control groups. The results of the logistic analysis demonstrated that LSTV (odds ratio [OR] = 2.734, 95% confidence interval [CI]:1.222-6.117, p < 0.014), number of levels with senior-grade facet degeneration (OR = 1.622, 95% CI:1.137-2.315, p = 0.008), and SMI (OR = 0.997, 95% CI:0.995-0.999, p = 0.001) were associated with reoperation after PTED. The application of the nomogram based on these three factors showed good discrimination (area under the receiver operating characteristic curve 0.754, 95% CI 0.670-0.837) and good calibration. Conclusion LSTV, more levels with senior-grade facet degeneration, and severe paraspinal muscle atrophy are independent risk factors for reoperation after PTED. These factors can thus be used to predict reoperation risk and to help tailor treatment plans for patients with DLSS.
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Doi T, Ohtomo N, Oguchi F, Tozawa K, Nakarai H, Nakajima K, Sakamoto R, Okamoto N, Nakamoto H, Kato S, Taniguchi Y, Matsubayashi Y, Oka H, Matsudaira K, Tanaka S, Oshima Y. Association Between Deep Posterior Cervical Paraspinal Muscle Morphology and Clinical Features in Patients With Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J 2023; 13:8-16. [PMID: 33504203 PMCID: PMC9837499 DOI: 10.1177/2192568221989655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN A retrospective observational study. OBJECTIVE To clarify the association of the paraspinal muscle area and composition with clinical features in patients with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS Consecutive patients with cervical OPLL who underwent cervical magnetic resonance imaging (MRI) before surgery were reviewed. The cross-sectional area (CSA) and fatty infiltration ratio (FI%) of deep posterior cervical paraspinal muscles (multifidus [MF] and semispinalis cervicis [SCer]) were examined. We assessed the association of paraspinal muscle measurements with the clinical characteristics and clinical outcomes, such as Neck Disability Index (NDI) score. Moreover, we divided the patients into 2 groups according to the extent of the ossified lesion (segmental and localized [OPLL-SL] and continuous and mixed [OPLL-CM] groups) and compared these variables between the 2 groups. RESULTS 49 patients with cervical OPLL were enrolled in this study. The FI% of the paraspinal muscles was significantly associated with the number of vertebrae (ρ = 0.283, p = 0.049) or maximum occupancy ratio of OPLL (ρ = 0.397, p = 0.005). The comparative study results indicated that the NDI score was significantly worse (OPLL-SL, 22.9 ± 13.7 vs. OPLL-CM, 34.4 ± 13.7) and FI% of SCer higher (OPLL-SL, 9.1 ± 1.7% vs. OPLL-CM, 11.1 ± 3.7%) in the OPLL-CM group than those in the OPLL-SL group. CONCLUSIONS Our results suggest that OPLL severity may be associated with fatty infiltration of deep posterior cervical paraspinal muscles, which could affect neck disability in patients with cervical OPLL.
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Affiliation(s)
- Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Fumihiko Oguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Nakarai
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Ryuji Sakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Naoki Okamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Hiroyuki Oka
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center,
Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center,
Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan,Yasushi Oshima, Department of Orthopaedic
Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Yang F, Liu Z, Zhu Y, Zhu Q, Zhang B. Imaging of muscle and adipose tissue in the spine: A narrative review. Medicine (Baltimore) 2022; 101:e32051. [PMID: 36626484 PMCID: PMC9750571 DOI: 10.1097/md.0000000000032051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Interpretation of the morphology and characteristics of soft tissues, such as paravertebral muscles and fat, has always been a "relative blind spot" in the spine. The imaging features of the non-bony structures of the spine have been studied and reinterpreted, and changes in the non-bony structure are associated with spinal disease. Soft tissue parameters such as, the "paraspinal muscle cross-sectional area," "subcutaneous fat thickness," and the "paraspinal muscle fat infiltration rate" on computed tomography, magnetic resonance imaging and other imaging techniques are reproducible in the diagnosis, treatment and prognosis of spinal disorders and have the potential for clinical application. In addition, focus on the association between sarcopenia and spinal epidural lipomatosis with spinal disorders is increasing. Currently, there is no summary of studies on fat and muscle in the spinal region. Given this, within the context of recent research trends, this article provides a synthesis of research on adipose and muscle tissue in the spine, discusses advances in the study of the imaging manifestations of these structures in spinal disorders, and expands the perspectives.
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Affiliation(s)
- Fan Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhengang Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuhang Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qingsan Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Boyin Zhang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
- * Correspondence: Boyin Zhang, Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun 130033, China (e-mail: )
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Choi WJ, Kim WD, Park DC, Shin DC. Comparison of compensatory lumbar movement in participants with and without non-specific chronic low back pain: A cross-sectional study. J Back Musculoskelet Rehabil 2022; 35:1365-1372. [PMID: 35634844 DOI: 10.3233/bmr-210327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many studies have compared muscle length and muscle activity for low back pain. However, compensatory movement for non-specific low back pain has not yet been studied sufficiently. OBJECTIVE The purpose of this study was to compare the length of the hip flexor, lumbar extensor endurance and the muscle activity of the erector spinae and gluteus maximus during hip extension, and the compensatory movement of the lumbar in people with or without nonspecific chronic low back pain. METHODS In this case-control study, 16 participants with non-specific chronic LBP and 17 without LBP were included. Hip flexor length was assessed by the modified Thomas test. Lumbar extensor endurance was assessed by the modified Biering-Sorensen test. Muscle activity of the erector spinae and gluteus maximus during hip extension was measured using a Delsys-Trigno wireless EMG system. Compensatory lumbar movements during hip extension were measured using a digital inclinometer. RESULTS Muscle activity of the erector spinae and compensatory lumbar movements were significantly higher in the LBP group. (p< 0.05). Hip flexor length, muscle activity of the gluteus maximus and endurance of the lumbar extensor were significantly differences in the LBP group (p< 0.05). CONCLUSIONS Shortened hip flexors, low gluteus maximus activity, and high erector spinae activity during hip extension, lumbar extensor weak endurance, lumbar compensatory movement are potential factors for non-specific LBP.
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Affiliation(s)
- Won-Jun Choi
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon-si, Korea
| | - Won-Deuk Kim
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon-si, Korea
| | - Dong-Chun Park
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon-si, Korea
| | - Doo-Chul Shin
- Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon-si, Korea
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Tam WK, Cheung JPY, Koljonen PA, Kwan KYH, Cheung KM, Leung VYL. Slow twitch paraspinal muscle dysregulation in adolescent idiopathic scoliosis exhibiting HIF-2α misexpression. JOR Spine 2022; 5:e1227. [PMID: 36601371 PMCID: PMC9799082 DOI: 10.1002/jsp2.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) refers to a three-dimensional spinal deformity which has a typical onset during adolescence. In most cases, the cause of the deformity cannot be clearly identified. Unbalanced paraspinal muscle activity in AIS patients was reported and hypoxia was implicated to regulate myogenesis. This study aims to investigate the association between myogenesis/muscle toning and HIF-αs activity in the pathogenesis of AIS. Methods HIF-αs expression was examined by enzyme-linked immunosorbent assay and western blot in paraspinal myoblasts isolated from 18 subjects who underwent deformity correction surgery. QPCR was conducted to measure the gene expression levels of perinatal muscle fiber markers MYH3, MYH8; slow twitch muscle fiber markers MHY7; fast twitch muscle fiber markers MYH4; and myogenic regulatory factors MYF5 and MYOG. Slow and fast twitch muscle fiber composition in concave/convex paraspinal musculature of AIS subjects was evaluated by immunostaining of myosin heavy chain type I (MyHC I) and myosin heavy chain type II (MyHC II). Results Reduced HIF-2α induction under hypoxia was found in paraspinal myoblast culture of 33% AIS subjects. We detected a suppression of perinatal and slow twitch muscle fiber associated genes, but not fast twitch muscle fiber-associated genes and myogenic regulatory factors in HIF-2α misexpressed AIS myoblasts. Distinct reduction of slow twitch muscle fiber was evidenced in convex paraspinal musculature, suggesting an asymmetric expression of slow twitch muscle fiber in HIF-2α misexpressed AIS patients. Conclusions This study indicates an association of abnormal HIF-2α expression in paraspinal myoblasts and a disproportionate slow twitch muscle fiber content in the convexity of the curvature in a subset of AIS subjects, suggesting HIF-2α dysregulation as a possible risk factor for AIS. The role of HIF-2α in paraspinal muscle function during spinal growth and its relevance in AIS prognosis warrants further investigation.
