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Kim TK, Gil HY. Effects of Paraspinal Intramuscular Injection of Atelocollagen in Patients with Chronic Low Back Pain: A Retrospective Observational Study. J Clin Med 2024; 13:2607. [PMID: 38731135 PMCID: PMC11084233 DOI: 10.3390/jcm13092607] [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: 03/12/2024] [Revised: 04/21/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Atelocollagen is used for soft tissue repair and reconstruction by replacing defective or damaged muscles, membranes, ligaments, and tendons. This study aimed to evaluate the clinical efficacy and safety of additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection for reducing pain and improving functional capacity of patients with chronic low back pain (CLBP). Methods: We retrospectively enrolled 608 consecutive patients with CLBP who received lumbar epidural steroid injection with or without additional paraspinal intramuscular injection of atelocollagen. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure, and three months after the injection. Also, we analyzed the relationship between the additional paraspinal intramuscular injection of atelocollagen and the success rate. Results: Both Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups at three months after injection. However, there was a significant difference between the two groups. Furthermore, the success rate was significantly higher in the additional paraspinal intramuscular injection of atelocollagen group. Conclusions: This study's results showed that additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection reduced pain and improved functional capacity for patients with CLBP. Therefore, the paraspinal intramuscular injection of atelocollagen may be a promising option for the treatment of patients with CLBP.
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Affiliation(s)
- Tae Kwang Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea;
| | - Ho Young Gil
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi 39371, Republic of Korea
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Suzuki K, Mizoguchi Y, Hasebe Y, Kimura F, Saita K, Ogihara S. Association of Preoperative Osteoporotic Vertebral Compression Fractures with Muscle Atrophy in Lumbar Spinal Stenosis: A Retrospective Cohort Study. Prog Rehabil Med 2024; 9:20240011. [PMID: 38567018 PMCID: PMC10984831 DOI: 10.2490/prm.20240011] [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: 02/07/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Osteoporotic vertebral compression fractures (OVCFs) are common in older individuals and lead to pain, spinal deformities, and limited mobility. Paraspinal muscle function correlates with fracture severity, and this association may be more significant in patients with lumbar spinal stenosis (LSS). However, studies on the effects of OVCFs are lacking. This study aimed to investigate the relationship between OVCFs, fat infiltration, and muscle atrophy in patients with LSS. Methods This study included 177 patients with preoperative LSS, of whom 16 had OVCFs and 161 did not. Lumbar lordosis angle, fat infiltration, and paraspinal muscle atrophy were evaluated in these patients. Information on patient characteristics such as smoking, diabetes, hemodialysis, steroid use, American Society of Anesthesiologists score, and bladder or bowel dysfunction were obtained from medical records. Logistic regression analysis was conducted to identify factors independently associated with OVCF. Results Patients in the OVCF group were significantly older (P=0.006) than those without fractures, and a higher proportion of the OVCF group showed muscle atrophy (P=0.034). Significant variables and those with moderate effect sizes were included in the logistic regression analysis. Muscle atrophy (P=0.028) was independently associated with OVCF. Conclusions Muscle atrophy was associated with preoperative OVCFs in patients with LSS. Identifying OVCFs in these patients may underscore the importance of tailored treatment and rehabilitation strategies for the paraspinal muscles.
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Affiliation(s)
- Kenta Suzuki
- Department of Rehabilitation, Kimura Orthopedic Clinic,
Kumagaya, Japan
| | - Yasuaki Mizoguchi
- Department of Rehabilitation, Kimura Orthopedic Clinic,
Kumagaya, Japan
- Saitama Medical University Graduate School of Medicine,
Moroyama, Japan
| | - Yuki Hasebe
- Department of Rehabilitation, Saitama Medical Center,
Saitama Medical University, Kawagoe, Japan
| | - Fumihiko Kimura
- Department of Rehabilitation, Kimura Orthopedic Clinic,
Kumagaya, Japan
| | - Kazuo Saita
- Department of Orthopedic Surgery, Saitama Medical Center,
Saitama Medical University, Kawagoe, Japan
| | - Satoshi Ogihara
- Department of Orthopedic Surgery, Saitama Medical Center,
Saitama Medical University, Kawagoe, Japan
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Nakata A, Osuka S, Ishida T, Saito Y, Koshino Y, Samukawa M, Kasahara S, Tohyama H. Relationship between onset of trunk muscle activities and pelvic kinematics in individuals with and without chronic low back pain. J Back Musculoskelet Rehabil 2024:BMR240028. [PMID: 38607752 DOI: 10.3233/bmr-240028] [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: 04/14/2024]
Abstract
BACKGROUND Lumbopelvic movement patterns during prone hip extension has been proposed as a clinical screening method for trunk muscle dysfunction in patients with chronic low back pain (CLBP). However, correlations between trunk muscle onset and pelvic kinematics have not been investigated. OBJECTIVE To examine the correlation between trunk muscle onset and pelvic kinematics during prone hip extension in participants with CLBP. METHODS Fifteen patients with CLBP and 15 healthy individuals participated. We evaluated the muscle activities of the lumbar multifidus, the longissimus, and the semitendinosus via electromyogram and the displacement angles of the pelvic tilt, oblique and rotation. RESULTS The onset of the multifidus at the ipsilateral side of hip extension was significantly delayed in the patients with CLBP compared to the control group (P< 0.001). The onset of the ipsilateral multifidus in the control group was significantly correlated with increased anterior pelvic tilt angle (P= 0.019, r= 0.597), whereas no significant correlation was observed in the CLBP group (P= 0.810, r=-0.068). CONCLUSION The results suggest that pelvic kinematics during prone hip extension does not predict the delayed trunk muscle onset in patients with CLBP.
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Affiliation(s)
- Akimi Nakata
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Satoshi Osuka
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Division of Rehabilitation, Hokkaido University Hospital, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yuki Saito
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Ornowski J, Dziesinski L, Hess M, Krug R, Fortin M, Torres‐Espin A, Majumdar S, Pedoia V, Bonnheim NB, Bailey JF. Thresholding approaches for estimating paraspinal muscle fat infiltration using T1- and T2-weighted MRI: Comparative analysis using water-fat MRI. JOR Spine 2024; 7:e1301. [PMID: 38222819 PMCID: PMC10782057 DOI: 10.1002/jsp2.1301] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/09/2023] [Accepted: 10/31/2023] [Indexed: 01/16/2024] Open
Abstract
Background Paraspinal muscle fat infiltration is associated with spinal degeneration and low back pain, however, quantifying muscle fat using clinical magnetic resonance imaging (MRI) techniques continues to be a challenge. Advanced MRI techniques, including chemical-shift encoding (CSE) based water-fat MRI, enable accurate measurement of muscle fat, but such techniques are not widely available in routine clinical practice. Methods To facilitate assessment of paraspinal muscle fat using clinical imaging, we compared four thresholding approaches for estimating muscle fat fraction (FF) using T1- and T2-weighted images, with measurements from water-fat MRI as the ground truth: Gaussian thresholding, Otsu's method, K-mean clustering, and quadratic discriminant analysis. Pearson's correlation coefficients (r), mean absolute errors, and mean bias errors were calculated for FF estimates from T1- and T2-weighted MRI with water-fat MRI for the lumbar multifidus (MF), erector spinae (ES), quadratus lumborum (QL), and psoas (PS), and for all muscles combined. Results We found that for all muscles combined, FF measurements from T1- and T2-weighted images were strongly positively correlated with measurements from the water-fat images for all thresholding techniques (r = 0.70-0.86, p < 0.0001) and that variations in inter-muscle correlation strength were much greater than variations in inter-method correlation strength. Conclusion We conclude that muscle FF can be quantified using thresholded T1- and T2-weighted MRI images with relatively low bias and absolute error in relation to water-fat MRI, particularly in the MF and ES, and the choice of thresholding technique should depend on the muscle and clinical MRI sequence of interest.
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Affiliation(s)
- Jessica Ornowski
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Lucas Dziesinski
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Madeline Hess
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Roland Krug
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Maryse Fortin
- Department of Health, Kinesiology, and Applied PhysiologyConcordia UniversityMontrealQuébecCanada
| | - Abel Torres‐Espin
- School of Public Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
- Department of Physical TherapyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Neurological SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Valentina Pedoia
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Noah B. Bonnheim
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jeannie F. Bailey
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Li YC, Bruijn SM, Lemaire KK, Brumagne S, van Dieën JH. Vertebral level specific modulation of paraspinal muscle activity based on vestibular signals during walking. J Physiol 2024; 602:507-525. [PMID: 38252405 DOI: 10.1113/jp285831] [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: 10/24/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Evoking muscle responses by electrical vestibular stimulation (EVS) may help to understand the contribution of the vestibular system to postural control. Although paraspinal muscles play a role in postural stability, the vestibulo-muscular coupling of these muscles during walking has rarely been studied. This study aimed to investigate how vestibular signals affect paraspinal muscle activity at different vertebral levels during walking with preferred and narrow step width. Sixteen healthy participants were recruited. Participants walked on a treadmill for 8 min at 78 steps/min and 2.8 km/h, at two different step width, either with or without EVS. Bipolar electromyography was recorded bilaterally from the paraspinal muscles at eight vertebral levels from cervical to lumbar. Coherence, gain, and delay of EVS and EMG responses were determined. Significant EVS-EMG coupling (P < 0.01) was found at ipsilateral and/or contralateral heel strikes. This coupling was mirrored between left and right relative to the midline of the trunk and between the higher and lower vertebral levels, i.e. a peak occurred at ipsilateral heel strike at lower levels, whereas it occurred at contralateral heel strike at higher levels. EVS-EMG coupling only partially coincided with peak muscle activity. EVS-EMG coherence slightly, but not significantly, increased when walking with narrow steps. No significant differences were found in gain and phase between the vertebral levels or step width conditions. In summary, vertebral level specific modulation of paraspinal muscle activity based on vestibular signals might allow a fast, synchronized, and spatially co-ordinated response along the trunk during walking. KEY POINTS: Mediolateral stabilization of gait requires an estimate of the state of the body, which is affected by vestibular afference. During gait, the heavy trunk segment is controlled by phasic paraspinal muscle activity and in rodents the medial and lateral vestibulospinal tracts activate these muscles. To gain insight in vestibulospinal connections in humans and their role in gait, we recorded paraspinal surface EMG of cervical to lumbar paraspinal muscles, and characterized coherence, gain and delay between EMG and electrical vestibular stimulation, during slow walking. Vestibular stimulation caused phasic, vertebral level specific modulation of paraspinal muscle activity at delays of around 40 ms, which was mirrored between left, lower and right, upper vertebral levels. Our results indicate that vestibular afference causes fast, synchronized, and spatially co-ordinated responses of the paraspinal muscles along the trunk, that simultaneously contribute to stabilizing the centre of mass trajectory and to keeping the head upright.
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Affiliation(s)
- Yiyuan C Li
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Rehabilitation Sciences, Leuven, KU, Belgium
| | - Sjoerd M Bruijn
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Koen K Lemaire
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simon Brumagne
- Department of Rehabilitation Sciences, Leuven, KU, Belgium
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Yang P, Liang X, Xu X, Liu Q, Guo Z, Yuan H, Wang H, Ding W. Incidence and Predictive Factors of New Onset Postoperative Sacroiliac Joint Pain After Posterior Lumbar Fusion Surgery for Degenerative Lumbar Disease. J Pain Res 2023; 16:4291-4299. [PMID: 38111748 PMCID: PMC10726953 DOI: 10.2147/jpr.s431197] [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: 08/31/2023] [Accepted: 11/03/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction To explore the incidence and predictive factors of new onset postoperative sacroiliac joint pain (PSJP) after posterior lumbar fusion surgery for degenerative lumbar disease. Methods Three hundred and sixty-seven patient medical records from January 2020 to December 2021 were retrieved. The patients were divided into two groups: PSJP group and N-PSJP (non-postoperative sacroiliac joint pain group). To investigate potential risk factors for PSJP, HU value (Hounsfield unit value) was assessed on CT scans. ImageJ software was used to assess the fat and muscle of the lumbar multifidus muscle (LMM) in the axial MRI image, the red area was marked as fat and the rest were muscles to calculate the ratio of fatty infiltration. Patient characteristics, surgical variables and radiographic parameters were analyzed statistically. Results Twenty of 367 patients were diagnosed with PJSP at postoperative follow-up. Patients with PSJP presented with significantly higher HU value. For surgical variables, PSJP patients received more operations including distal fusion level at sacrum than the N-PSJP group. For radiographic parameters, most of the patients in the PSJP group had more severe fatty atrophic muscle in the LMM compared to the N-PSJP group. There was no statistically significant difference between the two groups in preoperative and postoperative lumbar lordosis (LL), angle of lumbar lordosis of fixed lumbar vertebrae (FV-LL), pelvic incidence (PI), sacrum slope (SS). The bivariate logistic regression model revealed preoperative fat infiltration rate of the LMM, and higher HU value were independently associated with PSJP. Conclusion PSJP for degenerative lumbar disease was 5.4%, the predictive factors included preoperative severe infiltration of LMM, distal fusion level at sacrum and higher HU value.
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Affiliation(s)
- Puxin Yang
- Department of Spine Surgery, HeBei Medical University Third Hospital, Shijiazhuang, People’s Republic of China
| | - Xiao Liang
- Department of Spine Surgery, HeBei Medical University Third Hospital, Shijiazhuang, People’s Republic of China
| | - Xingzhu Xu
- Department of Spine Surgery, HeBei Medical University Third Hospital, Shijiazhuang, People’s Republic of China
| | - Qingtao Liu
- Department of Spine Surgery, HeBei Medical University Third Hospital, Shijiazhuang, People’s Republic of China
| | - Zhiyuan Guo
- Department of Spine Surgery, HeBei Medical University Third Hospital, Shijiazhuang, People’s Republic of China
| | - Hongru Yuan
- Department of Spine Surgery, HeBei Medical University Third Hospital, Shijiazhuang, People’s Republic of China
| | - Hui Wang
- Department of Spine Surgery, HeBei Medical University Third Hospital, Shijiazhuang, People’s Republic of China
| | - Wenyuan Ding
- Department of Spine Surgery, HeBei Medical University Third Hospital, Shijiazhuang, People’s Republic of China
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Vlazna D, Krkoska P, Sladeckova M, Parmova O, Barusova T, Hrabcova K, Vohanka S, Matulova K, Adamova B. Trunk muscle dysfunction in patients with myotonic dystrophy type 2 and its contribution to chronic low back pain. Front Neurol 2023; 14:1258342. [PMID: 37954643 PMCID: PMC10637363 DOI: 10.3389/fneur.2023.1258342] [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: 07/13/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Myotonic dystrophy type 2 (MD2) presents with a varied manifestation. Even though the myopathy in these patients is more widespread, axial musculature involvement is one of the most prominent conditions. MD2 patients also often report chronic low back pain (CLBP). The purpose of this study was to evaluate trunk muscle function, including respiratory muscles, in patients with MD2 and to compare it with healthy controls, to determine the occurrence of CLBP in patients with MD2, and to assess whether trunk muscle dysfunction increases the risk of CLBP in these patients. Methods We enrolled 40 MD2 patients (age range 23 to 76 years, 26 women). A comprehensive battery of tests was used to evaluate trunk muscle function. The tests consisted of quantitative muscle strength testing of low back extensor muscles and respiratory muscles and the assessment of trunk muscle endurance. A neurological evaluation contained procedures assessing the distribution of muscle weakness, myotonia, and pain, and used questionnaires focused on these items and on disability, depression, and physical activity. Results The results of this study suggest that patients with MD2 show significant dysfunction of the trunk muscles, including the respiratory muscles, expressed by decreased muscle strength and endurance. The prevalence of CLBP in patients with MD2 was 52.5%. Based on our analysis, the only independent significant risk factor for CLBP in these patients was maximal isometric lower back extensor strength in a prone position ≤ 15.8 kg (OR = 37.3). Other possible risk factors were severity of myotonia and reduced physical activity. Conclusion Outcomes of this study highlighted the presence of axial muscle dysfunction, respiratory muscle weakness, and frequent occurrence of CLBP together with its risk factors in patients with MD2. We believe that the findings of this study may help in management and prevention programs for patients with MD2.
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Affiliation(s)
- Daniela Vlazna
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Rehabilitation, University Hospital Brno, Brno, Czechia
| | - Peter Krkoska
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Michaela Sladeckova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Rehabilitation, University Hospital Brno, Brno, Czechia
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Olesja Parmova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
| | | | | | - Stanislav Vohanka
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Blanka Adamova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
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Fan Z, Wang T, Wang Y, Zhou Z, Wu T, Liu D. Risk Factors in Patients with Low Back Pain Under 40 Years Old: Quantitative Analysis Based on Computed Tomography and Magnetic Resonance Imaging mDIXON-Quant. J Pain Res 2023; 16:3417-3431. [PMID: 37841453 PMCID: PMC10573373 DOI: 10.2147/jpr.s426488] [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: 07/07/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose While low back pain (LBP) constitutes a global life disorder cause, the contribution of paraspinal muscles to its pathogenicity remains elusive. We characterized the paraspinal muscles of patients with LBP using lumbar three-dimensional computed tomography (CT) and magnetic resonance imaging (MRI) mDIXON-Quant, and evaluated the risk factors combined with clinical data. Methods A retrospective study involving 181 patients (10-40 years) who underwent lumbar 3D-CT and MRI mDIXON from January 1, 2021 to December 31, 2022, and divided into normal, non-chronic LBP [non-CLBP], and CLBP groups. Clinical data, paraspinal muscle cross-sectional area, Hounsfield unit for CT values, and fat fraction derived from mDIXON-Quant were compared. Three readers analyzed the images independently; intra- and interobserver agreement was measured. Spearman analysis and multiple logistic regression were used to analyze the correlation between clinical data, radiologic and paraspinal muscle parameters. A nomogram was constructed for individualized prediction. Results Correlation analysis revealed that body mass index, visual analog scale score, Pfirrmann grade, annulus fibrosus tear, lumbar lordosis (LL), and Modic changes correlated with LBP (all P<0.05). The Pfirrmann grade and annulus fibrosus tear showed positive correlation (r=0.673, 0.559), whereas LL was negatively correlated (r=-0.469). The multifidus CT values were negatively correlated with LBP at L4-5/L5-S1; the multifidus fat fraction was positively correlated at L4-5/L5-S1 (r=0.734, r=0.584, P<0.001). The multiple logistic regression showed that L4-5 multifidus fat fraction (P=0.046, OR=1.167), Pfirrmann grade (P=0.017, OR=0.063), LL (P=0.002, OR=0.828) and annulus fibrosus tear (P=0.005, OR=0.024) were risk factors for predicting LBP in the non-CLBP group; in the CLBP group, BMI (P=0.048 OR=1.225), L4-5 multifidus fat fraction (P=0.001 OR=1.299), LL (P=0.003, OR=0.841) and Pfirrmann classification (P=0.009, OR=0.046) were risk factors. Conclusion BMI, L4-5 multifidus fat fraction, LL, and Pfirrmann grade are risk factors for CLBP in patients under 40; whereas annulus fibrosus tear is an independent risk factor for non-CLBP, nomograms derived from these parameters can help predict LBP and MRI mDIXON-Quant is recommended for quantitatively analyzing paraspinal muscle fat infiltration.
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Affiliation(s)
- Zheng Fan
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Tong Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yang Wang
- Departments of Orthopedics, The 4th People’s Hospital of Shenyang, Liaoning, Shenyang, Liaoning, People’s Republic of China
| | - Zimo Zhou
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Tong Wu
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Da Liu
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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Currie SJ, Myers CA, Enebo BA, Davidson BS. Treatment and Response Factors in Muscle Activation during Spinal Manipulation. J Clin Med 2023; 12:6377. [PMID: 37835021 PMCID: PMC10573245 DOI: 10.3390/jcm12196377] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
The forces applied during a spinal manipulation produce a neuromuscular response in the paraspinal muscles. A systematic evaluation of the factors involved in producing this muscle activity provides a clinical insight. The purpose of this study is to quantify the effect of treatment factors (manipulation sequence and manipulation site) and response factors (muscle layer, muscle location, and muscle side) on the neuromuscular response to spinal manipulation. The surface and indwelling electromyographies of 8 muscle sites were recorded during lumbar side-lying manipulations in 20 asymptomatic participants. The effects of the factors on the number of muscle responses and the muscle activity onset delays were compared using mixed-model linear regressions, effect sizes, and equivalence testing. The treatment factors did not reveal statistical differences between the manipulation sequences (first or second) or manipulation sites (L3 or SI) in the number of muscle responses (p = 0.11, p = 0.28, respectively), or in muscle activity onset delays (p = 0.35 p = 0.35, respectively). There were significantly shorter muscle activity onset delays in the multifidi compared to the superficial muscles (p = 0.02). A small effect size of side (d = 0.44) was observed with significantly greater number of responses (p = 0.02) and shorter muscle activity onset delays (p < 0.001) in the muscles on the left side compared to the right. The location, layer, and side of the neuromuscular responses revealed trends of decreasing muscle response rates and increasing muscle activity onset delays as the distance from the manipulation site increased. These results build on the body of work suggesting that the specificity of manipulation site may not play a role in the neuromuscular response to spinal manipulation-at least within the lumbar spine. In addition, these results demonstrate that multiple manipulations performed in similar areas (L3 and S1) do not change the response significantly, as well as contribute to the clinical understanding that the muscle response rate is higher and with a shorter delay, the closer it is to the manipulation.
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Affiliation(s)
| | - Casey A. Myers
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Ave, Denver, CO 80208, USA; (C.A.M.)
| | | | - Bradley S. Davidson
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Ave, Denver, CO 80208, USA; (C.A.M.)
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Yoshida Y, Doi T, Oka H, Kato S, Ohtomo N, Nakamoto H, Takeda N, Inuzuka R, Yagi H, Oshima Y, Tanaka S, Fukatsu K, Taniguchi Y. Reduced volume and altered composition of paraspinal muscles in Marfan syndrome: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e35382. [PMID: 37773813 PMCID: PMC10545292 DOI: 10.1097/md.0000000000035382] [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] [Received: 06/15/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
Retrospective cohort study. Spinal deformities in patients with Marfan syndrome (MFS) are distinct from those in patients with idiopathic scoliosis (IS). It is more prone to progression and more likely to present with sagittal malalignment than IS. However, the etiology of this characteristic spinal deformity in MFS remains unclear. This study aimed to determine the spinal musculature characteristics in patients with MFS on the hypothesis that the paraspinal muscles of patients with MFS would be qualitatively or quantitatively different from those of patients with IS. Seventeen consecutive patients with MFS aged 25 years or younger undergoing surgery for scoliosis in our hospital were compared with age- and sex-matched patients with IS undergoing surgery for scoliosis. The body size-adjusted relative cross-sectional area (rCSA), fatty infiltration ratio (FI%), and relative functional cross-sectional area (rFCSA) of the psoas muscles (PM) and paravertebral muscles (PVM) at L3/4 and L4/5 were measured using preoperative T2-weighted magnetic resonance imaging. Functional CSA was defined as total CSA minus the fatty infiltration area of each muscle and rFCSA was calculated as the body size-adjusted functional CSA. The rCSA of the PM at L3/4 and L4/5 was significantly smaller in the MFS group than in the IS group (L3/4, P = .021; L4/5, P = .002). The FI% of the PM at L4/5 was significantly higher in the MFS group (P = .044). Consequently, the rFCSA of the PM at L3/4 and L4/5 and the rFCSA of the PVM at L3/4 in the MFS group were significantly smaller than those in the IS group (PM at L3/4, P = .021; PM at L4/5, P = .001; PVM at L3/4, P = .025). Compared with patients with IS, patients with MFS exhibited significantly decreased body-size-adjusted CSA of the PM and reduced body-size-adjusted functional CSA of the PVM and PM. These findings may partially explain the characteristics of distinctive spinal deformities in patients with MFS.
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Affiliation(s)
- Yuichi Yoshida
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hiroyuki Oka
- Division of Musculoskeletal AI System Development, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Marfan syndrome center, The University of Tokyo Hospital, Tokyo, Japan
| | - Ryo Inuzuka
- Marfan syndrome center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroki Yagi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Marfan syndrome center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Marfan syndrome center, The University of Tokyo Hospital, Tokyo, Japan
- Surgical Center, The University of Tokyo Hospital, Tokyo, Japan
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11
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Fortin M, Rye M, Roussac A, Montpetit C, Burdick J, Naghdi N, Rosenstein B, Bertrand C, Macedo LG, Elliott JM, Dover G, DeMont R, Weber MH, Pepin V. The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. J Clin Med 2023; 12:5920. [PMID: 37762861 PMCID: PMC10532355 DOI: 10.3390/jcm12185920] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability.
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Affiliation(s)
- Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Meaghan Rye
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Alexa Roussac
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Chanelle Montpetit
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Jessica Burdick
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Neda Naghdi
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Brent Rosenstein
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Cleo Bertrand
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Luciana G. Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - James M. Elliott
- Faculty of Medicine and Health, School of Health Sciences, The Kolling Institute, University of Sydney, Sydney, NSW 2050, Australia;
- Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia
| | - Geoffrey Dover
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Richard DeMont
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Michael H. Weber
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC H3J 1A4, Canada;
| | - Véronique Pepin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
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12
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Shaffrey C, Gilligan C. Effect of Restorative Neurostimulation on Major Drivers of Chronic Low Back Pain Economic Impact. Neurosurgery 2023; 92:716-724. [PMID: 36786565 PMCID: PMC9988326 DOI: 10.1227/neu.0000000000002305] [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: 07/29/2022] [Accepted: 10/04/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND High-impact chronic low back pain (CLBP) correlates with high healthcare resource utilization. Therapies that can alter impact status may provide beneficial long-term economic benefits. An implantable restorative neurostimulation system (ReActiv8, Mainstay Medical) designed to over-ride multifidus inhibition to facilitate motor control restoration, thereby resolving mechanical low back pain symptoms, has shown significant durable clinical effects in moderately and severely impacted patients. OBJECTIVE To examine changes in high-impact chronic low back pain in patients treated with restorative neurostimulation at 2 years. METHODS ReActiv8-B is a prospective, international, multicenter trial to evaluate the safety and efficacy of restorative neurostimulation in patients with intractable CLBP and no prior surgery. For this longitudinal subanalysis, patients were stratified into low-, moderate-, and high-impact CLBP categories using the US Department of Health and Human Services definition comprising pain intensity, duration, and impact on work, self-care, and daily activities. RESULTS Of 2-year completers (n = 146), 71% had high-impact CLBP at baseline and this proportion reduced to 10%, with 85% reporting no or low impact. This corresponds with measurements of HRQoL returning to near-population norms. CONCLUSION In addition to clinically meaningful improvements in pain and function with long-term durability, the overwhelming majority of patients transitioned from a high- to a no- or low-impact CLBP state. This is typically associated with significantly lower healthcare-utilization levels. The of recovery trajectory is consistent with a restorative mechanism of action and suggests that over the long term, the improvement in these health states will be maintained.