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Affiliation(s)
- Wai Kit Tam
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong SARChina
| | - Jason P. Y. Cheung
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong SARChina,Orthopaedic Medical CenterHKU‐Shenzhen HospitalShenzhenChina
| | - Paul A. Koljonen
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong SARChina
| | - Kenny Y. H. Kwan
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong SARChina,Orthopaedic Medical CenterHKU‐Shenzhen HospitalShenzhenChina
| | - Kenneth M.C. Cheung
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong SARChina,Orthopaedic Medical CenterHKU‐Shenzhen HospitalShenzhenChina
| | - Victor Y. L. Leung
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong SARChina,Orthopaedic Medical CenterHKU‐Shenzhen HospitalShenzhenChina
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20
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Wang Z, Tian Y, Li C, Li D, Ibrahim Y, Yuan S, Wang X, Tang J, Zhang S, Wang L, Liu X. Radiographic risk factors for degenerative lumbar spondylolisthesis: A comparison with healthy control subjects. Front Surg 2022; 9:956696. [PMID: 36311947 PMCID: PMC9614147 DOI: 10.3389/fsurg.2022.956696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Objective To evaluate the radiologic parameters of degenerative lumbar spondylolisthesis (DLS) and determine the radiographic risk factors for DLS by making comparisons with healthy control subjects. Methods Seventy-five patients with L4/5 DLS (Meyerding grade I) and 53 healthy control subjects were analyzed. The L1-S1 disc height index (DHI), L4/5 facet joint angle (FJA), and relative cross-sectional area (RCSA) of paravertebral muscles were measured in both groups. The initial L4/5 DHI (iDHI) before the onset of DLS were estimated based on the L3/4 DHI of the DLS group and DHI of the control group. The sagittal parameters of DLS were also included in this study. Results The DHI of L4/5 was lower in the DLS group than in the control group (P < 0.05), but the DHI of the L1-L4 segments were much higher than in the control group (P < 0.05). The initial L4/5 DHI and FJA of the DLS group were significantly higher than those of the control group (P < 0.05). The RCSA of the paravertebral muscles were smaller in the DLS group than in the control group (P < 0.05). Binary logistic regression analysis showed that iDHI, FJA, and RCSA of the total paraspinal muscles were risk factors for DLS. The cutoff values for iDHI, FJA, and RCSA were 0.504, 56.968°, and 1.991 respectively. The iDHI was associated with lumbar lordosis (LL), while L4/5 DHI was associated with the RCSA of the multifidus muscle and psoas major muscle (P < 0.05). Conclusion A large initial lumbar disc height, large FJA, and paravertebral muscle atrophy may be risk factors for DLS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Xinyu Liu
- Correspondence: Xinyu Liu Lianlei Wang
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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He C, Yang JT, Zheng Q, Mei Z, Ma CZ. How do Paraspinal Muscles Contract during the Schroth Exercise Treatment in Patients with Adolescent Idiopathic Scoliosis (AIS)? Bioengineering (Basel) 2022; 9. [PMID: 35735477 DOI: 10.3390/bioengineering9060234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
The Schroth exercise can train the paraspinal muscles of patients with adolescent idiopathic scoliosis (AIS), however, muscle performance during the training remains unknown. This study applied surface electromyography (sEMG) to investigate the paraspinal muscle activities before, during and after Schroth exercise in nine AIS patients. This study found that after the Schroth exercise, the paraspinal muscle symmetry index (PMSI) was significantly reduced (PMSI = 1.3), while symmetry exercise significantly lowered the PMSI (PMSI = 0.93 and 0.75), and asymmetric exercise significantly increased the PMSI (PMSI = 2.56 and 1.52) compared to relax standing (PMSI = 1.36) in participants (p < 0.05). Among the four exercises, the PMSI of on all fours (exercise 1) and kneeling on one side (exercise 3) was the most and the least close to 1, respectively. The highest root mean square (RMS) of sEMG at the concave and convex side was observed in squatting on the bar (exercise 2) and sitting with side bending (exercise 4), respectively. This study observed that the asymmetric and symmetric exercise induced more sEMG activity on the convex and concave side, respectively, and weight bearing exercise activated more paraspinal muscle contractions on both sides of the scoliotic curve in the included AIS patients. A larger patient sample size needs to be investigated in the future to validate the current observations.
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23
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Li Y, Kong C, Wang B, Sun W, Chen X, Zhu W, Ding J, Lu S. Identification of differentially expressed genes in mouse paraspinal muscle in response to microgravity. Front Endocrinol (Lausanne) 2022; 13:1020743. [PMID: 36313746 PMCID: PMC9611771 DOI: 10.3389/fendo.2022.1020743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022] Open
Abstract
Lower back pain (LBP) is the primary reason leading to dyskinesia in patients, which can be experienced by people of all ages. Increasing evidence have revealed that paraspinal muscle (PSM) degeneration (PSMD) is a causative contributor to LBP. Current research revealed that fatty infiltration, tissue fibrosis, and muscle atrophy are the characteristic pathological alterations of PSMD, and muscle atrophy is associated with abnormally elevated oxidative stress, reactive oxygen species (ROS) and inflammation. Interestingly, microgravity can induce PSMD and LBP. However, studies on the molecular mechanism of microgravity in the induction of PSMD are strongly limited. This study identified 23 differentially expressed genes (DEGs) in the PSM (longissimus dorsi) of mice which were flown aboard the Bion M1 biosatellite in microgravity by bioinformatics analysis. Then, we performed protein-protein interaction, Gene Ontology function, and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis for the DEGs. We found that Il6ra, Tnfaip2, Myo5a, Sesn1, Lcn2, Lrg1, and Pik3r1 were inflammatory genes; Fbox32, Cdkn1a, Sesn1, and Mafb were associated with muscle atrophy; Cdkn1a, Sesn1, Lcn2, and Net1 were associated with ROS; and Sesn1 and Net1 were linked to oxidative stress. Furthermore, Lcn2, Fbxo32, Cdkn1a, Pik3r1, Sesn1, Net1, Il6ra, Myo5a, Lrg1, and Pfkfb3 were remarkably upregulated, whereas Tnfaip2 and Mafb were remarkably downregulated in PSMD, suggesting that they might play a significant role in regulating the occurrence and development of PSMD. These findings provide theoretical basis and therapeutic targets for the treatment of PSMD.
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Affiliation(s)
- Yongjin Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Baobao Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenzhi Sun
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junzhe Ding
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Shibao Lu,
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24
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Kim YR, Yoon YS, Park H. Extra-Abdominal Desmoid-Type Fibromatosis Mimicking Myxofibrosarcoma. J Belg Soc Radiol 2022; 106:81. [PMID: 36213374 PMCID: PMC9504096 DOI: 10.5334/jbsr.2848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023] Open
Abstract
A 27-year-old woman was confirmed to have extraabdominal desmoid-type fibromatosis. Desmoid-type fibromatosis is a very rare connective tissue neoplasm with the extraabdominal type even more rare. It is most commonly found in proximal structures such as shoulders, neck, chest, and extremities. There are few case reports for desmoid-type fibromatosis located in paraspinal soft tissue. We report a case of desmoid-type fibromatosis mimicking a myxofibrosarcoma. Teaching Point: Even if there are suggestive findings for malignant soft tissue tumor on radiologic evaluation, histological confirmation is necessary before surgical treatment.
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Affiliation(s)
- Ye Rin Kim
- From the Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon 14584, Bucheon, Republic of Korea, KR
| | - Yu Sung Yoon
- From the Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon 14584, Bucheon, Republic of Korea, KR
| | - Hyerim Park
- From the Department of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea, KR
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25
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Chen H, Xu HW, Zhang SB, Yi YY, Wang SJ. Vitamin D inadequacy combined with high BMI affects paraspinal muscle atrophy and pain intensity in postmenopausal women. Climacteric 2021; 25:376-382. [PMID: 34694955 DOI: 10.1080/13697137.2021.1990257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study was performed to assess the effects of vitamin D deficiency/insufficiency combined with a high body mass index (BMI) on paraspinal muscle (PSM) atrophy and pain intensity in postmenopausal women with lower back pain (LBP). METHODS In total, 365 postmenopausal women were analyzed in the study. We divided the women into four groups according to BMI and vitamin D status. Outcome measurements included PSM atrophy, fatty infiltration (FI) and severity of LBP. Binary logistic regression was used to analyze the odds ratio (OR), and the interaction between the BMI and vitamin D status was tested. RESULTS Compared with the control group, the high BMI with vitamin D deficiency/insufficiency group had a significantly increased risk of FI > grade 2 (OR = 10.69, p < 0.001), hand grip strength of <16 kg (OR = 8.96, p < 0.001), Short Physical Performance Battery score of ≤8 (OR = 3.69, p < 0.001) and visual analog scale (VAS) score of >3 (OR = 4.76, p < 0.001). A significant positive additive interaction was found between the BMI and vitamin D status on PSM atrophy. CONCLUSION Vitamin D deficiency/insufficiency combined with a high BMI was associated with PSM atrophy and LBP intensity in postmenopausal women. The interaction analysis showed a positive additive interaction between BMI and vitamin D status.