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Affiliation(s)
- Christopher Shaffrey
- Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA;
| | - Christopher Gilligan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
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13
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Shen F, Kim HJ, Jeon SW, Chang BS, Lee CK, Yeom JS. Influence of Handgrip Strength and Paraspinal Muscles' Volume on Clinical Outcomes in the Patients With Each Sagittal Imbalance and Lumbar Spinal Stenosis. Global Spine J 2023; 13:609-616. [PMID: 33719649 DOI: 10.1177/21925682211001871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To compare handgrip strength (HGS), paraspinal muscles' (PSM) volume, and their effects on clinical symptom severity between the patients with sagittal imbalance (SI) and symptomatic lumbar spinal stenosis (LSS). METHODS A total of 54 paired consecutive patients with SI and LSS were enrolled after propensity score matching. Preoperative HGS, cross-sectional area (CSA) of psoas (PS) and multifidus (MF) muscles, and patient-reported measures, including visual analog scale (VAS) for back/ leg pain, Oswestry Disability Index (ODI), and EuroQOL (EQ-5D) were compared between both groups. Within each SI and LSS group, patient-reported measures were compared between high and low HGS subgroups. The correlation of HGS and CSA of PSMs to patient-reported measures was evaluated. RESULTS There was no difference in HGS between 2 groups, however, the CSA of PS and MF muscles in SI group was significantly lower than those in LSS group. Patients with low HGS showed inferior results for ODI and EQ-5D, compared to those with high HGS subgroup in both SI and LSS groups. HGS and CSA of MF muscle were correlated with ODI in both groups. CONCLUSIONS There was no significant difference between the SI and LSS groups in HGS, however, PSMs' volume in SI group were significantly lower than those in LSS group. Therefore SI would be associated with loss of localized muscle mass in back area, rather than global skeletal muscle weakness. HGS and PSMs' volume were adversely associated with functional status in SI and LSS patients.
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Affiliation(s)
- Feng Shen
- Department of Orthopedic Surgery, the 235960Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, 37990Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea
| | - Seung Won Jeon
- Spine Center and Department of Orthopedic Surgery, 37990Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine and 58927Seoul National University Hospital, Seoul, Korea
| | - Choon-Ki Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine and 58927Seoul National University Hospital, Seoul, Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopedic Surgery, 37990Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea
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14
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Kameyama K, Ohba T, Endo T, Katsu M, Koji F, Kensuke K, Oda K, Tanaka N, Haro H. Radiological Assessment of Postoperative Paraspinal Muscle Changes After Lumbar Interbody Fusion With or Without Minimally Invasive Techniques. Global Spine J 2023; 13:295-303. [PMID: 33657897 PMCID: PMC9972276 DOI: 10.1177/2192568221994794] [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: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. BACKGROUND Percutaneous pedicle screws (PPS) have the advantage of being able to better preserve the paraspinal muscles when compared with a traditional open approach. However, the nature of changes in postoperative paraspinal muscle after damage by lumbar fusion surgery has remained largely unknown. It is clinically important to clarify and compare changes in paraspinal muscles after the various surgeries. OBJECTIVE (1) To determine postoperative changes of muscle density and cross-sectional area using computed tomography (CT), and (2) to compare paraspinal muscle changes after posterior lumbar interbody fusion (PLIF) with traditional open approaches and minimally invasive lateral lumbar interbody fusions (LLIF) with PPS. METHODS We included data from 39 consecutive female patients who underwent open PLIF and 23 consecutive patients who underwent single-staged treatment with LLIF followed by posterior PPS fixation at a single level (L4-5). All patients underwent preoperative, 6 months postoperative, and 1-year postoperative CT imaging. Measurements of the cross-sectional area (CSA) and muscle densities of paraspinal muscles were obtained using regions of interest defined by manual tracing. RESULTS We did not find any decrease of CSA in any paraspinal muscles. We did find a decrease of muscle density in the multifidus at 1 year after surgery in patients in the PILF group, but not in those in LLIF/PPS group. CONCLUSIONS One year after surgery, a significant postoperative decrease of muscle density of the multifidi was observed only in patients who underwent open PLIF, but not in those who underwent LLIF/PPS.
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Affiliation(s)
- Keigo Kameyama
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan,Tetsuro Ohba, MD, PhD, Department of
Orthopaedics, University of Yamanashi, Shimokato, Chuo, Yamanashi 409-3898,
Japan.
| | - Tomoka Endo
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Marina Katsu
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Fujita Koji
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Koyama Kensuke
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Nobuki Tanaka
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
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15
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Lee D, Cha B, Kim J, Choi YS, Kim M, Han I, Min K. Paraspinal muscles atrophy on both sides and at multiple levels after unilateral lumbar partial discectomy. Medicine (Baltimore) 2023; 102:e32688. [PMID: 36701703 PMCID: PMC9857383 DOI: 10.1097/md.0000000000032688] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To identify the changes in cross-sectional areas (CSAs) and fatty infiltration of both sides of the paravertebral muscles and their associations with prognostic factors in patients who underwent unilateral lumbar discectomy. We retrospectively reviewed 27 patients who underwent magnetic resonance imaging before and after 1- or 2-level lumbar discectomy. The CSAs and functional cross-sectional areas of the paraspinal muscles were bilaterally measured from L1 to L2 to L5 to S1 based on T2-weighted axial images. These parameters were compared pre-and postoperatively. CSAs and functional cross-sectional areas decreased also in non-operative, non-surgical levels, not only in operated levels after discectomy. In the correlation analysis, the CSA of psoas major muscle at L1 to L2 was significantly decreased in patients with lower preoperative lordosis (r = 0.598, P = .040). The postoperative CSA of psoas major muscle at L4 to L5 was lower in those with the higher Pfirrmann grade (r = -0.590, P = .002); however, the CSA of quadratus lumborum muscle at L1 to L2 showed the opposite result (r = 0.526, P = .036). Similar results were also observed in the partial correlation adjusted for age and postoperative duration. Patients who underwent discectomy experienced overall paraspinal muscle atrophy in the lumbar region, including surgical and non-surgical sites. Such atrophic changes emphasized the need for core strengthening and lumbar rehabilitation from the early period after partial discectomy.
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Affiliation(s)
- Doyoung Lee
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Byungwoo Cha
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jongwook Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yong-Soo Choi
- Department of Biotechnology, CHA University, Seongnam, Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Inbo Han
- Department of Neurosurgery, Spine Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- * Correspondence: Kyunghoon Min, Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea (e-mail: )
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16
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Getzmann JM, Ashouri H, Burgstaller JM, Valeri F, Winklhofer S, Ulrich NH, Guggenberger R. The Effect of Paraspinal Fatty Muscle Infiltration and Cumulative Lumbar Spine Degeneration on the Outcome of Patients With Lumbar Spinal Canal Stenosis: Analysis of the Lumbar Stenosis Outcome Study (LSOS) Data. Spine (Phila Pa 1976) 2023; 48:97-106. [PMID: 36130038 PMCID: PMC9750091 DOI: 10.1097/brs.0000000000004477] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/06/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective. OBJECTIVE To investigate the influence of paraspinal fatty muscle infiltration (FMI) and cumulative lumbar spine degeneration as assessed by magnetic resonance imaging on long-term clinical outcome measures in patients with lumbar spinal canal stenosis (LSCS) of the Lumbar Stenosis Outcome Study (LSOS) cohort. SUMMARY OF BACKGROUND DATA Past studies have tried to establish correlations of morphologic imaging findings in LSCS with clinical endpoints. However, the impact of FMI and overall lumbar spinal degeneration load has not been examined yet. MATERIALS AND METHODS Patients from the LSOS cohort with moderate to severe LSCS were included. Two radiologists assessed the degree of LSCS as well as cumulative degeneration of the lumbar spine. FMI was graded using the Goutallier scoring system. Spinal Stenosis Measure (SSM) was used to measure the severity level of symptoms and disability. European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) was used to measure health-related quality of life. RESULTS The nonsurgically treated group consisted of 116 patients (age 74.8±8.5 yr), whereas the surgically treated group included 300 patients (age 72.3±8.2 yr). Paraspinal FMI was significantly different between the groups (54.3% vs. 32.0% for Goutallier grade ≥2; P <0.001). Total degeneration score was comparable in both groups (9.5±2.0 vs. 9.3±2.0; P =0.418). FMI was associated with lower SSM function and lower EQ-5D-3L (all P <0.05), but not with SSM symptoms. Total degeneration of the lumbar spine was associated neither with SSM symptoms, nor with SSM function, nor with EQ-5D-3L (all P >0.05). CONCLUSIONS FMI is associated with higher disability and worse health-related quality of life of LSCS patients in the LSOS cohort. There was no significant association between total cumulative lumbar spine degeneration and the outcome of either surgically or nonsurgically treated patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jonas M. Getzmann
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Zurich, Switzerland
- University of Zurich (UZH), Zurich, Switzerland
| | - Hamidreza Ashouri
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Zurich, Switzerland
- University of Zurich (UZH), Zurich, Switzerland
| | - Jakob M. Burgstaller
- University of Zurich (UZH), Zurich, Switzerland
- Institute of Primary Care, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Fabio Valeri
- University of Zurich (UZH), Zurich, Switzerland
- Institute of Primary Care, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Sebastian Winklhofer
- University of Zurich (UZH), Zurich, Switzerland
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Nils H. Ulrich
- University of Zurich (UZH), Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich (USZ), Zurich, Switzerland
- University of Zurich (UZH), Zurich, Switzerland
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Krkoska P, Vlazna D, Sladeckova M, Minarikova J, Barusova T, Batalik L, Dosbaba F, Vohanka S, Adamova B. Adherence and Effect of Home-Based Rehabilitation with Telemonitoring Support in Patients with Chronic Non-Specific Low Back Pain: A Pilot Study. Int J Environ Res Public Health 2023; 20:1504. [PMID: 36674258 PMCID: PMC9860722 DOI: 10.3390/ijerph20021504] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Home-based exercises have been on the rise recently. This pilot study aimed to assess the adherence and effect of a home-based rehabilitation programme using telemonitoring in patients with chronic non-specific low back pain (CNLBP). Twenty-seven patients with CNLBP were enrolled in the study, each of whom underwent a neurological assessment, including patient-oriented measures and a functional assessment-a battery of tests that comprehensively evaluated trunk muscle function. The rehabilitation programme lasted 18 weeks and included daily home-based exercises. A mobile application or an exercise diary was used to monitor compliance. Adherence to the programme was excellent for both the diary and mobile application groups, with 82.3% in the diary group exercising at least once a day and 72.9% twice a day, and 94.8% in the mobile application group exercising at least once a day and 86.6% twice a day. Both patient-oriented and functional outcomes improved significantly; however, the relative changes of the parameters in these two groups did not correlate, which supports the idea that trunk muscle function does not directly relate to patient complaints and that CNLBP is a multifactorial issue. This model of rehabilitation programme should be used in clinical practice, as its adherence and effectiveness seem noticeable.
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Affiliation(s)
- Peter Krkoska
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Daniela Vlazna
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Michaela Sladeckova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Jitka Minarikova
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, 150 06 Prague, Czech Republic
| | - Tamara Barusova
- Institute of Biostatistics and Analysis Ltd., 602 00 Brno, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Stanislav Vohanka
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Blanka Adamova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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18
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Yazici A, Yerlikaya T, Oniz A. Evaluation of the degeneration of the multifidus and erector spinae muscles in patients with low back pain and healthy individuals. J Back Musculoskelet Rehabil 2023; 36:637-650. [PMID: 36776035 DOI: 10.3233/bmr-220055] [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: 02/10/2023]
Abstract
BACKGROUND Although several studies have been conducted to determine the cause of low back pain (LBP), a sufficient correlation has not been found between research findings and symptoms. Therefore there seems to be a need for studies to explain the relationship between pain and morphological changes in the paraspinal muscles of patients with LBP through comparisons with healthy control subjects. OBJECTIVE The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) muscles in patients with chronic LBP with non-radiculopathy lumbar disc herniation (LDH), patients with mechanical LBP, and healthy individuals. METHODS The study included 35 patients with mechanical LBP, 38 patients with non-radiculopathy LDH, and a control group of 36 healthy participants. In all patients and the control group, evaluations were made on axial magnetic resonance imaging slices at L3-S1 level of the LMF and LES cross-sectional areas (CSA), total CSA (TCSA = LMF+LES), fat infiltrations and asymmetries. RESULTS The mean CSA values of the right and left LMF and LES showed significant differences between the groups (p< 0.001, p= 0.002, p= 0.002, p= 0.010, respectively). Fat infiltrations showed a difference between the right-left LMF and left LES groups (p= 0.007, p< 0.001, p= 0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides. CONCLUSION A correlation was found between fat infiltration in the LMF and mechanical LBP and LDH. However, no significant correlation was determined between LBP and the CSA and TCSA of the LMF and LES. This was thought to be due to an incorrect result of CSA and TCSA in the evaluation of muscle mass. Therefore, for a more accurate evaluation of muscle mass, it can be considered necessary to measure muscle atrophy associated with fat infiltration or functional CSA.