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Affiliation(s)
- H Chen
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - H-W Xu
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - S-B Zhang
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Y-Y Yi
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - S-J Wang
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Orthopedic, East Hospital, Ji'an Hospital, Jinggangshan University School of Medicine, Jiangxi, China
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26
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Burian E, Becherucci EA, Junker D, Sollmann N, Greve T, Hauner H, Zimmer C, Kirschke JS, Karampinos DC, Subburaj K, Baum T, Dieckmeyer M. Association of Cervical and Lumbar Paraspinal Muscle Composition Using Texture Analysis of MR-Based Proton Density Fat Fraction Maps. Diagnostics (Basel) 2021; 11:diagnostics11101929. [PMID: 34679627 PMCID: PMC8534863 DOI: 10.3390/diagnostics11101929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
In this study, the associations of cervical and lumbar paraspinal musculature based on a texture analysis of proton density fat fraction (PDFF) maps were investigated to identify gender- and anatomical location-specific structural patterns. Seventy-nine volunteers (25 men, 54 women) participated in the present study (mean age ± standard deviation: men: 43.7 ± 24.6 years; women: 37.1 ± 14.0 years). Using manual segmentations of the PDFF maps, texture analysis was performed and texture features were extracted. A significant difference in the mean PDFF between men and women was observed in the erector spinae muscle (p < 0.0001), whereas the mean PDFF did not significantly differ in the cervical musculature and the psoas muscle (p > 0.05 each). Among others, Variance(global) and Kurtosis(global) showed significantly higher values in men than in women in all included muscle groups (p < 0.001). Not only the mean PDFF values (p < 0.001) but also Variance(global) (p < 0.001), Energy (p < 0.001), Entropy (p = 0.01), Homogeneity (p < 0.001), and Correlation (p = 0.037) differed significantly between the three muscle compartments. The cervical and lumbar paraspinal musculature composition seems to be gender-specific and has anatomical location-specific structural patterns.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (E.A.B.); (N.S.); (C.Z.); (J.S.K.); (T.B.); (M.D.)
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (D.J.); (D.C.K.)
- Correspondence:
| | - Edoardo A. Becherucci
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (E.A.B.); (N.S.); (C.Z.); (J.S.K.); (T.B.); (M.D.)
| | - Daniela Junker
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (D.J.); (D.C.K.)
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (E.A.B.); (N.S.); (C.Z.); (J.S.K.); (T.B.); (M.D.)
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany
| | - Tobias Greve
- Department of Neurosurgery, University of Munich, 81377 Munich, Germany;
| | - Hans Hauner
- Institute of Nutritional Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 80992 Munich, Germany;
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (E.A.B.); (N.S.); (C.Z.); (J.S.K.); (T.B.); (M.D.)
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (E.A.B.); (N.S.); (C.Z.); (J.S.K.); (T.B.); (M.D.)
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (D.J.); (D.C.K.)
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore 487372, Singapore;
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (E.A.B.); (N.S.); (C.Z.); (J.S.K.); (T.B.); (M.D.)
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (E.A.B.); (N.S.); (C.Z.); (J.S.K.); (T.B.); (M.D.)
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27
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Pinter ZW, Wagner SC, Fredericks DR, Xiong A, Freedman BA, Elder BD, Nassr A, Bydon M, Kepler CK, Sebastian AS. Higher Paraspinal Muscle Density Effect on Outcomes After Anterior Cervical Discectomy and Fusion. Global Spine J 2021; 11:931-935. [PMID: 32677527 PMCID: PMC8258832 DOI: 10.1177/2192568220935108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Studies in the lumbar spine suggest a correlation between sarcopenia and worse patient outcomes. The purpose of this study was to determine whether paraspinal Goutalier grade of fat degeneration is associated with patient-reported outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF). METHODS We performed a retrospective review of a prospective cohort of patients undergoing 1- to 3-level ACDF at a single institution between the years 2011-2014. We utilized preoperative magnetic resonance images to classify patients into Goutalier grades. Patient-reported outcomes, including Neck Disability Index (NDI), RAND score, and EQ-5D score were collected and analyzed according to patients' Goutalier grade. RESULTS We identified 69 patients for inclusion. A total of 29 patients were classified as Goutalier 0-1 (group 1), 29 were Goutalier 1.5-2 (group 2), and 11 were Goutalier 2.5-4.0 (group 3). All Goutalier groups experienced significant improvement in all 3 outcome scores. Average postoperative NDI scores were 25.3 in group 1, 13.9 in group 2, and 25.1 in group 3 (P = .02). The percentage of patients in each group reporting worse disability after surgery was 17.2%, 3.3%, and 9.1%, respectively (P = .05). No statistically significant difference was seen between groups in postoperative EQ-5D (P = .07) or RAND scores (P > .05). CONCLUSIONS The present study is the first to assess the association between cervical paraspinal muscle Goutalier grade and patient-reported outcomes following ACDF. Based on our study, patients with worse cervical paraspinal degeneration may benefit from improved symptom relief in comparison to patients with a lesser degree of degeneration undergoing ACDF.
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Affiliation(s)
| | - Scott C. Wagner
- Walter Reed National Military Medical Center, Bethesda, MD, USA,Scott Wagner, Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 55905-002, USA.
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28
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Burian E, Sollmann N, Mei K, Dieckmeyer M, Juncker D, Löffler M, Greve T, Zimmer C, Kirschke JS, Baum T, Noël PB. Low-dose MDCT: evaluation of the impact of systematic tube current reduction and sparse sampling on quantitative paraspinal muscle assessment. Quant Imaging Med Surg 2021; 11:3042-3050. [PMID: 34249633 DOI: 10.21037/qims-20-1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/18/2021] [Indexed: 11/06/2022]
Abstract
Background Wasting disease entities like cachexia or sarcopenia are associated with a decreasing muscle mass and changing muscle composition. For valid and reliable disease detection and monitoring diagnostic techniques offering quantitative musculature assessment are needed. Multi-detector computed tomography (MDCT) is a broadly available imaging modality allowing for muscle composition analysis. A major disadvantage of using MDCT for muscle composition assessment is the radiation exposure. In this study we evaluated the performance of different methods of radiation dose reduction for paravertebral muscle composition assessment. Methods MDCT scans of eighteen subjects (6 males, age: 71.5±15.9 years, and 12 females, age: 71.0±8.9 years) were retrospectively simulated as if they were acquired at 50%, 10%, 5%, and 3% of the original X-ray tube current or number of projections (i.e., sparse sampling). Images were reconstructed with a statistical iterative reconstruction (SIR) algorithm. Paraspinal muscles (psoas and erector spinae muscles) at the level of L4 were segmented in the original-dose images. Segmentations were superimposed on all low-dose scans and muscle density (MD) extracted. Results Sparse sampling derived mean MD showed no significant changes (P=0.57 and P=0.22) down to 5% of the original projections in the erector spinae and psoas muscles, respectively. All virtually reduced tube current series showed significantly different (P>0.05) mean MD in the psoas and erector spinae muscles as compared to the original dose except for the images of 5% of the original tube current in the erector spinae muscle. Conclusions Our findings demonstrated the possibility of considerable radiation dose reduction using MDCT scans for assessing the composition of the paravertebral musculature. The sparse sampling approach seems to be promising and a potentially superior technique for dose reduction as compared to tube current reduction.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kai Mei
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniela Juncker
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Maximilian Löffler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Greve
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Neurosurgery, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Peter B Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Patel T, Watterson C, McKenzie-Brown AM, Spektor B, Egan K, Boorman D. Lumbar Spondylolisthesis Progression: What is the Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis Progression? A Single-Center, Observational Study. J Pain Res 2021; 14:1193-1200. [PMID: 33976569 PMCID: PMC8104986 DOI: 10.2147/jpr.s310238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a denervation therapy commonly performed for pain of facet etiology. Degenerative spondylolisthesis, a malalignment of the spinal vertebrae, may be a co-existing condition contributing to pain; yet the effect of RFA on advancing listhesis is unknown. To the extent that denervating RFA may weaken paraspinal muscles that provide stability to the spine, the therapy can potentially contribute to progressive spinal instability. METHODS Single-center, prospective, observational pilot study in an interventional pain practice to test the hypothesis that RFA of painful facets in the setting of spondylolisthesis may contribute to advancement of further degenerative spondylolisthesis. Fifteen participants with pre-existing degenerative Grade I or Grade II spondylolisthesis and coexisting axial lumbar pain underwent lumbar RFA encompassing spondylolisthesis level and followed with post-RFA imaging at 12 months and beyond to measure percent change in spondylolisthesis. RESULTS The primary outcome was the percent advancement of spondylolisthesis per year measured on post-RFA lateral lumbar spine imaging compared with non-intervention inferred baseline advancement of 2% per very limited observational studies. Among the 15 participants enrolled, 14 completed the study (median age 66; 64.3% women; median BMI 33.5; mean follow-up time 23.9 months). The mean advancement of spondylolisthesis per year after RFA was 1.30% (95% CI -0.14 to 2.78%), with 9/14 below 1.25%. CONCLUSION Among patients with lumbar pain originating from facets in the setting of degenerative spondylolisthesis who underwent lumbar RFA, the observed advancement of spondylolisthesis is clinically similar to the estimated maximum baseline of 2% per year change. The study findings did not find a destabilizing effect of lumbar RFA in advancing spondylolisthesis in this patient population.