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Affiliation(s)
- Alikemal Yazici
- Orthopedics and Traumatology Department, Faculty of Medicine, Near East University, Nicosia, Cyprus.,Orthopedics and Traumatology Department, Buyuk Anadolu Hospital, Samsun, Turke
| | - Tuba Yerlikaya
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Near East University, Nicosia, Cyprus
| | - Adile Oniz
- Faculty of Health Sciences, Near East University, Nicosia, Cyprus.,Institute of Graduate Studies, Department of Biophysics, Near East University, Nicosia, Cyprus
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19
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Chen Z, Shi T, Li W, Sun J, Yao Z, Liu W. Role of paraspinal muscle degeneration in the occurrence and recurrence of osteoporotic vertebral fracture: A meta-analysis. Front Endocrinol (Lausanne) 2023; 13:1073013. [PMID: 36686478 PMCID: PMC9845601 DOI: 10.3389/fendo.2022.1073013] [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] [Received: 10/19/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Recently, the effects of paraspinal muscle degeneration on osteoporotic vertebral fractures (OVFs) have attracted the attention of researchers; however, studies are limited, and their results vary. Hence, this study aimed to determine the role of paraspinal muscle degeneration in the occurrence and recurrence of OVF. Methods Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline, the PubMed, Embase, Web of Science, Wanfang Data, China National Knowledge Infrastructure, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies comparing the cross-sectional area (CSA) or fatty infiltration (FI) of the paraspinal muscles (including the psoas (PS), erector spinae plus multifidus (ES+MF), quadratus lumborum) in patients with and without initial OVF, or with and without recurrent OVF were included and analyzed. Results Eleven studies were included in the meta-analysis. Seven studies investigated the effects of paraspinal muscles on initial OVF, and the overall results revealed significantly lower CSAES+MF (SMD: -0.575, 95% CI: -0.866 to -0.285) and CSAPS (SMD: -0.750, 95% CI: -1.274 to -0.226), and higher FI (SMD: 0.768, 95% CI: 0.475 to 1.062) in the fracture group. Meanwhile, four studies evaluated the effects of the paraspinal muscles on recurrent OVF, and the pooled results demonstrated significantly higher FI (SMD:0.720, 95% CI: 0.258 to 1.182) in the refracture group, although no significant difference in CSAES+MF (SMD: -0.103, 95% CI: -0.395 to 0.189) was observed between the two groups. Conclusions Paraspinal muscle degeneration plays a role in the occurrence and recurrence of OVF. Assessing the paraspinal muscles may be useful for identifying high-risk populations. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier (CRD42021276681).
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Affiliation(s)
- Zhi Chen
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Tengbin Shi
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wenwen Li
- The School of Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Sun
- Department of Emergency, Zhaotong Traditional Chinese Medicine Hospital, Zhaotong, Yunnan, China
| | - Zhipeng Yao
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wenge Liu
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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20
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Shima D, Nishimura Y, Hashizaki T, Minoshima Y, Yoshikawa T, Umemoto Y, Kinoshita T, Kouda K, Tajima F, Kamijo YI. Surface electromyographic activity of the erector spinae and multifidus during arm- and leg-ergometer exercises in young healthy men. Front Physiol 2022; 13:974632. [PMID: 36505070 PMCID: PMC9732940 DOI: 10.3389/fphys.2022.974632] [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: 06/21/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: Ergometer exercise was considered a new loading method that can be used for participants who are unable to assume the core strengthening exercise posture commonly used to strengthen the erector spinae and multifidus. This study aimed to investigate with healthy participants whether arm and leg ergometers could be used for core strengthening exercises and whether different exercise sites would affect the results. Methods: The study was conducted with 15 healthy adult male participants aged 20-35 years. The intervention consisted of arm- and leg-ergometer exercises performed by the participants. The exercise protocol consisted of three 1-min sessions (rest, 50W, and 100 W), which were measured consecutively. Surface electromyography (sEMG) was measured during the sessions. Maximal voluntary contraction (MVC) of the erector spinae and multifidus was also measured, during which sEMG was measured. The sEMG during ergometer exercise was calculated as a percentage of the MVC (calculated as % MVC). The root mean square (RMS) was recorded from the sEMG activity. Muscle activity of the erector spinae and multifidus was compared between ergometer exercises and between intensity levels. Heart rate (HR) was recorded by electrocardiogram. Results: In the arm-ergometer exercise, the % MVC values of the erector spinae were 6.3 ± 3.1, 10.9 ± 5.4, and 16.9 ± 8.3% at rest, 50 W, and 100 W conditions, respectively. The multifidus was 4.6 ± 2.9, 9.2 ± 5.6, and 12.6 ± 7.6% at rest, 50 W, and 100 W conditions, respectively. The respective % MVC values during the leg-ergometer exercise were 3.8 ± 1.7, 7.2 ± 3.8, and 10.4 ± 4.0% at rest, 50 W, and 100 W conditions, respectively. Leg-ergometer exercises were 2.6 ± 2.1, 6.9 ± 5.7, and 10.3 ± 6.8% at rest, 50 W, and 100 W conditions, respectively. The activities of the two muscles increased at comparable levels with increased workload in both types of exercises (p < 0.01, each). HR increased with the increased workload and the increase was larger during arm-than leg-ergometer exercises. Conclusion: These results demonstrate that both arm- and leg-ergometer exercises are potentially alternative methods for erector spinae and multifidus training for healthy participants. Further research is needed to target elderly.
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Affiliation(s)
- Daichi Shima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Division of Rehabilitation Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Morioka, Japan,*Correspondence: Yukihide Nishimura,
| | - Takamasa Hashizaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Division of Rehabilitation Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yuta Minoshima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Division of Rehabilitation Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Tatsuya Yoshikawa
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Division of Rehabilitation Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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21
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Shah A, Iyengar KP, Azzopardi C, Haleem S, Mehta J, Botchu R. Alteration in the Cross-sectional Area (CSA) Ratio of the Paraspinal Muscles following Vertebral Insufficiency Fractures. Indian J Radiol Imaging 2022; 33:8-11. [PMID: 36855732 PMCID: PMC9968526 DOI: 10.1055/s-0042-1758522] [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: 11/27/2022] Open
Abstract
Background Vertebral insufficiency fractures in the elderly are associated with increased morbidity and mortality. Early diagnosis is essential to direct patient-specific rehabilitation. Aims We hypothesize that in patients with vertebral insufficiency fractures, there is atrophy of the psoas and paraspinal muscles with alteration in the cross-sectional area (CSA) of the muscles. Materials and Methods Magnetic resonance imaging (MRI) studies for 100 consecutive patients, older than 60 years presenting with lower back pain, were included in the study. For each MRI study, the CSA of the psoas and paraspinal muscles (multifidus) at the level of L4/5-disc space was measured to calculate the cross-sectional area ratio (CSAR) by two readers. One reader repeated the measurements after an interval of 2 weeks. We divided the patients ( n = 100) into various groups based on the number of vertebral fractures. Results In total, 77 patients with vertebral body fractures (48 with one, 16 with two and 13 with more than two fractures) were identified with a mean age of 73 (range 60-92) years. The ratio of multifidus CSA to psoas CSA was calculated with mean values of each group (1-4) as 2.56, 1.89, 2.09 and 2.16, respectively. There was statistically significance difference of the CSAR between the cohorts ( p -value = 0.0115). Conclusion Vertebral insufficiency fractures in the elderly are associated not only with atrophy of psoas and the multifidus group of muscles as evident by the CSA values, but they also affect the CSAR depending on the number of fractures. This finding may help to direct targeted patient-specific physiotherapy rehabilitation and interventions to prevent further such fractures.
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Affiliation(s)
- Ali Shah
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | | | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Shahnawaz Haleem
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Jwalant Mehta
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom,Address for correspondence Rajesh Botchu Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road SouthNorthfield, BirminghamUnited Kingdom
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Han IH, Song YS, Lee IS, Kim DH, Choi KU. Myositis Ossificans with Aneurysmal Bone Cystic Changes at the Thoracic Paraspinal Region: A Case Report. Medicina (B Aires) 2022; 58:1452. [PMID: 36295612 DOI: 10.3390/medicina58101452] [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: 09/30/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Myositis ossificans (MO) is a benign heterotopic bone formation in muscle or soft tissue. It is a self-limiting disease that is usually initiated by trauma and often occurs in the extremities of the body. Here we report a rare case of traumatic myositis ossificans caused by unusual trauma (extracorporeal shock wave therapy) at thoracic paraspinal muscles. After a needle biopsy, the lesion increased in size, and the patient's symptoms worsened. Malignant soft tissue tumors such as osteosarcoma should be differentiated, so excision of the mass was performed. The final diagnosis was MO with aneurysmal bone cystic change. This case is a very rare form of MO that showed an unusual cause, location, clinical course, and pathologic result on follow-up. This can be an instructive case for radiologists as it is a common disease entity with unusual manifestations.
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23
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Kim HJ, Ban MG, Rho M, Jeon W, Kim SH. Evaluation of Sagittal Spinopelvic Alignment on Analgesic Efficacy of Lumbar Epidural Steroid Injection in Geriatric Patients. Medicina (Kaunas) 2022; 58. [PMID: 36295544 DOI: 10.3390/medicina58101383] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/08/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate the impact of sagittal imbalance based on pelvic incidence−lumbar lordosis (PI-LL) mismatch on the analgesic efficacy of epidural steroid injection in geriatric patients. Materials and Methods: Patients aged 65 years or older who received lumbar epidural steroid injections under fluoroscopy were enrolled. The cutoff of PI-LL mismatch >20° was used as an indicator of a marked sagittal imbalance. The cross-sectional area of the psoas and paraspinal muscles, as well as the paraspinal fat infiltration grade were measured. A 50% or more decrease in pain score at four weeks after injection was considered as good analgesia. Variables were compared between PI-LL ≤ 20° and >20° groups and multivariate analysis was used to identify factors related to pain relief after injection. Results: A total of 237 patients consisting of 150 and 87 patients in the PI-LL ≤ 20° and >20° groups, respectively, were finally analyzed. Female patients, patients with lumbar surgery history, and the smaller cross-sectional area of the psoas muscles were predominantly observed in patients with sagittal imbalance. There was no difference in analgesic outcome after injection according to the PI-LL mismatch (good analgesia 60.0 vs. 60.9%, p = 0.889). Multivariate analysis showed that pre-injection opioid use, moderate to severe foraminal stenosis, and high-graded paraspinal fat infiltration were significantly associated with poor analgesia after injection. Conclusions: There was no significant correlation between sagittal spinopelvic alignment and pain relief after lumbar epidural steroid injection for geriatric patients.
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24
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Sponbeck JK, Moody MA, Mitchell UH, Neves CD, Johnson AW. Multifidus muscle cross-sectional area adaptations over two volleyball seasons and one off-season in athletes with and without low back pain. J Back Musculoskelet Rehabil 2022; 35:1135-1142. [PMID: 35342078 DOI: 10.3233/bmr-210234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The multifidus muscle is important in spine stabilization. Atrophy of the multifidus muscle has been associated with low back pain. OBJECTIVE To examine multifidus muscle cross-sectional area (CSA) adaptations over two volleyball seasons and one off-season in volleyball athletes experiencing low back pain or no low back pain. METHODS Twelve female NCAA division 1 volleyball athletes participated. Athletes were placed into a low back pain or no low back pain group. Athlete's multifidus was imaged and measured using ultrasound at four time points across seasons. Imaging time points were before season one, following season one, following off-season, and following season two. A single level mixed-model analysis of variance was used for all analyses. A Tukey HSD post hoc test was used to determine differences between and within the low back pain and the no low back pain groups. RESULTS Following off-season training the pain group had clinically significant smaller multifidus CSA at the L4 (-2.36 cm2 difference or 17.5%) and L5 (-2.40 cm2 or 12.5%) levels. Non-significant (p> 0.05) decreases in multifidus CSA were seen in both groups following season one and two. Athletes with pain had decreased multifidus CSA at the L4 and L5 vertebral levels at all time points which was non-significant (p> 0.05). CONCLUSIONS Clinically significant decreases in multifidus CSA occurred in female volleyball athletes with low back pain at the L4 and L5 level following off-season training. Volleyball athletes with pain had smaller multifidus CSA averages at all time points measured of the two year period.
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Kim HJ, Rho M, Yoon KB, Jo M, Lee DW, Kim SH. Influence of cross-sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients. Pain Pract 2022; 22:621-630. [PMID: 35735193 DOI: 10.1111/papr.13141] [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: 04/28/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND An assessment of paraspinal muscle degeneration based on magnetic resonance imaging has been used to investigate both sarcopenia and myosteatosis. The morphologic changes in cross-sectional area and fat infiltration of the paraspinal muscles can affect pain outcomes after epidural steroid injection. METHODS Patients ≥65 years of age who underwent fluoroscopy-guided lumbar epidural steroid injections were enrolled. Good analgesia was defined as ≥50% reduction in pain score at 4 weeks after injection. Cross-sectional area and grade of fat infiltration of the paraspinal muscles on magnetic resonance images at the level of L3-L4 disc were measured. Patient demographics, pain-related factors, clinical factors, and paraspinal muscle measurements were compared between good and poor analgesia groups. The factors associated with pain outcomes after injection were identified using multivariate analysis. RESULTS A total of 245 patients consisting of 149 and 96 patients in the good and poor analgesia groups, respectively, fully satisfied the study criteria for analysis. Patients of older age, opioid use, and high-grade foraminal stenosis were frequently observed in the poor analgesia group. The grade of fat infiltration of the paraspinal muscles was significantly higher in the poor analgesia group (Grade 2, 20.8% vs. 42.7%, p < 0.001), and this result was predominantly observed in female patients. However, there was no difference in the muscle cross-sectional area between the two groups (18.29 ± 3.16 vs. 18.59 ± 3.03 cm2 /m2 , p = 0.460). The percentage of patients with good analgesia decreased as the grade of fat infiltration increased (Grade 0 = 75.0%, Grade 1 = 65.8%, Grade 2 = 43.0%, p < 0.001). Multivariate logistic regression analysis revealed that preinjection opioid use [adjusted odds ratio (aOR) = 1.926, 95% confidence interval (CI) = 1.084-3.422, p = 0.025], moderate to severe foraminal stenosis (aOR = 2.859, 95% CI = 1.371-5.965, p = 0.005), and high-grade fat infiltration of the paraspinal muscles (aOR = 4.258, 95% CI = 1.805-10.043, p = 0.001) were significantly associated with poor analgesia after injection. CONCLUSION High fat infiltration of the paraspinal muscles at the mid-lumbar region appeared to be an independent factor associated with poor analgesia after epidural steroid injection in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care. However, the cross-sectional area of the paraspinal muscles was not associated with pain relief after injection.