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Affiliation(s)
- Trusharth Patel
- Department of Anesthesiology, Division of Pain Management, Emory University School of Medicine, Atlanta, GA, 30308, USA
| | - Christopher Watterson
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30308, USA
| | | | - Boris Spektor
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30308, USA
| | - Katherine Egan
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30308, USA
| | - David Boorman
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30308, USA
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Pai S A, Zhang H, Street J, Wilson DR, Brown SHM, Oxland TR. Preliminary investigation of spinal level and postural effects on thoracic muscle morphology with upright open MRI. JOR Spine 2021; 4:e1139. [PMID: 33778411 PMCID: PMC7984016 DOI: 10.1002/jsp2.1139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/29/2020] [Accepted: 01/17/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Spinal-muscle morphological differences between weight-bearing and supine postures have potential diagnostic, prognostic, and therapeutic applications. While the focus to date has been on cervical and lumbar regions, recent findings have associated spinal deformity with smaller paraspinal musculature in the thoracic region. We aim to quantitatively investigate the morphology of trapezius (TZ), erector spinae (ES) and transversospinalis (TS) muscles in upright postures with open upright MRI and also determine the effect of level and posture on the morphological measures. METHODS Six healthy volunteers (age 26 ± 6 years) were imaged (0.5 T MROpen, Paramed, Genoa, Italy) in four postures (supine, standing, standing with 30° flexion, and sitting). Two regions of the thorax, middle (T4-T5), and lower (T8-T9), were scanned separately for each posture. 2D muscle parameters such as cross-sectional area (CSA) and position (radius and angle) with respect to the vertebral body centroid were measured for the three muscles. Effect of spinal level and posture on muscle parameters was examined using 2-way repeated measures ANOVA separately for T4-T5 and T8-T9 regions. RESULTS The TZ CSA was smaller (40%, P = .0027) at T9 than at T8. The ES CSA was larger at T5 than at T4 (12%, P = .0048) and at T9 than at T8 (10%, P = .0018). TS CSA showed opposite trends at the two spinal regions with it being smaller (16%, P = .0047) at T5 than at T4 and larger (11%, P = .0009) at T9 than at T8. At T4-T5, the TZ CSA increased (up to 23%), and the ES and TS CSA decreased (up to 10%) in upright postures compared to supine. CONCLUSION Geometrical parameters that describe muscle morphology in the thorax change with level and posture. The increase in TZ CSA in upright postures could result from greater activation while upright. The decrease in ES CSA in flexed positions likely represents passive stretching compared to neutral posture.
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Affiliation(s)
- Anoosha Pai S
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverCanada
- ICORDUniversity of British ColumbiaVancouverCanada
| | - Honglin Zhang
- Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
| | - John Street
- ICORDUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
| | - David R. Wilson
- ICORDUniversity of British ColumbiaVancouverCanada
- Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional SciencesUniversity of GuelphGuelphCanada
| | - Thomas R. Oxland
- ICORDUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
- Department of Mechanical EngineeringUniversity of British ColumbiaVancouverCanada
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Pai S A, Zhang H, Shewchuk JR, Al Omran B, Street J, Wilson D, Doroudi M, Brown SHM, Oxland TR. Quantitative identification and segmentation repeatability of thoracic spinal muscle morphology. JOR Spine 2020; 3:e1103. [PMID: 33015576 PMCID: PMC7524235 DOI: 10.1002/jsp2.1103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE MRI derived spinal-muscle morphology measurements have potential diagnostic, prognostic, and therapeutic applications in spinal health. Muscle morphology in the thoracic spine is an important determinant of kyphosis severity in older adults. However, the literature on quantification of spinal muscles to date has been limited to cervical and lumbar regions. Hence, we aim to propose a method to quantitatively identify regions of interest of thoracic spinal muscle in axial MR images and investigate the repeatability of their measurements. METHODS Middle (T4-T5) and lower (T8-T9) thoracic levels of six healthy volunteers (age 26 ± 6 years) were imaged in an upright open scanner (0.5T MROpen, Paramed, Genoa, Italy). A descriptive methodology for defining the regions of interest of trapezius, erector spinae, and transversospinalis in axial MR images was developed. The guidelines for segmentation are laid out based on the points of origin and insertion, probable size, shape, and the position of the muscle groups relative to other recognizable anatomical landmarks as seen from typical axial MR images. 2D parameters such as muscle cross-sectional area (CSA) and muscle position (radius and angle) with respect to the vertebral body centroid were computed and 3D muscle geometries were generated. Intra and inter-rater segmentation repeatability was assessed with intraclass correlation coefficient (ICC (3,1)) for 2D parameters and with dice coefficient (DC) for 3D parameters. RESULTS Intra and inter-rater repeatability for 2D and 3D parameters for all muscles was generally good/excellent (average ICC (3,1) = 0.9 with ranges of 0.56-0.98; average DC = 0.92 with ranges from 0.85-0.95). CONCLUSION The guidelines proposed are important for reliable MRI-based measurements and allow meaningful comparisons of muscle morphometry in the thoracic spine across different studies globally. Good segmentation repeatability suggests we can further investigate the effect of posture and spinal curvature on muscle morphology in the thoracic spine.
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Affiliation(s)
- Anoosha Pai S
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverCanada
- ICORDUniversity of British ColumbiaVancouverCanada
| | - Honglin Zhang
- Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
| | | | - Bedoor Al Omran
- Department of RadiologyVancouver General HospitalVancouverCanada
| | - John Street
- ICORDUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
| | - David Wilson
- ICORDUniversity of British ColumbiaVancouverCanada
- Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
| | - Majid Doroudi
- Department of Cellular and Physiological SciencesUniversity of British ColumbiaVancouverCanada
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional SciencesUniversity of GuelphGuelphCanada
| | - Thomas R. Oxland
- ICORDUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
- Department of Mechanical EngineeringUniversity of British ColumbiaVancouverCanada
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32
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Peng X, Li X, Xu Z, Wang L, Cai W, Yang S, Liao W, Cheng X. Age-related fatty infiltration of lumbar paraspinal muscles: a normative reference database study in 516 Chinese females. Quant Imaging Med Surg 2020; 10:1590-1601. [PMID: 32742954 DOI: 10.21037/qims-19-835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Fatty infiltration, as a result of aging, is an essential biomarker of muscle degeneration. This research aimed to investigate the age-dependent change of fatty degeneration in the paraspinal muscles of healthy Chinese women. This study also explores the effect of body size on fatty infiltration of paraspinal muscles. Methods Cross-sectional area of paraspinal muscles (CSAmuscle) and intermuscular adipose tissue (CSAIMAT) were measured at the L3 mid-vertebral level of 516 healthy females, who underwent abdomen quantitative computed tomography (QCT) scans. Subsequently, IMAT% [CSAIMAT / (CSAIMAT + CSAmuscle)] were calculated. The relationship between basic information and measurements was evaluated using Spearman correlations. Comparisons of QCT results among different BMI subgroups in different age groups were analyzed with the Kruskal-Wallis H test and LSD, post-hoc correction. Age-related changes were calculated after the adjustment of height and weight. Results The mean CSAIMAT of 20-29 years group (n=69) and 70-79 years group (n=25) were 3.00 cm2 and 11.06 cm2, respectively. While the mean CSAmuscle of 20-29 years group was 38.46 cm2 and 70-79 years group was 30.86 cm2. The mean IMAT% difference between 20-29 years group and 70-79 years group was -18.55%. Strong, positive non-linear associations were observed between ageing and CSAIMAT, along with IMAT% (r=0.656, P<0.01; r=0.714, P<0.01). However, CSAmuscle was shown to decrease with age in a weak, negative linear fashion (r=-0.265, P<0.01). Positive relationships between BMI and CSAIMAT, CSAmuscle, along with IMAT%, were found. Significant differences were observed between obesity and normal BMI subgroup for all variables in three age groups. CSAIMAT showed a larger age-related difference compared to CSAmuscle. Conclusions Fatty infiltration in paraspinal muscles increased with age and BMI, while muscle loss may be associated with aging. The present study provided standardized reference data for the fatty degeneration of paraspinal muscles across the adult lifespan of Chinese females, which will play a critical role in future studies.
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Affiliation(s)
- Xianjing Peng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xintong Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Zhengyang Xu
- Department of Radiology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Cai
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
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Lo WLA, Lei D, Leng Y, Huang H, Wang B, Yu Q, Li L. Impact of nonsurgical spinal decompression on paraspinal muscle morphology and mechanical properties in young adults with low back pain. J Int Med Res 2020; 48:300060520919232. [PMID: 32723102 PMCID: PMC7391436 DOI: 10.1177/0300060520919232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective The mechanism underlying the benefit of nonsurgical spinal decompression (NSSD) on low back pain is unclear. This study was performed to investigate the immediate impact of NSSD on the mechanical properties and morphology of the paraspinal muscles. Methods Participants with low back pain were recruited. NSSD therapy was provided on one occasion. A myotonometer was placed perpendicularly on the skin surface over the paraspinal muscle at the level of L3/L4 to measure the mechanical muscle properties. The multifidus thickness was measured using B-mode ultrasound and defined as the distance between the transverse process and subcutaneous tissue fascia. The difference between before and after NSSD was analyzed by a paired t-test. Results Thirty participants (mean age, 20.9 ± 0.8 years; 9 male, 21 female) were recruited. No significant difference was observed in the muscle mechanical properties or morphology between before and after the intervention. Conclusions NSSD intervention did not induce immediate changes in the paraspinal muscle mechanical properties or multifidus thickness in young adults with low back pain. NSSD might produce benefits by stimulating mechanical receptors rather than inducing morphological changes or mechanical property alterations of the muscle fibers. These parameters may not be suitable outcome measures for NSSD intervention.