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Affiliation(s)
- Hee Jung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Miribi Rho
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Minju Jo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Woo Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Seyedhoseinpoor T, Taghipour M, Dadgoo M, Ebrahimi Takamjani I, Sanjari MA, Kazemnejad A, Elliott JM, Hides J. Relationship between the morphology and composition of the lumbar paraspinal and psoas muscles and lumbar intervertebral motion in people with chronic low back pain. Clin Anat 2022; 35:762-772. [PMID: 35445452 DOI: 10.1002/ca.23893] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022]
Abstract
Muscles of the lumbar spine play an important role in controlling segmental intervertebral motion. This study aimed to evaluate the association between lumbar intervertebral motion and changes in lumbar morphology/composition in people with chronic low back pain (CLBP). A sample of 183 patients with CLBP participated in this cross-sectional study. Participants underwent lumbar flexion-extension X-Rays to determine vertebral motion (translational and/or rotational motion) of lumbar levels (L1-L2 to L5-S1) and lumbar spine Magnetic Resonance Imaging (MRI) to quantify total and functional cross-sectional areas (CSAs) and asymmetry of the multifidus, lumbar erector spinae and psoas muscles. The relationship between morphology/composition of the muscles and lumbar intervertebral motion was investigated. Smaller total and functional CSAs of the multifidus and greater CSAs of the lumbar erector spinae muscle were observed in participants with greater intervertebral motion. Muscle asymmetry was observed at different lumbar vertebral levels. The greatest amount of translational intervertebral motion was observed at the L3-L4 level, while the greatest amount of rotational translation occurred at the L4-5 level. Associations were observed between the morphology of the paraspinal muscles at the vertebral levels adjacent to the L3-L4 level and the increased intervertebral motion at this level. Relationships between measures of muscle morphology/composition and increased segmental vertebral motion were observed. The results may provide a plausible biological reason for the effectiveness of rehabilitating deficient paraspinal muscles in a subset of people with CLBP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tahere Seyedhoseinpoor
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran.,Mobility impairment research center, Health institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Taghipour
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran.,Mobility impairment research center, Health institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Dadgoo
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran
| | - Ismail Ebrahimi Takamjani
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA.,Faculty of Medicine and Health, The Kolling Research Institute, The University of Sydney, the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia
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He Z, Li CY, Mak CHK, Tse TS, Cheung FC. Minimally Invasive Tubular Retractor Surgery for Intradural Extramedullary Spinal Tumor Reduces Postoperative Degeneration of Paraspinal Muscle. Asian J Neurosurg 2022; 17:74-84. [PMID: 35873837 PMCID: PMC9298595 DOI: 10.1055/s-0042-1749127] [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: 10/25/2022] Open
Abstract
Background Minimally invasive surgery (MIS) using a tubular retractor has been increasingly utilized in spinal surgery for degenerative conditions with the benefit of paraspinal muscle preservation. This benefit has not been previously reported for intradural extramedullary tumors using the MIS approach. In this study, we aimed to compare the degree of postoperative fatty degeneration in paraspinal muscle between MIS with tubular retractor (MIS) and open laminectomy (Open) for intradural extramedullary spinal tumors. Methods This was a retrospective review conducted in a tertiary neurosurgical center from 2015 to 2019. The degree of paraspinal muscle fatty degeneration, as measured by Goutallier grade on postoperative magnetic resonance imaging (MRI), was analyzed, and the degree of excision, tumor recurrence rate, and chronic pain were compared between the two surgical approaches. Results Among 9 patients in the MIS group and 33 patients in the Open group, the rate of gross total resection was comparable (MIS: 100.0%, Open: 97.0%, p = 1.000). The degree of paraspinal muscle fatty degeneration was significantly reduced in the MIS group (median Goutallier grade 1 in MIS group vs. median Goutallier grade 2 in Open group, p = 0.023). There was no significant difference in the tumor recurrence rate, complication rate, and chronic pain severity. A consistent trend of reduced analgesic consumption was observed in the MIS group, though not statistically significant. Conclusions Minimally invasive tubular retractor surgery is an effective approach for appropriately selected intradural extramedullary spinal tumors with significantly reduced postoperative fatty degeneration in paraspinal muscle.
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Affiliation(s)
- Zhexi He
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China.,Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China
| | - Cho Ying Li
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
| | | | - Tat Shing Tse
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
| | - Fung Ching Cheung
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
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Álvarez-Velasco R, Nuñez-Peralta CA, Alonso-Pérez J, Gallardo E, Collet-Vidiella R, Reyes-Leiva D, Pascual-Goñi E, Martín-Aguilar L, Caballero-Ávila M, Carbayo-Viejo A, Llauger-Roselló J, Díaz-Manera J, Olivé M. HIGH PREVALENCE OF PARASPINAL MUSCLE INVOLVEMENT IN ADULTS WITH McARDLE DISEASE. Muscle Nerve 2022; 65:568-573. [PMID: 35174518 DOI: 10.1002/mus.27523] [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: 08/06/2021] [Revised: 02/08/2022] [Accepted: 02/12/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS Very few studies analyzing the pattern of muscle involvement in magnetic resonance imaging (MRI) of patients with McArdle disease have been reported to date. We aimed to examine the pattern of muscle fat replacement in patients with McArdle disease. METHODS We performed a retrospective study including all patients with genetically confirmed McArdle disease followed in our center from January 2010 to March 2021. Clinical data were collected from the medical record. Whole-body MRI was performed as part of the diagnostic evaluation. The distribution of muscle fat replacement and its severity were analyzed. RESULTS Nine patients were included. Median age at onset was 7 years (range:5-58) and median age at the time when MRI was performed was 57.3 years (range 37.2-72.8). At physical examination 4 patients had permanent weakness: in 3 the weakness was limited to paraspinal muscles whereas in one the weakness involved the paraspinal and proximal upper limb muscles. Muscle MRI showed abnormalities in 6 of the 7 studied patients. In all of them fat replacement of paravertebral muscles was found. Other muscles frequently affected were the tongue in 3, subscapularis in 3, and long head of biceps femoris and semimembranosus in 2. DISCUSSION Our findings suggest that paraspinal muscle involvement is common in McArdle disease and support the need to include this disease in the differential diagnosis of the causes of paraspinal muscle weakness. Involvement of the tongue and subscapularis are also frequent in McArdle disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- R Álvarez-Velasco
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - C A Nuñez-Peralta
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Alonso-Pérez
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - E Gallardo
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - R Collet-Vidiella
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - D Reyes-Leiva
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - E Pascual-Goñi
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - L Martín-Aguilar
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Caballero-Ávila
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - A Carbayo-Viejo
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Llauger-Roselló
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Díaz-Manera
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,John Walton Muscular Dystrophy Research Centre, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK
| | - M Olivé
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
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29
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Revsbech KL, Rudolf K, Sheikh AM, Khawajazada T, de Stricker Borch J, Dahlqvist JR, Løkken N, Witting N, Vissing J. Axial muscle involvement in patients with Limb girdle muscular dystrophy type R9. Muscle Nerve 2022; 65:405-414. [PMID: 35020210 DOI: 10.1002/mus.27491] [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: 07/12/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION/AIMS Limb girdle muscular dystrophy type R9 (LGMDR9) is characterized by progressive weakness of the shoulder and hip girdles. Involvement of proximal extremity muscles is well-described whereas information about axial muscle involvement is lacking. It is important to recognize the involvement of axial muscles to understand functional challenges for the patients. The aim of this study was to investigate the involvement of axial and leg muscles in patients with LGMDR9. METHODS This observational, cross-sectional study investigated fat replacement of axial and leg muscles in 14 patients with LGMDR9 and 13 matched, healthy controls using quantitative MRI (Dixon technique). We investigated paraspinal muscles at three levels, psoas major at the lumbar level, and leg muscles in the thigh and calf. Trunk strength was assessed with stationary dynamometry and manual muscle tests. RESULTS Patients with LGMDR9 had significantly increased fat replacement of all investigated axial muscles compared with healthy controls (p < 0.05). Trunk extension and flexion strength were significantly reduced in patients. Extension strength correlated negatively with mean fat fraction of paraspinal muscles. Fat fractions of all investigated leg muscles were significantly increased vs. controls, with the posterior thigh muscles being the most severely affected. DISCUSSION Patients with LGMDR9 have severe involvement of their axial muscles and correspondingly have reduced trunk extension and flexion strength. Our findings define the axial muscles as some of the most severely involved muscle groups in LGMDR9, which should be considered in the clinical management of the disorder and monitoring of disease progression.
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Affiliation(s)
- Karoline Lolk Revsbech
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Karen Rudolf
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Aisha Munawar Sheikh
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Tahmina Khawajazada
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Josefine de Stricker Borch
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Julia Rebecka Dahlqvist
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Nanna Witting
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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30
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Huang Y, Wang L, Luo B, Yang K, Zeng X, Chen J, Zhang Z, Li Y, Cheng X, He B. Associations of Lumber Disc Degeneration With Paraspinal Muscles Myosteatosis in Discogenic Low Back Pain. Front Endocrinol (Lausanne) 2022; 13:891088. [PMID: 35634490 PMCID: PMC9136003 DOI: 10.3389/fendo.2022.891088] [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: 03/07/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Accompanied with intervertebral disc (IVD) degeneration, increasing fat infiltration of paraspinal muscles may be related to discogenic low back pain (DLBP), but their relationship is still unclear and the classical animal models are not completely applicable. The purpose of this study was to assess the paraspinal muscle fat infiltration in patients with DLBP by quantitative MRI, and to develop a novel DLBP rat model to explore the potential relationship between DLBP paraspinal muscle fat infiltration and TNF-α levels. We measured the proton density fat fraction (PDFF) of the multifidus and erector spinae muscles of 70 DLBP patients and 36 healthy volunteers by using quantitative MRI IDEAL-IQ. In addition, we developed a DLBP experimental rat model by puncturing the L4/5 and L5/6 IVDs under the guidance of X-ray fluoroscopy. Then various behavioral experiments, MRI and pathological examination of IVDs were used to evaluate the performance of the DLBP animal model. The gait analysis, hot plate test, acetone test, grasping test and tail suspension test were used to evaluate the pain and muscle dysfunction in rats. Through quantitative MRI and histological examination, the degeneration of IVDs and fat infiltration in the muscles were observed in vivo and ex vivo. Enzyme linked immunosorbent assay detects the level of TNF-α in rat IVDs and paraspinal muscles. In the human study, compared with healthy volunteers, the PDFF of multifidus and erector muscles of DLBP patients increased significantly at L4/5 and L5/S1 levels (p<0.05). In the rat experiment, compared with control group and sham group, DLBP group had reduced gait score, shortened response time to cold and heat stimuli, prolonged bending time, and shortened struggling time. Rat lumbar MRI T2WI showed that the signal intensity of L4/5 and L5/6 IVDs were progressively decreased. Histological examination revealed that IVDs had increased collagen fibers, reduced nucleus pulposus, thickened annulus fibrosus, and distorted shape. The PDFF of multifidus muscle at L4/5 and L5/6 level in the DLBP group were more than that in other groups (p<0.05), and HE staining and oil red O staining of paraspinal muscles showed that the muscle bundle space of the DLBP group muscles increased, and the muscle tissues Increased lipid droplets. Finally, the expression of TNF-α in IVDs and paraspinal muscles in the DLBP group were significantly higher than that in the control group (p<0.05). It is reliable and feasible to establish a DLBP rat model by puncturing the lumbar IVDs under the guidance of X-ray fluoroscopy. The degeneration of lumbar IVDs with DLBP leads to the occurrence of fat infiltration of paraspinal muscles, which is related to the expression of TNF-α.