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Affiliation(s)
- Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Lei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Leng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huanjie Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Biru Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Jeppesen TD, Levison L, Codeluppi L, Krarup C. Quantitative electromyography: Normative data in paraspinal muscles. Muscle Nerve 2020; 62:358-362. [PMID: 32530492 DOI: 10.1002/mus.27000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Quantitative electromyography of paraspinal muscle is a valuable diagnostic tool, but normative data are lacking. METHODS Needle electromyography (EMG) was obtained in 65 healthy subjects (49% men, 51% women) aged 21 to 82 years at C7, Th10, and L5 segments bilaterally. The incidence of spontaneous activity; motor unit potential (MUP) amplitudes, durations, and the incidence of polyphasic potentials; and the recruitment pattern at maximal voluntary contraction (MVC) were evaluated. RESULTS The incidence of fibrillation potentials was similar to limb muscles. The mean MUP duration and amplitude, and the amplitude at MVC increased caudally, while the incidence of polyphasic potentials was similar at all levels. EMG parameters did not correlate with sex or age. CONCLUSIONS In contrast to limb muscles, EMG parameters did not change with age, while polyphasic potentials were more frequent in paraspinal muscle than in limb muscles. The EMG gradient suggests larger motor units at more caudal segments.
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Affiliation(s)
- Tina D Jeppesen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Levison
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Luca Codeluppi
- Department of Neurology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Christian Krarup
- Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Agha O, Mueller‐Immergluck A, Liu M, Zhang H, Theologis AA, Clark A, Kim HT, Liu X, Feeley BT, Bailey JF. Intervertebral disc herniation effects on multifidus muscle composition and resident stem cell populations. JOR Spine 2020; 3:e1091. [PMID: 32613166 PMCID: PMC7323461 DOI: 10.1002/jsp2.1091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/14/2020] [Accepted: 04/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Paraspinal muscles are crucial for vertebral stabilization and movement. These muscles are prone to develop fatty infiltration (FI), fibrosis, and atrophy in many spine conditions. Fibro-adipogenic progenitors (FAPs), a resident muscle stem cell population, are the main contributors of muscle fibrosis and FI. FAPs are involved in a complex interplay with satellite cells (SCs), the primary myogenic progenitor cells within muscle. Little is known about the stem cell composition of the multifidus. The aim of this study is to examine FAPs and SCs in the multifidus in disc herniation patients. Multifidus muscle samples were collected from 10 patients undergoing decompressive spine surgery for lumbar disc herniation. Hamstring muscle was collected from four patients undergoing hamstring autograft ACL reconstruction as an appendicular control. Multifidus tissue was analyzed for FI and fibrosis using Oil-Red-O and Masson's trichrome staining. FAPs and SCs were visualized using immunostaining and quantified with fluorescence-activated cell sorting (FACS) sorting. Gene expression of these cells from the multifidus were analyzed with reverse transcription-polymerase chain reaction and compared to those from hamstring muscle. FI and fibrosis accounted for 14.2%± 7.4% and 14.8%±4.2% of multifidus muscle, respectively. The multifidus contained more FAPs (11.7%±1.9% vs 1.4%±0.2%; P<.001) and more SCs (3.4%±1.6% vs 0.08%±0.02%; P=.002) than the hamstring. FAPs had greater α Smooth Muscle Actin (αSMA) and adipogenic gene expression than FAPs from the hamstring. SCs from the multifidus displayed upregulated expression of stem, proliferation, and differentiation genes. CONCLUSION The multifidus in patients with disc herniation contains large percentages of FAPs and SCs with different gene expression profiles compared to those in the hamstring. These results may help explain the tendency for the multifidus to atrophy and form FI and fibrosis as well as elucidate potential approaches for mitigating these degenerative changes by leveraging these muscle stem cell populations.
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Affiliation(s)
- Obiajulu Agha
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Orthopaedic SurgerySan Francisco Veterans Affair Health Care SystemSan FranciscoCaliforniaUSA
| | - Andreas Mueller‐Immergluck
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Orthopaedic SurgerySan Francisco Veterans Affair Health Care SystemSan FranciscoCaliforniaUSA
| | - Mengyao Liu
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Orthopaedic SurgerySan Francisco Veterans Affair Health Care SystemSan FranciscoCaliforniaUSA
| | - He Zhang
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Orthopaedic SurgerySan Francisco Veterans Affair Health Care SystemSan FranciscoCaliforniaUSA
- Department of Exercise PhysiologyBeijing Sport UniversityBeijingChina
| | - Alekos A. Theologis
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Orthopaedic SurgerySan Francisco Veterans Affair Health Care SystemSan FranciscoCaliforniaUSA
| | - Aaron Clark
- Department of NeurosurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Hubert T. Kim
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Orthopaedic SurgerySan Francisco Veterans Affair Health Care SystemSan FranciscoCaliforniaUSA
| | - Xuhui Liu
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Orthopaedic SurgerySan Francisco Veterans Affair Health Care SystemSan FranciscoCaliforniaUSA
| | - Brian T. Feeley
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Orthopaedic SurgerySan Francisco Veterans Affair Health Care SystemSan FranciscoCaliforniaUSA
| | - Jeannie F. Bailey
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Lee C, Agha O, Liu M, Davies M, Bertoy L, Kim HT, Liu X, Feeley BT. Rotator Cuff Fibro-Adipogenic Progenitors Demonstrate Highest Concentration, Proliferative Capacity, and Adipogenic Potential Across Muscle Groups. J Orthop Res 2020; 38:1113-1121. [PMID: 31799698 PMCID: PMC9262119 DOI: 10.1002/jor.24550] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/30/2019] [Indexed: 02/04/2023]
Abstract
Fatty infiltration (FI) of rotator cuff (RC) muscles is common in patients with RC tears. Studies have demonstrated that fibro-adipogenic progenitors (FAPs), a population of resident muscle stem cells, are the main contributors of FI, which adversely affects muscle quality and RC repair success. Although FI is common in RC injuries, it is not frequently reported after other musculotendinous injuries. Additionally, studies have shown the development of different pathology patterns across muscle groups suggestive of intrinsic differences in cellular composition and behavior. This study evaluates FAP distribution and differentiation properties across anatomic locations in mice. Muscles from seven different anatomic locations were harvested from PDGFRα-eGFP FAP reporter mice. FAPs were quantified using histology and FACS sorting with BD Aria II with CD31- /CD45- /Integrinα7- /Sca-1+ and PDGFRα reporter signal (n = 3 per muscle). The cells were analyzed for adipogenesis using immunocytochemistry and for proliferation properties with Brdu-Ki67 staining. In a separate group of mice, RC and tibialis anterior muscles received glycerol injection and were harvested after 2 weeks for FI quantification (n = 4). One-way analysis of variance was used for statistical comparisons among groups, with significance at p < 0.05. FAPs from the RC, masseter, and paraspinal muscles were more numerous and demonstrated greater proliferative capacity and adipogenic potency than those from the tibialis anterior and gastrocnemius. The RC demonstrated significantly greater levels of FI than the tibialis anterior after glycerol-injection injury. Clinical Significance: This study suggests differences in FAP distribution and differentiation characteristics may account for the propensity to develop FI in RC tears as compared with other musculotendinous injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1113-1121, 2020.
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Affiliation(s)
- Carlin Lee
- San Francisco Veteran Affairs Health Care System, San Francisco, California, 94158,Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, 94158
| | - Obiajulu Agha
- San Francisco Veteran Affairs Health Care System, San Francisco, California, 94158,Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, 94158
| | - Mengyao Liu
- San Francisco Veteran Affairs Health Care System, San Francisco, California, 94158,Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, 94158
| | - Michael Davies
- San Francisco Veteran Affairs Health Care System, San Francisco, California, 94158,Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, 94158
| | - Lauren Bertoy
- San Francisco Veteran Affairs Health Care System, San Francisco, California, 94158,Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, 94158
| | - Hubert T. Kim
- San Francisco Veteran Affairs Health Care System, San Francisco, California, 94158,Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, 94158
| | - Xuhui Liu
- San Francisco Veteran Affairs Health Care System, San Francisco, California, 94158,Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, 94158
| | - Brian T. Feeley
- San Francisco Veteran Affairs Health Care System, San Francisco, California, 94158,Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, 94158
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Huang YL, Zhou JL, Jiang YM, Zhang ZG, Zhao W, Han D, He B. Assessment of lumbar paraspinal muscle activation using fMRI BOLD imaging and T2 mapping. Quant Imaging Med Surg 2020; 10:106-115. [PMID: 31956534 DOI: 10.21037/qims.2019.10.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Our study aimed to investigate the feasibility of functional magnetic resonance imaging [blood oxygen level-dependent (BOLD) imaging and T2 mapping] in monitoring the activation of lumbar paraspinal muscles before and after exercise. Methods The ethics committee of the First Affiliated Hospital of Kunming Medical University approved our study. Both BOLD and T2 mapping of paraspinal muscles were performed in 50 healthy, young volunteers before and after upper-body extension exercises. The movement tasks included upper body flexion and extension using a simple Roman chair. Cross-sectional area (CSA), R2*, and T2 values were measured in various lower-back anatomical regions. The SPSS22.0 statistical software was used to analyze all the data. Results Post-exercise CSA and T2 values were higher than those recorded in the pre-exercise session for the three lower-back muscles that were evaluated (iliocostalis, longissimus, and multifidus) (P<0.01). However, R2* values of these muscles were significantly lower after exercise (P<0.01). A significant difference in the R2*, CSA, and T2 values of the iliocostalis occurred between males and females (P<0.05). No statistically significant differences were evident for R2*, CSA, and T2 of the lower-back muscles between L3 and L4 levels, or between the left and right sides. The total CSA of the iliocostalis was higher than that of the multifidus and longissimus (P<0.05). Conclusions BOLD and T2 mapping are feasible non-invasive indirect assessments of lumbar paraspinal muscle activation before and after exercise.