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Affiliation(s)
- Yilong Huang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Baofa Luo
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kaiwen Yang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaomin Zeng
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiaxin Chen
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhenguang Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanlin Li
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Bo He
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Bo He,
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31
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Huang Y, Wang L, Zeng X, Chen J, Zhang Z, Jiang Y, Nie L, Cheng X, He B. Association of Paraspinal Muscle CSA and PDFF Measurements With Lumbar Intervertebral Disk Degeneration in Patients With Chronic Low Back Pain. Front Endocrinol (Lausanne) 2022; 13:792819. [PMID: 35721738 PMCID: PMC9204273 DOI: 10.3389/fendo.2022.792819] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
Abstract
There is an interaction between the lumbar spine and paraspinal muscles, which may play a role in the development of intervertebral disc (IVD) degeneration and may affect CLBP. The study aims to assess the relationship between IVD degeneration and paraspinal muscle fat infiltration in CLBP patients by quantitative MR imaging, and to evaluate the influence of sex and age on CLBP muscle fat infiltration. Sixty CLBP patients (46.3 years ±17.0) and thirty-two healthy subjects (44.9 years ±17.6) were recruited for this study. 3.0 T MRI was used to perform the sagittal and axial T1, T2 of the lumbar spine, and axial paraspinal muscle IDEAL imaging at the L4/5 and L5/S1 levels. Proton density fat fraction (PDFF) of the multifidus and erector spinae at two IVD levels were measured. The Pfirrmann grades of IVD degeneration, Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) were also evaluated. Compare the cross-sectional area (CSA) and PDFF of the paraspinal muscles between CLBP patients and healthy subjects, and analyze the relationship between the muscle PDFF and Pfirrmann grades, gender, and age of CLBP patients. Compared with healthy subjects, the CSA of the multifidus muscle in CLBP patients decreased (1320.2±188.1mm2vs. 1228.7±191.0 mm2, p<0.05) at the L4/5 level, the average PDFF increased, (7.7±2.6% vs. 14.79±5.3%, 8.8±4.2% vs. 16.03±5.3%, all p<0.05) at both L4/5 and L5/S1 levels. The PDFF of paraspinal muscles were correlated with adjacent IVD degeneration, ODI and VSA in CLBP patients (all p<0.05). After using age and body mass index (BMI) as control variables, significance was retained (all p<0.05). Multiple regression analysis revealed sex and age also were significantly associated with multifidus PDFF (all p < 0.05). This study confirmed that the CSA decreased and the PDFF increased of the paraspinal muscles in CLBP patients. It reveals a significant correlation between the PDFF of CLBP paraspinal muscles and the grade of IVD degeneration. Sex and age are also important factors influencing CLBP paraspinal muscle infiltration.
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Affiliation(s)
- Yilong Huang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaomin Zeng
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
- GE Healthcare, Magnetic Resonance Field Application Team, Chengdu, China
| | - Jiaxin Chen
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhenguang Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuanming Jiang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lisha Nie
- GE Healthcare, Magnetic Resonance Research China, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Bo He, ; Xiaoguang Cheng,
| | - Bo He
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Bo He, ; Xiaoguang Cheng,
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32
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Wang Z, Zhao Z, Han S, Hu X, Ye L, Li Y, Gao J. Advances in research on fat infiltration and lumbar intervertebral disc degeneration. Front Endocrinol (Lausanne) 2022; 13:1067373. [PMID: 36568091 PMCID: PMC9768030 DOI: 10.3389/fendo.2022.1067373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 10/11/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Low back pain (LBP) is a disabling condition with no available cure, severely affecting patients' quality of life. Intervertebral disc degeneration (IVDD) is the leading cause of chronic low back pain (CLBP). IVDD is a common and recurrent condition in spine surgery. Disc degeneration is closely associated with intervertebral disc inflammation. The intervertebral disc is an avascular tissue in the human body. Transitioning from hematopoietic bone marrow to bone marrow fat may initiate an inflammatory response as we age, resulting in bone marrow lesions in vertebrae. In addition, the development of LBP is closely associated with spinal stability imbalance. An excellent functional state of paraspinal muscles (PSMs) plays a vital role in maintaining spinal stability. Studies have shown that the diminished function of PSMs is mainly associated with increased fat content, but whether the fat content of PSMs is related to the degree of disc degeneration is still under study. Given the vital role of PSMs lesions in CLBP, it is crucial to elucidate the interaction between PSMs changes and CLBP. Therefore, this article reviews the advances in the relationship and the underlying mechanisms between IVDD and PSMs fatty infiltration in patients with CLBP.
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Affiliation(s)
- Zairan Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zijun Zhao
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Shiyuan Han
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianghui Hu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liguo Ye
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Yongning Li, ; Jun Gao,
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Yongning Li, ; Jun Gao,
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Kim HJ, Yang JH, Chang DG, Suk SI, Suh SW, Nam Y, Kim SI, Song KS. Long-Term Influence of Paraspinal Muscle Quantity in Adolescent Idiopathic Scoliosis Following Deformity Correction by Posterior Approach. J Clin Med 2021; 10:jcm10204790. [PMID: 34682913 PMCID: PMC8538741 DOI: 10.3390/jcm10204790] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 01/23/2023] Open
Abstract
Pedicle screw instrumentation (PSI) through posterior approach has been the mainstay of deformity correction for adolescent idiopathic scoliosis (AIS). However, changes in the quantity of paraspinal muscles after AIS surgery has remained largely unknown. The aim of this study was to investigate long-term follow-up changes in paraspinal muscle volume in AIS surgery via a posterior approach. Forty-two AIS patients who underwent deformity correction by posterior approach were analyzed through a longitudinal assessment of a cross-sectional area (CSA) in paraspinal muscles with a minimum five-year follow-up. The CSA were measured using axial computed tomography images at the level of the upper endplate L4 by manual tracing. The last follow-up CSA ratio of the psoas major muscle (124.5%) was significantly increased compared to the preoperative CSA ratio (122.0%) (p < 0.005). The last follow-up CSA ratio of the multifidus and erector spine muscles significantly decreased compared to the preoperative CSA ratio (all p < 0.005). The CSA ratio of the erector spine muscle was correlated with the CSA ratio of the psoas major (correlation coefficient = 0.546, p < 0.001). Therefore, minimizing the injury to the erector spine muscle is imperative to maintaining psoas major muscle development in AIS surgery by posterior approach.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (S.-I.S.)
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea; (J.H.Y.); (S.W.S.); (Y.N.)
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (S.-I.S.)
- Correspondence: ; Tel.: +82-2-950-1284
| | - Se-Il Suk
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (S.-I.S.)
| | - Seung Woo Suh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea; (J.H.Y.); (S.W.S.); (Y.N.)
| | - Yunjin Nam
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea; (J.H.Y.); (S.W.S.); (Y.N.)
| | - Sang-Il Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 06973, Korea;
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Bilek F, Tekin F. Effectiveness of Extracorporeal Shock Wave Therapy on Postural Control and Balance in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial. Percept Mot Skills 2021; 128:2621-2637. [PMID: 34474622 DOI: 10.1177/00315125211044057] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the effects of Extracorporeal Shock Wave Therapy (ESWT) applied to paraspinal muscles on balance and postural control in children with unilateral Cerebral Palsy (CP). A total of 32 children with unilateral CP were included in the study. The children participated in a one-session control to evaluate their reactions to ESWT before randomly assigning them into experimental and control groups. We evaluated children twice: before and after the treatment. We used the Trunk Control Measurement Scale, Trunk Impairment Scale, Pediatric Balance Scale (PBS), and Timed Up and Go (TUG) test in these assessments. Following the pre-test session, we applied Neuro-Developmental Treatment (NDT) programs to both groups at the rate of twice per week for eight weeks; additionally, we applied ESWT only to the experimental group at the rate of twice a week for eight weeks. While there were trends toward increased trunk control skills, PBS scores and TUG test performances from pre- to post-testing in both groups, these improvements were only statistically significant in the experimental group (p < 0.05). We conclude that for children with unilateral CP, ESWT applied to paraspinal muscles has significant additive value when combined with NDT to improve postural control and balance.
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Affiliation(s)
- Furkan Bilek
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Fatih Tekin
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
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Uçar İ, Karartı C, Cüce İ, Veziroğlu E, Özüdoğru A, Koçak FA, Dadalı Y. The relationship between muscle size, obesity, body fat ratio, pain and disability in individuals with and without nonspecific low back pain. Clin Anat 2021; 34:1201-1207. [PMID: 34378252 DOI: 10.1002/ca.23776] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/08/2021] [Accepted: 08/08/2021] [Indexed: 01/24/2023]
Abstract
Patients with nonspecific low back pain (NSLBP) may face motor control problems and health disability barriers during various tasks. However, studies investigating the extent of these disadvantages, and possible associated factors are quite limited in patients with NSLBP. To compare motor control performances and physical assessment domains between patients with NSLBP and asymptomatic controls. Twenty-seven patients with NSBLP and 27 age- and sex-matched asymptomatic controls participated in this cross-sectional study. Ultrasonographic imaging was used to determine abdominal and multifidus muscles thicknesses and adipose tissue rate. Visual analog scale was used to assess LBP severity. Body mass index (BMI) and Oswestry Disability Index (ODI) scores of the participants were physical assessment domains of LBP. BMI values were greater in the NSLBP group compared to the asymptomatic participants. ANCOVA revealed a significant interaction effect regarding external abdominal oblique and multifidus lumborum muscles thickness, and abdominal adipose tissue (p = 0.015; p = 0.001; p = 0.006), respectively in terms of two groups. The thicknesses of these muscles were lesser in the NSLBP group compared with the control group. Similarly, abdominal adipose tissue was higher in the NSLBP group. The stepwise multiple regression analysis demonstrated that the Oswestry Disability Index and abdominal adipose tissue rate were significant and independent factors of the low back pain severity with 73.5% of the variance. The study results indicate that increased disability and fat infiltration are possible determinants influencing pain severity, although further research is required. Examining musculoskeletal properties of lumbar region could provide information about the limitation in patients with NSBLP.
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Affiliation(s)
- İlyas Uçar
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Caner Karartı
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsa Cüce
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Enes Veziroğlu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Anıl Özüdoğru
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Fatmanur Aybala Koçak
- Physical Medicine and Rehabilitation, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Yeliz Dadalı
- Department of Radiology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Remedios E, Sommerfield D, Fellingham W, Powers N, Stannage K, Hii JWS. Paraspinal desmoid fibromatosis after lumbar epidural analgesia. Anaesth Rep 2021; 9:e12129. [PMID: 34396135 DOI: 10.1002/anr3.12129] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 14-year-old girl with cerebral palsy presented for bilateral lower limb surgery for spasticity. A lumbar epidural catheter was sited under general anaesthesia on the third attempt and used intra-operatively with good effect. A local anaesthetic infusion was used for postoperative analgesia but was noted to be leaking under the dressing with a patchy, unilateral block. The catheter was therefore removed on the second postoperative day. Following discharge, the patient progressively developed new back and leg pain for which she was re-admitted seven weeks later. This was investigated and initially thought to be myositis of the erector spinae muscles on magnetic resonance imaging. When the patient failed to respond to treatment, a muscle biopsy demonstrated desmoid fibromatosis. Trauma may cause or accelerate the development of desmoid fibromatosis, which has also been theorised to arise from scar tissue in previously injured areas. We hypothesise that challenging epidural placement or the leakage of the local anaesthetic agent into the surrounding muscular tissue, inducing local myonecrosis, could have been the triggering or accelerating event in tumour development. This may be the first reported case of extra-abdominal desmoid fibromatosis in association with epidural placement.
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Affiliation(s)
- E Remedios
- Perth Children's Hospital Perth Australia
| | - D Sommerfield
- Department of Anaesthesia Perth Children's Hospital Perth Australia.,Telethon Kids Institute Perth Australia
| | - W Fellingham
- Department of Anaesthesia Perth Children's Hospital Perth Australia
| | - N Powers
- Department of Radiology Perth Children's Hospital Perth Australia
| | - K Stannage
- Department of Orthopaedic Surgery Perth Children's Hospital Perth Australia
| | - J W S Hii
- Perth Children's Hospital Perth Australia.,Perioperative Medicine Team Telethon Kids Institute Perth Australia
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Lee SY, Park J, Kim DH, Lim JY. Combined exercise and nutrition intervention for spinal sarcopenia: A pilot study protocol. Medicine (Baltimore) 2021; 100:e26421. [PMID: 34128906 PMCID: PMC8213246 DOI: 10.1097/md.0000000000026421] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Spinal sarcopenia is a multifactorial disorder associated with the atrophy of and fatty changes to the paraspinal muscles. We previously developed the concept of spinal sarcopenia in community-dwelling older adults and investigated the association between conventional sarcopenic indices and spinal sarcopenia. However, interventional studies of spinal sarcopenia are lacking. This pilot study will aim to evaluate the effectiveness of a combined exercise and nutrition intervention for treating spinal sarcopenia. METHODS AND ANALYSIS This open-label single-arm prospective study will include 35 community-dwelling older women who were diagnosed with spinal sarcopenia in our previous cohort study. The 12-week combined intervention will consist of back extensor strengthening exercise and nutritional supplementation. The primary outcome of this study will be isometric back extensor strength after the 12-week intervention. All functional and radiographic outcomes will be measured at 0, 12, and 24 weeks post-intervention. The data will be analyzed using the intention-to-treat principle.
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Affiliation(s)
| | | | - Dong Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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De Martino E, Hides J, Elliott JM, Hoggarth M, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. Lumbar muscle atrophy and increased relative intramuscular lipid concentration are not mitigated by daily artificial gravity after 60-day head-down tilt bed rest. J Appl Physiol (1985) 2021; 131:356-368. [PMID: 34080918 DOI: 10.1152/japplphysiol.00990.2020] [Citation(s) in RCA: 7] [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: 11/22/2022] Open
Abstract
Exposure to axial unloading induces adaptations in paraspinal muscles, as shown after spaceflights. This study investigated whether daily exposure to artificial gravity (AG) mitigated lumbar spine flattening and muscle atrophy associated with 60-day head-down tilt (HDT) bed rest (Earth-based space analog). Twenty-four healthy individuals participated in the study: 8 received 30-min continuous AG; 8 received 6 × 5-min AG interspersed with rest periods; and 8 received no AG exposure (control group). Magnetic resonance imaging (MRI) of the lumbopelvic region was conducted at baseline (BDC) and at day 59 of HDT (HDT59). Longitudinal relaxation time (T1)-weighted images were used to assess morphology of the lumbar spine (spinal length, intervertebral disk angles, disk area) and volumes of the lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 vertebral levels. A chemical shift-based two-point lipid/water Dixon sequence was used to evaluate muscle composition. Results showed that spinal length and disk area increased (P < 0.05); intervertebral disk angles (P < 0.05) and muscle volumes of LM, LES, and QL reduced (P < 0.01); and lipid-to-water ratio for the LM and LES muscles increased (P < 0.01) after HDT59 in all groups. Neither of the AG protocols mitigated the lumbar spinae deconditioning induced by HDT bed rest. The increase in lipid-to-water ratio in LM and LES muscles indicates an increased relative intramuscular lipid concentration. Altered muscle composition in atrophied muscles may impair lumbar spine function after body unloading, which could increase injury risk to vulnerable soft tissues. This relationship needs further investigation.NEW & NOTEWORTHY This study presents novel insights into the morphological adaptations occurring in the lumbar spine after 60-day head-down bed rest and the potential role of artificial gravity (AG) to mitigate them. Results demonstrated no protective effect of AG protocols used in this study. In atrophied paraspinal muscles, the ratio of lipids versus intramuscular water increased in the postural lumbar muscles, which could impair muscle function during upright standing. These findings have relevance for future space explorations.
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Affiliation(s)
- Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Julie Hides
- School of Allied Health Sciences, Griffith University, Nathan Campus, Brisbane, Queensland, Australia
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine Northwestern University, Chicago, Illinois.,Kolling Research Institute, Faculty of Medicine and Health, The University of Sydney and Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- NIHR Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jonathan A Cook
- NIHR Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sauro E Salomoni
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Tobias Weber
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency (ESA), Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency (ESA), Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Paul W Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Sheikh AM, Rudolf K, de Stricker Borch J, Khawajazada T, Witting N, Vissing J. Patients With Becker Muscular Dystrophy Have Severe Paraspinal Muscle Involvement. Front Neurol 2021; 12:613483. [PMID: 34093388 PMCID: PMC8177107 DOI: 10.3389/fneur.2021.613483] [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: 10/02/2020] [Accepted: 04/27/2021] [Indexed: 01/26/2023] Open
Abstract
Introduction: Paraspinal muscles are important for gross motor functions. Impairment of these muscles can lead to poor postural control and ambulation difficulty. Little knowledge exists about the involvement of paraspinal muscles in Becker muscular dystrophy. Objective: In this cross-sectional study, we investigated the involvement of paraspinal muscles with quantitative trunk strength measure and quantitative muscle MRI. Methods and Materials: Eighteen patients with Becker muscular dystrophy underwent trunk, hip, and thigh strength assessment using a Biodex dynamometer and an MRI Dixon scan. Fourteen age- and body mass index-matched healthy men were included for comparison. Results: Muscle fat fraction (FF) of the paraspinal muscles (multifidus and erector spinae) was higher in participants with Becker muscular dystrophy vs. healthy controls at all three examined spinal levels (C6, Th12, and L4/L5) (p < 0.05). There was a strong and inverse correlation between paraspinal muscle FF and trunk extension strength (ρ = −0.829, p < 0.001), gluteus maximus FF and hip extension strength (ρ = −0.701, p = 0.005), FF of the knee extensor muscles (quadriceps and sartorius) and knee extension strength (ρ = −0.842, p < 0.001), and FF of the knee flexor muscles (hamstring muscles) and knee flexion strength (ρ = −0.864, p < 0.001). Fat fraction of the paraspinal muscles also correlated with muscle FF of the thigh muscles and lower leg muscles. Conclusion: In conclusion, patients with Becker muscular dystrophy demonstrate severe paraspinal muscular involvement indicated by low back extension strength and high levels of fat replacement, which parallel involvement of lower limb muscles. Assessment of paraspinal muscle strength and fat replacement may serve as a possible biomarker for both the clinical management and further study of the disease.
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Affiliation(s)
- Aisha M Sheikh
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karen Rudolf
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Josefine de Stricker Borch
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tahmina Khawajazada
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Witting
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Lee ET, Lee SA, Soh Y, Yoo MC, Lee JH, Chon J. Association of Lumbar Paraspinal Muscle Morphometry with Degenerative Spondylolisthesis. Int J Environ Res Public Health 2021; 18:ijerph18084037. [PMID: 33921317 PMCID: PMC8070567 DOI: 10.3390/ijerph18084037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 12/27/2022]
Abstract
The objective of this study was to assess the cross-sectional areas (CSA) of lumbar paraspinal muscles and their fatty degeneration in adults with degenerative lumbar spondylolisthesis (DLS) diagnosed with chronic radiculopathy, compare them with those of the same age- and sex-related groups with radiculopathy, and evaluate their correlations and the changes observed on magnetic resonance imaging (MRI). This retrospective study included 62 female patients aged 65–85 years, who were diagnosed with lumbar polyradiculopathy. The patients were divided into two groups: 30 patients with spondylolisthesis and 32 patients without spondylolisthesis. We calculated the CSA and fatty degeneration of the erector spinae (ES) and multifidus (MF) on axial T2-weighted magnetic resonance (MR) images from the inferior end plate of the L4 vertebral body levels. The functional CSA (FCSA): CSA ratio, skeletal muscle index (SMI), and MF CSA: ES CSA ratio were calculated and compared between the two groups using an independent t-test. We performed logistic regression analysis using spondylolisthesis as the dependent variable and SMI, FCSA, rFCSA, fat infiltration rate as independent variables. The result showed more fat infiltration of MF in patients with DLS (56.33 vs. 44.66%; p = 0.001). The mean FCSA (783.33 vs. 666.22 mm2; p = 0.028) of ES muscle was a statistically larger in the patients with DLS. The ES FCSA / total CSA was an independent predictor of lumbar spondylolisthesis (odd ratio =1.092, p = 0.016), while the MF FCSA / total CSA was an independent protective factor (odd ratio =0.898, p = 0.002)
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Affiliation(s)
- Eun Taek Lee
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Korea; (E.T.L.); (S.A.L.); (Y.S.); (M.C.Y.)
| | - Seung Ah Lee
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Korea; (E.T.L.); (S.A.L.); (Y.S.); (M.C.Y.)
| | - Yunsoo Soh
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Korea; (E.T.L.); (S.A.L.); (Y.S.); (M.C.Y.)
| | - Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Korea; (E.T.L.); (S.A.L.); (Y.S.); (M.C.Y.)
| | - Jun Ho Lee
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Jinmann Chon
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Korea; (E.T.L.); (S.A.L.); (Y.S.); (M.C.Y.)
- Correspondence: ; Tel.: +82-2-958-8565; Fax: +82-2-958-8560
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Mazy A, Serry M, Kassem M. High-volume, multilevel local anesthetics-Epinephrine infiltration in kyphoscoliosis surgery: Intra and postoperative analgesia. J Anaesthesiol Clin Pharmacol 2021; 37:73-78. [PMID: 34103827 PMCID: PMC8174417 DOI: 10.4103/joacp.joacp_338_17] [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: 11/20/2017] [Revised: 07/14/2019] [Accepted: 10/28/2019] [Indexed: 11/29/2022] Open
Abstract
Background and Aims: Local anesthetic (LA) infiltration is one of the analgesic techniques employed during scoliosis correction surgery. However, its efficacy is controversial. In the present study for optimizing analgesia using the infiltration technique, we proposed two modifications; first is the preemptive use of high volume infiltration, second is applying three anatomical multilevel infiltrations involving the sensory, motor, and sympathetic innervations consecutively. Material and Methods: This prospective study involved 48 patients randomized into two groups. After general anesthesia (GA), the infiltration group (I) received bupivacaine 0.5% 2 mg/kg, lidocaine 5 mg/kg, and epinephrine 5 mcg/mL of the total volume (100 mL per 10 cm of the wound length) as a preemptive infiltration at three levels; subcutaneous, intramuscular, and the deep neural paravertebral levels, timed before skin incision, muscular dissection, and instrumentation consecutively. The control group (C) received normal saline in the same manner. Data were compared by Mann-Whitney, Chi-square, and t-test as suitable. Results: Intraoperatively, the LA infiltration reduced fentanyl, atracurium, isoflurane, nitroglycerine, and propofol consumption. Postoperatively, there was a 41% reduction in morphine consumption, longer time to the first analgesic request, lower VAS, early ambulation, and hospital discharge with high-patient satisfaction. Conclusion: The preemptive, high-volume, multilevel infiltration provided a significant intra and postoperative analgesia in scoliosis surgery.
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Affiliation(s)
- Alaa Mazy
- Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Mohamed Serry
- Orthopedic Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Mohamed Kassem
- Neurosurgery, Faculty of Medicine, Mansoura University, Egypt
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Lévesque J, Rivaz H, Rizk A, Frenette S, Boily M, Fortin M. Lumbar Multifidus Muscle Characteristics, Body Composition, and Injury in University Rugby Players. J Athl Train 2021; 55:1116-1123. [PMID: 32997748 DOI: 10.4085/1062-6050-304-19] [Citation(s) in RCA: 7] [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: 11/09/2022]
Abstract
CONTEXT A smaller lumbar multifidus (LM) muscle was reported to be a strong predictor of lower limb injury in professional Australian Football League players. However, despite the high prevalence of low back pain (LBP) and lower limb injury in rugby players, their LM characteristics have yet to be explored. OBJECTIVE To (1) examine LM characteristics in male and female university rugby players and their possible associations with LBP and lower limb injury and (2) investigate the relationship between LM characteristics and body composition in this group of athletes. DESIGN Cross-sectional study. SETTING University research center. PATIENTS OR OTHER PARTICIPANTS Thirty-four university rugby players (20 women, 14 men). MAIN OUTCOME MEASURE(S) Ultrasound measurements of LM cross-sectional area (CSA), thickness, and percentage change in thickness during contraction were obtained bilaterally, at the L5-S1 level, in prone and standing positions. Body composition measures were obtained using dual-energy x-ray absorptiometry. Self-reported questionnaires were used to obtain LBP and lower limb injury history. RESULTS Players who reported LBP in the previous 3 months showed a smaller percentage change in thickness during contraction in the standing position (F = 5.21, P = .03). The LM CSA side-to-side asymmetry (right versus left) was greater in players who reported having a lower limb injury in the previous 12 months (F = 4.98, P = .03). The LM CSA was significantly associated with body composition measurements. A greater percentage change in thickness during contraction was significantly associated with a lower percentage of body fat. The LM echo intensity was strongly associated with the total percentage of body fat and was significantly greater in women. CONCLUSIONS The influence of body composition on LM morphology in athletes cannot be ignored and warrants further investigation. Our findings also provide preliminary evidence of an association among LM morphology, LBP, and lower limb injury in university rugby players.
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Affiliation(s)
- Jérome Lévesque
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QE, Canada
| | - Hassan Rivaz
- PERFORM Centre, Concordia University, Montreal, QE, Canada.,Department of Electrical & Computer Engineering, Concordia University, Montreal, QE, Canada
| | - Amanda Rizk
- PERFORM Centre, Concordia University, Montreal, QE, Canada
| | | | - Mathieu Boily
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, QE, Canada
| | - Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QE, Canada.,PERFORM Centre, Concordia University, Montreal, QE, Canada.,Department of Diagnostic Radiology, McGill University Health Center, Montreal, QE, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation, Montreal, QE, Canada
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Dieckmeyer M, Inhuber S, Schlaeger S, Weidlich D, Mookiah MRK, Subburaj K, Burian E, Sollmann N, Kirschke JS, Karampinos DC, Baum T. Texture Features of Proton Density Fat Fraction Maps from Chemical Shift Encoding-Based MRI Predict Paraspinal Muscle Strength. Diagnostics (Basel) 2021; 11:diagnostics11020239. [PMID: 33557080 PMCID: PMC7913879 DOI: 10.3390/diagnostics11020239] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
Texture analysis (TA) has shown promise as a surrogate marker for tissue structure, based on conventional and quantitative MRI sequences. Chemical-shift-encoding-based MRI (CSE-MRI)-derived proton density fat fraction (PDFF) of paraspinal muscles has been associated with various medical conditions including lumbar back pain (LBP) and neuromuscular diseases (NMD). Its application has been shown to improve the prediction of paraspinal muscle strength beyond muscle volume. Since mean PDFF values do not fully reflect muscle tissue structure, the purpose of our study was to investigate PDFF-based TA of paraspinal muscles as a predictor of muscle strength, as compared to mean PDFF. We performed 3T-MRI of the lumbar spine in 26 healthy subjects (age = 30 ± 6 years; 15 females) using a six-echo 3D spoiled gradient echo sequence for chemical-shift-encoding-based water–fat separation. Erector spinae (ES) and psoas (PS) muscles were segmented bilaterally from level L2–L5 to extract mean PDFF and texture features. Muscle flexion and extension strength was measured with an isokinetic dynamometer. Out of the eleven texture features extracted for each muscle, Kurtosis(global) of ES showed the highest significant correlation (r = 0.59, p = 0.001) with extension strength and Variance(global) of PS showed the highest significant correlation (r = 0.63, p = 0.001) with flexion strength. Using multivariate linear regression models, Kurtosis(global) of ES and BMI were identified as significant predictors of extension strength (R2adj = 0.42; p < 0.001), and Variance(global) and Skewness(global) of PS were identified as significant predictors of flexion strength (R2adj = 0.59; p = 0.001), while mean PDFF was not identified as a significant predictor. TA of CSE-MRI-based PDFF maps improves the prediction of paraspinal muscle strength beyond mean PDFF, potentially reflecting the ability to quantify the pattern of muscular fat infiltration. In the future, this may help to improve the pathophysiological understanding, diagnosis, monitoring and treatment evaluation of diseases with paraspinal muscle involvement, e.g., NMD and LBP.