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Affiliation(s)
- Yi-Long Huang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University Yunnan, Kunming 650032, China
| | - Jia-Long Zhou
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University Yunnan, Kunming 650032, China.,Department of Magnetic Resonance Imaging, The First People's Hospital of Yunnan Province, Kunming 650032, China
| | - Yuan-Ming Jiang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University Yunnan, Kunming 650032, China
| | - Zhen-Guang Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University Yunnan, Kunming 650032, China
| | - Wei Zhao
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University Yunnan, Kunming 650032, China
| | - Dan Han
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University Yunnan, Kunming 650032, China
| | - Bo He
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University Yunnan, Kunming 650032, China
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Burian E, Inhuber S, Schlaeger S, Dieckmeyer M, Klupp E, Franz D, Weidlich D, Sollmann N, Löffler M, Schwirtz A, Rummeny EJ, Zimmer C, Kirschke JS, Karampinos DC, Baum T. Association of thigh and paraspinal muscle composition in young adults using chemical shift encoding-based water-fat MRI. Quant Imaging Med Surg 2020; 10:128-136. [PMID: 31956536 DOI: 10.21037/qims.2019.11.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Paraspinal and thigh muscles comprise the major muscle groups of the body. We investigated the composition of the psoas, erector spinae, quadriceps femoris and hamstring muscle groups and their association to each other using chemical shift encoding-based water-fat magnetic resonance imaging (MRI) in adult volunteers. Our aim was to elucidate fat distribution patterns within these muscle groups. Methods Thirty volunteers [15 males, age: 30.5±4.9 years, body mass index (BMI): 27.6±2.8 kg/m2 and 15 females, age: 29.9±7.0 years, BMI: 25.8±1.4 kg/m2] were recruited for this study. A six-echo 3D spoiled gradient echo sequence was used for chemical shift encoding-based water-fat separation at the lumbar spine and bilateral thigh. Proton density fat fraction (PDFF), cross-sectional area (CSA) and contractile mass index (CMI) of the psoas, erector spinae, quadriceps femoris and hamstring muscle groups were determined bilaterally and averaged over both sides. Results CSA and CMI values calculated for the erector spinae, psoas, quadriceps and hamstring muscle groups showed significant differences between men and women (P<0.05). With regard to PDFF measurement only the erector spinae showed significant differences between men and women (9.5%±2.4% vs. 11.7%±2.8%, P=0.015). The CMI of the psoas muscle as well as the erector spinae muscle showed significant correlations with the quadriceps muscle (r=0.691, P<0.0001 and r=0.761, P<0.0001) and the hamstring group (r=0.588, P=0.001 and r=0.603, P<0.0001). Conclusions CMI values of the erector spinae and psoas muscles were associated with those of the quadriceps femoris and hamstring musculature. These findings suggest a concordant spatial fat accumulation within the analyzed muscles in young adults and warrants further investigations in ageing and diseased muscle.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephanie Inhuber
- Department of Sport and Health Sciences, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sarah Schlaeger
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Elisabeth Klupp
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian Löffler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ansgar Schwirtz
- Department of Sport and Health Sciences, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Jennings W, Hou M, Perterson D, Missiuna P, Thabane L, Tarnopolsky M, Samaan MC. Paraspinal muscle ladybird homeobox 1 (LBX1) in adolescent idiopathic scoliosis: a cross-sectional study. Spine J 2019; 19:1911-1916. [PMID: 31202838 DOI: 10.1016/j.spinee.2019.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) is the leading cause of spinal deformity in adolescents globally. Recent evidence from genome-wide association studies has implicated variants in or near the ladybird homeobox 1 (LBX1) gene, encoding the ladybird homeobox 1 transcription factor, in AIS development. This gene plays a critical role in guiding embryonic neurogenesis and myogenesis and is vital in muscle mass determination. Despite the confirmation of the role for LBX1 gene variants in the development of AIS, the biological basis of LBX1 contribution to AIS remains mostly unknown. PURPOSE To investigate the potential role of LBX1 in driving spinal curving, curve laterality, and progression through muscle-based mechanisms in AIS patients by analyzing its gene and protein expression. STUDY DESIGN This is a cross-sectional study using clinical data and biological samples from the Immunometabolic CONnections to Scoliosis study (ICONS study). PATIENT SAMPLE Twenty-five patients with AIS provided informed consent. Paraspinal muscle biopsies from the maximal points of concavity and convexity for gene expression and protein analysis were obtained at the start of corrective spinal surgery. OUTCOME MEASURES The outcome measures included the detection of paraspinal muscle LBX1 mRNA abundance and LBX1 protein expression and the correlation of the latter with age, sex, and curve severity. METHODS The measurement of mRNA abundance was done using quantitative real-time polymerase chain reaction (qRT-PCR). Additionally, protein lysates from the biopsied muscle samples were probed with a monoclonal LBX1 antibody to compare the muscle protein levels on either side of the scoliotic curve by western blot. This study received funding from the Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada ($39,900 CAN for 2 years). The authors have no conflicts of interest to disclose. RESULTS LBX1 mRNA abundance (concave 2.98±0.87, convex 3.40±1.10, p value 0.73) and protein expression (concave 1.20±0.13, convex 1.21±0.10, p value 0.43) were detected on both sides of the scoliotic curve at equivalent levels. The expression of LBX1 protein did not correlate with age (concave: correlation coefficient 0.32, p value 0.12; convex: correlation coefficient 0.08, p value 0.69), sex (concave: correlation coefficient -0.03, p value 0.08; convex: correlation coefficient 0.07, p value 0.72), or the severity of spinal curving measured using the Cobb angle (concave: correlation coefficient -0.16, p value 0.45; convex: correlation coefficient -0.08, p value 0.69). CONCLUSIONS LBX1 is expressed in erector spinae muscles, and its levels are equal in muscles on both sides of the scoliotic curve in AIS. The expression of LBX1 on the convex and concave sides of the scoliotic curve did not correlate with age, sex, or the severity of spinal curving. The molecular mechanisms by which LBX1contributes to the development and propagation of AIS need to be explored further in muscle and other tissues.
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Affiliation(s)
- William Jennings
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Maggie Hou
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Devin Perterson
- Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul Missiuna
- Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Ontario, Canada; Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada
| | - Mark Tarnopolsky
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
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40
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Chang MY, Park Y, Ha JW, Zhang HY, Lee SH, Hong TH, Lee SH. Paraspinal Lean Muscle Mass Measurement Using Spine MRI as a Predictor of Adjacent Segment Disease After Lumbar Fusion: A Propensity Score-Matched Case-Control Analysis. AJR Am J Roentgenol 2019; 212:1310-7. [PMID: 30860899 DOI: 10.2214/AJR.18.20441] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. The purpose of this study was to compare paraspinal muscle mass between patients with and without adjacent segment disease (ASD) after lumbar fusion. MATERIALS AND METHODS. Fifty patients with ASD (mean age, 61.4 years; ratio of male to female patients: 13:37; mean body mass index [BMI; weight in kilograms divided by the square of height in meters], 25.1) were matched to 50 control patients on the basis of age, sex, BMI, and fusion segment. The total cross-sectional area (CSA) and functional CSA (FCSA; i.e., the area containing lean muscle tissue only) of the paraspinal muscle group (the multifidus and erector spinae muscles) and the psoas muscles were measured on preoperative MRI. The ratio of the FCSA to the total CSA and the skeletal muscle index (SMI; calculated as muscle area [expressed as centimeters squared] divided by the square of the patient's height in meters]) were calculated and compared between the two groups with use of the independent-sample t test. RESULTS. The mean FCSA (2178.6 mm2 vs 2594.0 mm2; p = 0.004), the ratio of the FCSA to the total CSA (45.4% vs 52.2%; p = 0.001), and the SMI of the FCSA (8.8 vs 10.6; p = 0.001) of the paraspinal muscle group were significantly smaller in patients with ASD compared to the control group. When the paraspinal and psoas muscle groups were combined, the mean FCSA (3680.8 mm2 vs 4268.2 mm2; p = 0.013), the ratio of FCSA to total CSA (53.3% vs 58.6%; p = 0.004), the SMI of the total CSA (27.7 vs 29.3; p = 0.049), and the SMI of the FCSA (14.9 vs 17.3; p = 0.002) were significantly lower in patients with ASD than in control patients. CONCLUSION. Patients with ASD had smaller lean muscle mass (FCSA), a lower ratio of FCSA to total CSA, and a lower SMI of the FCSA of the paraspinal muscle group on pre-operative MRI, compared with control patients.
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Li AY, Dai JB, Post AF, Choudhri TF. Dynamic Cervical Cord Compression Post-laminectomy Visualized by Flexion-extension Magnetic Resonance Imaging: Case Report. Cureus 2019; 11:e3878. [PMID: 30899629 PMCID: PMC6420335 DOI: 10.7759/cureus.3878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Flexion-extension magnetic resonance imaging (MRI) in the cervical spine is not universally used in cervical spine surgery. However, flexion-extension MRIs can identify previously undetected spinal stenosis, improve surgical decision-making, and maybe a better tool to evaluate postoperative outcomes. One uncommon complication after laminectomy, to treat cervical spinal stenosis, is muscle weakness due to subsequent dynamic cord compression by posterior paraspinal musculature. We present a case of a 41-year-old male who underwent posterior cervical decompression and developed subsequent neurological deficits and muscle weakness. MRI with neutral cervical positioning did not show spinal stenosis necessitating surgical intervention. However, given the patient’s increasing tetraparesis, flexion-extension MRI was performed and it revealed significant spinal stenosis in both flexion and extension positions due to spondylosis and compression from paraspinal muscles. This case demonstrates the utility of flexion-extension MRI in identifying pathologies such as cord compression by paraspinal muscles. Exclusive use of a neutral-position MRI scan may not be sufficient to provide proper diagnoses for cervical spine pathologies. Flexion-extension MRI should be considered when the degree of neurological symptoms outweighs minimal or absent pathology seen on neutral-position sagittal MRI.
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Affiliation(s)
- Adam Y Li
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jennifer B Dai
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alexander F Post
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tanvir F Choudhri
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cha JR, Kim YC, Yoon WK, Lee WG, Kim TH, Oh JK, Kim SW, Ohn SH, Cui JH. The recovery of damaged paraspinal muscles by posterior surgical treatment for patients with lumbar degenerative diseases and its clinical consequence. J Back Musculoskelet Rehabil 2018; 30:801-809. [PMID: 28372312 DOI: 10.3233/bmr-150455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Posterior lumbar surgery can lead to damage on paraspinal muscles. OBJECTIVE Our study aimed to examine the recovery in the denervated paraspinal muscles by posterior lumbar surgery and to determine that of improvement in the lower back pain (LBP). METHODS Depending on surgical treatments, the patients were divided into two groups: The group I (interspinous implantation with decompression) and II (posterior lumbar interbody fusion with decompression). The paraspinal mapping score was recorded for individual muscle. RESULTS In the group I, there was reinnervation in the denervated multifidus and erector spinae at the upper, surgical and lower levels at 12 months. In the group II, there was reinnervation in the denervated erector spinae at the upper, surgical and lower levels at 12 months. There was significant aggravation in the LBP in both groups at immediate postoperative. But there was significant improvement in it at 6 months in the group I and at 12 months in the group II. CONCLUSION There was reinnervation in not only denervated multifidus and erector spinae at 12 months following interspinous ligament stabilization but also in denervated erector spinae at 12 months following pedicle screw fixation with fusion.
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Affiliation(s)
- Jae-Ryong Cha
- Department of Orthopaedic Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, Korea
| | - Yong-Chan Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Wan-Keun Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Won-Gyu Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, Dongan-gu, Anyang-si, Korea
| | - Jae-Keun Oh
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, Dongan-gu, Anyang-si, Korea
| | - Seok-Woo Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, Dongan-gu, Anyang-si, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University, Dongan-gu, Anyang-si, Korea
| | - Ji Hao Cui
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Pishnamaz M, Schemmann U, Herren C, Horst K, Lichte P, Hildebrand F, Pape HC, Kobbe P. Muscular changes after minimally invasive versus open spinal stabilization of thoracolumbar fractures: A literature review. J Musculoskelet Neuronal Interact 2018; 18:62-70. [PMID: 29504580 PMCID: PMC5881130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This review addressed the question of whether minimally invasive surgery after traumatic thoracolumbar spine fractures can reduce paraspinal muscle injury, limit changes in muscular structure and function, and lead to better functional outcome. Special emphasis was given to studies using imaging techniques or electromyography to evaluate the lumbar multifidus muscle structure and function. METHODS The authors searched the literature in the PubMed/Medline, EMBASE, by cross-referencing and additional hand search. Included were comparative studies between conventional open and minimally invasive or percutaneous surgical approaches. Twelve studies were included. RESULTS AND CONCLUSIONS The literature review supports the assumption that minimally invasive surgery preserves muscles for the early post-operative period, even though the level of evidence is still low. The correlation of changes in muscular structure to pain, strength, disability, and quality of life remains ambiguous and should be addressed in further studies with a focus on the surgical approach.
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Affiliation(s)
- Miguel Pishnamaz
- University of Aachen Medical Center, Department of Orthopaedic Trauma, Germany,Corresponding author: Miguel Pishnamaz, MD, University of Aachen Medical Center, Department of Orthopaedic Trauma, Pauwelsstraße 30, 52074 Aachen E-mail:
| | - Ulrike Schemmann
- University of Aachen Medical Center, Department of Orthopaedic Trauma, Germany
| | - Christian Herren
- University of Aachen Medical Center, Department of Orthopaedic Trauma, Germany
| | - Klemens Horst
- University of Aachen Medical Center, Department of Orthopaedic Trauma, Germany
| | - Philipp Lichte
- University of Aachen Medical Center, Department of Orthopaedic Trauma, Germany
| | - Frank Hildebrand
- University of Aachen Medical Center, Department of Orthopaedic Trauma, Germany
| | | | - Philipp Kobbe
- University of Aachen Medical Center, Department of Orthopaedic Trauma, Germany
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Trampus P, Goepfert C, Welle M, Henke D, Forterre F, Schweizer-Gorgas D. Magnetic Resonance Imaging Signal Alterations in Paraspinal Muscles in Dogs with Acute Thoracolumbar Intervertebral Disk Extrusion. Front Vet Sci 2018; 5:16. [PMID: 29497616 PMCID: PMC5819315 DOI: 10.3389/fvets.2018.00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/29/2018] [Indexed: 11/17/2022] Open
Abstract
Muscle signal alteration detected on MRI is seen in diverse pathologic conditions. We observed signal alterations within the paraspinal muscles in dogs with acute thoracolumbar intervertebral disk extrusion. The aim of this retrospective study was to describe MRI features of paraspinal muscle signal alteration in dogs with acute thoracolumbar intervertebral disk extrusion and to investigate an association of the signal alterations with neurological grade, type and location of intervertebral disk extrusion, degree of spinal cord compression, and presence of epidural hemorrhage. Medical records of dogs undergoing MRI because of thoracolumbar intervertebral disk extrusion between August 2014 and June 2016 were reviewed. MRI was evaluated for SI changes within the paravertebral musculature, their location, extension, affected muscles, contrast enhancement, and signal void in T2* sequences. Intervertebral disk herniation was categorized as acute non-compressive nucleus pulposus extrusion (ANNPE) or compressive intervertebral disk disease. In five patients, muscle biopsies of areas with signal intensity changes were taken during surgery. In total, 103 dogs were enrolled in the study. Paraspinal muscle signal alterations were visible in 37 dogs (36%) affecting the epaxial musculature (n = 17), hypaxial musculature (n = 12), or both (n = 8). All signal alterations were hyperintense on T2-weighted images and iso- or hypointense in T1-weighted images. Signal void in T2* was not observed in any dog. Postcontrast sequences were available in 30 of the 37 dogs and showed enhancement in 45%. There was neither an association with degree of compression nor epidural hemorrhage. Intervertebral disk extrusion caudal to L1 and a higher neurological grade was associated with the presence of muscle changes. Histopathology revealed mild to moderate acute muscle fiber degeneration with edema and necrosis in three of five samples. The MRI, as well as the muscle samples, show rather unspecific changes. The underlying pathomechanism might be related to ischemia or muscle spasm, but also denervation edema may explain the signal alteration.
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Affiliation(s)
- Peter Trampus
- Division of Clinical Radiology, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Christine Goepfert
- Institute of Animal Pathology, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Monika Welle
- Institute of Animal Pathology, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Diana Henke
- Division of Clinical Neurology, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Franck Forterre
- Division of Small Animal Surgery, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
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Zhang L, Fang X, Zhao X, Xu W, Liu G. [Short-term effectiveness of transforaminal unilateral approach for bilateral decompression in lumbar interbody fusion for the treatment of lumbar spinal stenosis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017; 31:519-526. [PMID: 29798539 DOI: 10.7507/1002-1892.201612131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To assess the clinical application value of tranforaminal unilateral approach for bilateral decompression by comparing the short-term effectiveness of bilateral decompression via unilateral approach of intervertebral foramen with via small surgical incision of bilateral spinous process in lumbar interbody fusion for the treatment of lumbar spinal stenosis. Methods Between July 2014 and June 2015, 48 patients with lumbar spinal stenosis underwent decompression and internal fixation by unilateral approach in 24 cases (trial group) and by bilateral small incision approach in 24 cases (control group). There was no significant difference in gender, age, disease duration, disease type, involved segment, combined medical diseases, preoperative level of creatine phosphokinase (CPK), the visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, and the incidence of complications were recorded. The CPK levels were evaluated at 1, 3, and 7 days after operation. VAS score and ODI were used to evaluate the effectiveness, and lumbar X-ray film or CT scanning to determine the intervertebral bony fusion. Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization time between 2 groups ( P>0.05), but significant difference was found in postoperative drainage ( t=5.547, P=0.000). At 1 day after operation, the level of CPK in the trial group was significantly lower than that in the control group ( t=3.129, P=0.005), but there was no significant difference at 3 and 7 days after operation between 2 groups ( P>0.05). The patients were followed up 12-24 months (mean, 17 months). All the wounds healed primarily. Heart failure occurred in 1 case of the trial group, and cerebrospinal fluid leakage and pulmonary infection, and nerve root injury occurred in 1 case of the control group respectively. There was no significant difference in the incidence of complications between 2 groups ( χ2=0.273, P=0.602). The interbody fusion rate was 95.8% (23/24) in the trial group and was 91.7% (22/24) in the control group, showing no significant difference ( χ2=0.356, P=0.551). No cage sink, dislocation or plate and screw loosening and breakage was found in 2 groups. No adjacent segment degeneration occurred during the follow-up, and there was no change of scoliosis and lumbar sagittal curvature. At 3, 6, and 12 months after operation, the VAS score and ODI were significantly improved when compared with the preoperative scores in 2 groups ( P<0.05), and the VAS score and ODI of the trial group were significantly better than those of control group ( P<0.05). Conclusion The bilateral decompression via unilateral approach of intervertebral foramen and small surgical incision of bilateral spinous process in lumbar interbody fusion have satisfactory efficacy for the treatment of lumbar spinal stenosis, but the tranforaminal unilateral approach has the advantages of less trauma, avoidance of bilateral muscle stripping and soft paraspinal muscle injury, retention of posterior spinal structure, faster postoperative recovery, shorter hospital stay and good short-term effectiveness.
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Affiliation(s)
- Lei Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou Zhejiang, 310036, P.R.China
| | - Xiangqian Fang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou Zhejiang, 310036,
| | - Xing Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou Zhejiang, 310036, P.R.China
| | - Wenbin Xu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou Zhejiang, 310036, P.R.China
| | - Gang Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou Zhejiang, 310036, P.R.China
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Sha S, Li Y, Qiu Y, Liu Z, Sun X, Zhu W, Feng Z, Wu T, Jiang J, Zhu Z. Posterior fossa decompression in Chiari I improves denervation of the paraspinal muscles. J Neurol Neurosurg Psychiatry 2017; 88:438-444. [PMID: 28259858 DOI: 10.1136/jnnp-2016-315161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/28/2016] [Accepted: 02/13/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether posterior fossa decompression (PFD) could improve denervation of the paraspinal muscles in patients with Chiari I malformation (CMI). BACKGROUND Paraspinal muscle denervation is one of the essential elements in the pathophysiology of CMI/syringomyelia-related scoliosis. Although PFD has been widely used for managing CMI, whether denervation of the paraspinal muscles may benefit from this neurosurgical procedure remains ambiguous. Bax and Bcl-2 are two regulators of apoptosis that are closely related to the innervation status of skeletal muscles, and denervation is associated with upregulated Bax and downregulated Bcl-2. METHODS Thirty-seven patients who underwent PFD and subsequent deformity correction for CMI-associated scoliosis were enrolled. Biopsy specimens were obtained from bilateral erector spinae muscles during both procedures with an average interval of 6.5 months. The biopsy site was located within the spinal innervation region involved by the syrinx and near the level of upper instrumented vertebra. The expression levels of Bax and Bcl-2 as well as histological features of the muscle fibres were examined at the two time points. RESULTS After PFD, the mRNA level of antiapoptotic Bcl-2 was elevated by 178% and 260% in the convex and concave muscles, respectively, with a coincident decrease of 69% and 73% for proapoptotic Bax at the corresponding sites (p<0.001). Consistent with the mRNA data, the Bcl-2 protein in the paraspinal muscles was increased by 75% on the convex and by 169% on the concave side following PFD. For Bax protein, decreases of 45% and 52% were detected in the convex and concave muscles, respectively (p<0.001). On average, these changes led to a 60% decrease in the Bax/Bcl-2 ratio, suggesting reduced apoptotic signalling and improved innervation of the paraspinal muscles. Histologically, the specimens demonstrated improvements in denervation-associated changes of the muscle fibres following PFD, with the number of atrophic and necrotic/degenerated fibres decreasing significantly from 6.7 and 8.5 before surgery to 3.2 (p=0.012) and 4.2 (p<0.001) after surgery, respectively. CONCLUSION In patients with CMI, treatment with PFD led to a decrease in the Bax/Bcl-2 ratio at both the mRNA and protein levels, indicating an attenuated susceptibility to apoptotic cell death. These data, coupled with the observed improvements in histopathological features of the myofibres, suggest that PFD in Chiari I ameliorates denervation of the paraspinal muscles.
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Affiliation(s)
- Shifu Sha
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Li
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xu Sun
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Weiguo Zhu
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhenhua Feng
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Tao Wu
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian Jiang
- Department of Neurosurgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Abstract
BACKGROUND Degenerative flat back (DFB) is characterized by sagittal imbalance resulting from the loss of lumbar lordosis (LL). Extensive degeneration and weakness of lumbar paraspinal extensor muscle (PSE) are thought to be the main cause of DFB. This study is to evaluate correlation between preoperative PSE conditions and angular severity of DFB and to evaluate correlation between preoperative PSE conditions and degree of improvement of DFB obtained by corrective surgery. MATERIALS AND METHODS Forty five patients with DFB who took magnetic resonance image (MRI) preoperatively and conducted simple radiography and three-dimensional gait analysis before and 6 months after corrective surgery were included. To determine the severity of PSE atrophy, the ratio between cross-sectional area of PSE and disc was calculated from L1-L2 to L4-L5 on MRI. To assess the degree of fat infiltration, the signal intensity of PSE was measured. Static parameters of spinopelvic segment were measured by simple radiography. Dynamic parameters of spinopelvic and lower limb joints were obtained by three-dimensional gait analysis. RESULTS In static parameters, thoracic angle was correlated with atrophy and fat infiltration of upper PSE. Thoracic angle was less improved after surgery, as atrophy of upper PSE was more severe. In dynamic parameters, thoracic angle showed correlation with upper PSE conditions, whereas lumbar angle had correlation with middle to lower PSE conditions. While thoracic kyphosis was less improved after surgery, as atrophy of upper PSE was more severe, LL was less improved, as atrophy and fat infiltration of PSE from L1-L2 to L4-L5 were more severe. CONCLUSIONS Severity of atrophy or fat infiltration of PSE showed correlation with degree of angular deformity in patients with DFB and with less improvement after corrective surgery. Dynamic parameters showed more prominent correlation with PSE conditions than static parameters and also showed segmental specificity between PSE and angular deformity.
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Affiliation(s)
- Jung Hwan Lee
- Department of Physical Medicine and Rehabilitation, Wooridul Spine Hospital, Seoul, Korea,Address for correspondence: Dr. Jung Hwan Lee, Department of Physical Medicine and Rehabilitation, Wooridul Spine Hospital, 46-17 Chungdam-Dong, Gangnam-Gu, Seoul, Korea. E-mail:
| | - Sang-Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
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Abstract
Bleeding and hematoma formation is rarely reported in percutaneous vertebroplasty procedure. An 84 year old male presented with a large paraspinal muscle hematoma after a percutaneous vertebroplasty. The patient had neither any prior bleeding disorder nor any anticoagulant treatment. Vital signs of the patient were unstable, and his hemoglobin level decreased daily. After a month of conservative treatment, including transfusion, cryotherapy, pain control and bed rest, his hemoglobin level remained stable and he showed relief from pain. Four months later, hematoma resolved spontaneously and he could walk without back pain.
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Affiliation(s)
- Chang-Hoon Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jae-Heon Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea,Address for correspondence: Dr. Han-Dong Lee, San 5, Wonchon-dong, Youngtong-gu, Suwon, Kyounggi-do, 443-721, South Korea. E-mail:
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Xu WB, Chen S, Fan SW, Zhao FD, Yu XJ, Hu ZJ. Facet orientation and tropism: Associations with asymmetric lumbar paraspinal and psoas muscle parameters in patients with chronic low back pain. J Back Musculoskelet Rehabil 2016; 29:581-6. [PMID: 26836843 DOI: 10.3233/bmr-160661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many studies have explored the relationship between facet tropism and facet joint osteoarthritis, disc degeneration and degenerative spondylolisthesis. However, the associations between facet orientation and tropism, and paraspinal muscles have not been studied. OBJECTIVE To analyze the associations between facet orientation and tropism, and parameters of paraspinal muscles in patients with chronic low back pain. METHODS Ninety-five patients with chronic low back pain were consecutively enrolled. Their facet joint angles were measured on computed tomography (CT) while gross cross-sectional area (GCSA), functional cross-sectional area (FCSA) and T2 signal intensity of lumbar paraspinal and psoas muscle were evaluated on magnetic resonance imaging (MRI). RESULTS The GCSA and FCSA were significantly smaller for multifidus muscle (P< 0.001), but significantly larger for erector spinae and psoas muscles (P< 0.001), in coronally-orientated group than those in sagittally-orientated group. The differences of bilateral GCSA and FCSA of multifidus muscle were significantly larger in facet tropism group than those in no facet tropism group (P= 0.009 and P= 0.019). CONCLUSIONS Muscular asymmetries may develop in the lumbar region of the spine, which are associated with facet asymmetry in patients with chronic low back pain. Longitudinal studies are needed to understand the causal relationship between facet orientation and tropism and muscular asymmetry in future.
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Affiliation(s)
- W B Xu
- Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - S Chen
- Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - S W Fan
- Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - F D Zhao
- Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - X J Yu
- Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Z J Hu
- Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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