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Affiliation(s)
- Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universitär München, Ismaninger 22, 81675 Munich, Germany; (S.S.); (E.B.); (N.S.); (J.S.K.); (T.B.)
- Correspondence: ; Tel.: +49-89-4140-4651; Fax: +49-89-4140-4653
| | - Stephanie Inhuber
- Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60, 80992 Munich, Germany;
| | - Sarah Schlaeger
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universitär München, Ismaninger 22, 81675 Munich, Germany; (S.S.); (E.B.); (N.S.); (J.S.K.); (T.B.)
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar der Technischen Universitär München, Ismaninger 22, 81675 Munich, Germany; (D.W.); (D.C.K.)
| | | | - Karupppasamy Subburaj
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore 487372, Singapore;
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universitär München, Ismaninger 22, 81675 Munich, Germany; (S.S.); (E.B.); (N.S.); (J.S.K.); (T.B.)
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universitär München, Ismaninger 22, 81675 Munich, Germany; (S.S.); (E.B.); (N.S.); (J.S.K.); (T.B.)
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universitär München, Ismaninger 22, 81675 Munich, Germany; (S.S.); (E.B.); (N.S.); (J.S.K.); (T.B.)
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar der Technischen Universitär München, Ismaninger 22, 81675 Munich, Germany; (D.W.); (D.C.K.)
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universitär München, Ismaninger 22, 81675 Munich, Germany; (S.S.); (E.B.); (N.S.); (J.S.K.); (T.B.)
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Shah J, Tanwar T, Iram I, Aldabbas M, Veqar Z. Effect of Increased Lumbar Lordosis on Lumbar Multifidus and Longissimus Thoracis Activation During Quadruped Exercise in Patients With Chronic Low Back Pain: An EMG Study. J Appl Biomech 2020; 36:436-443. [PMID: 32963122 DOI: 10.1123/jab.2020-0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/18/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022]
Abstract
The objective was to investigate the electromyographic activity of the lumbar multifidus (MF) muscle and longissimus thoracis muscle, along with their activity ratio (MF longissimus thoracis ratio), during quadruped stabilization exercise performed with neutral posture and with increased lumbar lordosis in patients with chronic low back pain (CLBP). A total of 23 patients with CLBP (12 females and 11 males) were recruited based on inclusion and exclusion criterion. Each patient performed 4 exercises in random order, with surface electromyography electrodes and an electrogoniometer attached. A cross-sectional study design was used to measure the amplitude of muscle activation (as a percentage of maximum voluntary contraction) in each patient across the 2 muscles (MF and longissimus thoracis) during quadruped stabilization exercise with neutral posture and with increased lumbar lordosis. A 2-way analysis of variance was conducted, which demonstrated a statistically significant increase in the recruitment of MF with increased lumbar lordosis in patients with CLBP during quadruped exercise. An increase of 9.7% and 16.9% maximum voluntary contraction in MF electromyographic activity was observed in lumbar lordosis posture during the quadruped leg raise and quadruped leg-arm raise exercise, respectively (P < .01), when compared to the neutral posture. The increased recruitment of MF with lumbar lordosis in the quadruped position has strong implications in the assessment and management of patients with CLBP.
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Miki T, Naoki F, Takashima H, Takebayashi T. Associations between Paraspinal Muscle Morphology, Disc Degeneration, and Clinical Features in Patients with Lumbar Spinal Stenosis. Prog Rehabil Med 2020; 5:20200015. [PMID: 32844128 PMCID: PMC7429555 DOI: 10.2490/prm.20200015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 12/25/2022] Open
Abstract
Objective The purpose of this study was to examine the relationships between intervertebral disc degeneration in the lumbar spine, paraspinal muscle morphology, and clinical features in patients with lumbar spinal stenosis (LSS). Methods A total of 52 patients with LSS participated in this study. Magnetic resonance imaging was used to assess intervertebral disc degeneration at L4/5 and to measure the standardized cross-sectional areas (SCSAs) of the multifidus and erector spinae muscles. The intensity of low back pain (LBP) and lower limb pain, the level of disability, and the quality of life (QoL) were evaluated using patient-reported outcome measures. The associations between the image findings and clinical features, including the disability score, the pain score for low back pain, and the QoL score, were calculated using Spearman's rank correlation coefficient. Results No associations were found between disc degeneration and clinical features. However, disc degeneration and the SCSA of the multifidus muscle (r=-0.38, P <0.01) and of the erector spinae muscle (r=-0.29, P=0.04) were significantly associated. Analysis of the associations between muscle morphology and clinical features found that the SCSA of the multifidus muscle was associated with LBP (r=0.31, P=0.03). Conclusions These results suggest that there is some correlation between atrophy of the multifidus and pain intensity. Consequently, focusing on the CSA of the multifidus muscle may help to clarify the causes of LBP in patients with LSS. However, because of the cross-sectional nature of this study, causal relationships could not be determined and further research is needed.
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Affiliation(s)
- Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Hokkaido, Japan.,Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Fujita Naoki
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedics, Sapporo Maruyama Orthopedic Hospital, Sapporo, Hokkaido, Japan
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Chan-Tiopianco M, Huang CY, Jiang LY, Lai CR, Wang PH, Chen YJ. Endometriosis of the Paralumbar Muscles: A Case Report and Literature Review. Gynecol Minim Invasive Ther 2020; 9:170-174. [PMID: 33101921 PMCID: PMC7545041 DOI: 10.4103/gmit.gmit_81_19] [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: 12/02/2019] [Revised: 02/04/2020] [Accepted: 03/17/2020] [Indexed: 11/27/2022] Open
Abstract
The objective of this study is to report a case of deep endometriosis of the paralumbar muscles (psoas, multifidus, and erector spinae) and review existing literature on its management. A 34-year-old female with a history of endometriosis was seen for infertility. Paralumbar muscle masses seen on computed tomography (CT) scan were sampled, confirming endometriosis. Gonadotropin-releasing hormone agonist was given for 2 months. The patient was primed for assisted reproduction. A literature review was conducted to provide an understanding of paralumbar muscle endometriosis. To our knowledge, this is the first reported case of multifidus and erector spinae muscle endometriosis and fifth case of psoas muscle endometriosis. Because the available information is scarce, data from the existing literature on deep endometriosis may aid in the diagnosis and management. Magnetic resonance imaging and CT scan are essential imaging techniques to map lesions. Excision seems prudent, but the approach should be individualized depending on the patient's presentation and her preferences.
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Affiliation(s)
- Mareesol Chan-Tiopianco
- Department of Surgical Services, San Lazaro Hospital, Manila, Philippines.,Department of Obstetrics and Gynecology, ManilaMed - Medical Center Manila, Manila, Philippines
| | - Chen-Yu Huang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Yu Jiang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiung-Ru Lai
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Lohr C, Schmidt T, Braumann KM, Reer R, Medina-Porqueres I. Sex-Based Differences in Tensiomyography as Assessed in the Lower Erector Spinae of Healthy Participants: An Observational Study. Sports Health 2020; 12:341-346. [PMID: 32511080 DOI: 10.1177/1941738120917932] [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] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although there is mounting evidence on sex-linked differences in paraspinal muscle function, it is unknown whether sex-based variations in mechanical and contractile characteristics of the lumbar erector spinae (LES) can be monitored noninvasively in healthy participants at rest using tensiomyography (TMG). HYPOTHESIS Sex-specific effects in muscle displacement (Dm) and velocity of muscle deformation (Vd) will be observed via TMG assessed in the LES. STUDY DESIGN Observational study. LEVEL OF EVIDENCE Level 3. METHODS LES response was measured in a relaxed state in 40 healthy adults (20 females). Possible differences between the conditions were investigated using mixed-model analyses of variance. Two-stage hierarchical linear regression analyses were performed to predict the outcome of TMG Dm and Vd based on participant sex. RESULTS There were significant main effects of sex with large effect sizes for both TMG parameters, resulting from lower mean values in women compared with men (Dm, P < 0.01; Vd, P < 0.01). In contrast, neither the main effect of side (left vs right LES) nor the interaction between the side and sex reached significance (all P > 0.3). Introducing the sex variable in stage 2 of the regression analyses significantly improved the prediction of the TMG parameters (all ∆R2 ≥ 0.18; all P < 0.01; all f2 ≥ 0.29). CONCLUSION Sex-based differences in muscle stiffness and contractile characteristics could be observed by TMG on LES muscles in healthy individuals at rest. The data suggest that these disparities are not exclusively attributable to anthropometric measures but may be linked to intrinsic sex-based differences in skeletal muscle characteristics. CLINICAL RELEVANCE We recommend implementing TMG in a clinical setting using the obtained results as a basis to factor for the patient's biological sex when assessing effects of therapeutic/exercise regimens aiming at the optimization of myofascial tissue regeneration and performance.
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Affiliation(s)
- Christine Lohr
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Tobias Schmidt
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany.,Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.,Osteopathie Schule Deutschland (OSD) Hamburg, Hamburg, Germany
| | - Klaus-Michael Braumann
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Rüdiger Reer
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
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Tang Y, Yang S, Chen C, Luo K, Chen Y, Wang D, Tan J, Dai Q, Zhang C, Wu W, Xu J, Luo F. Assessment of the association between paraspinal muscle degeneration and quality of life in patients with degenerative lumbar scoliosis. Exp Ther Med 2020; 20:505-511. [PMID: 32509021 PMCID: PMC7271738 DOI: 10.3892/etm.2020.8682] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to determine the characteristics of multifidus, erector spinae and psoas major degeneration in elderly patients with degenerative lumbar scoliosis (DLS) and the correlation between asymmetric changes and patient quality of life. A total of 49 patients with lumbar scoliosis (DLS group) and 38 healthy individuals (control group) were prospectively examined. The functional cross-sectional area, cross-sectional area difference index (CDI) and fat infiltration rate (FIR) of the multifidus, erector spinae and psoas major at the apical vertebral level were measured using MRI. The visual analogue scale (VAS) score, Oswestry Disability Index (ODI) and 36-item Short Form Health Survey (SF-36) score were used to evaluate patient quality of life. Correlations between the degree of asymmetric muscular degeneration and quality of life were analysed. The CDI of the multifidus, erector spinal and psoas major was higher in the DLS group compared with that in the control group. The CDI of the multifidus was found to be positively associated with the Cobb angle of lumbar scoliosis. Similar results were obtained for fat infiltration between the two groups. In addition, the CDI and FIR difference index of the multifidus was positively correlated with the VAS score and ODI but negatively correlated with the SF-36 score. The quality of life significantly decreased with increasing asymmetric atrophy and fat infiltration in the multifidus. Thus, strategies to enhance the function of the multifidus may have a positive impact on quality of life (Chinese Clinical Trial Registry, registration date, 2018.11.12; registration no. ChiCTR1800019459.).
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Affiliation(s)
- Yong Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.,Department of Orthopaedics, The 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang 313000, P.R. China
| | - Sen Yang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Can Chen
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Keyu Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Yueqi Chen
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Donggui Wang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Jiulin Tan
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Qijie Dai
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Chengmin Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Wenjie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
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Mrkobrada S. Ultrasound analysis of cervical paraspinal muscles for needle EMG examination. Muscle Nerve 2020; 61:754-758. [PMID: 32246723 DOI: 10.1002/mus.26878] [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: 10/29/2019] [Revised: 02/29/2020] [Accepted: 03/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Ultrasound was used to determine optimal needle insertion parameters and assess the vasculature of paraspinal muscles at C5-T1 spinal levels across patients with different body mass indices (BMIs). METHODS Thirty patients underwent ultrasound examination of the cervical paraspinal muscles at the C5-T1 levels. Images were analyzed to determine the optimal distance and angle of needle insertion to reach the base of the right lamina. Color and spectral Doppler analysis were used to identify and map paraspinal blood vessels. RESULTS Mean distances and angles varied from 35.1 mm and 17.27 degrees for the low BMI group at C5 to 65.1 mm and 9.85 degrees for the high BMI group at T1. Paraspinal blood vessel mapping revealed a random distribution of vasculature. CONCLUSIONS Longer distances and steeper angles of needle insertion are required for patients with higher BMIs. Cervical paraspinal arteries vary in distribution and can be visualized with ultrasound.
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Affiliation(s)
- Serge Mrkobrada
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Kim JC, Lee SU, Jung SH, Lim JY, Kim DH, Lee SY. Natural aging course of paraspinal muscle and back extensor strength in community-dwelling older adults (sarcopenia of spine, SarcoSpine): a prospective cohort study protocol. BMJ Open 2019; 9:e032443. [PMID: 31492798 PMCID: PMC6731812 DOI: 10.1136/bmjopen-2019-032443] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Sarcopenia in the lumbar paraspinal muscles is receiving renewed attention as a cause of spinal degeneration. However, there are few studies on the precise concept and diagnostic criteria for spinal sarcopenia. Here, we develop the concept of spinal sarcopenia in community-dwelling older adults. In addition, we aim to observe the natural ageing process of paraspinal and back muscle strength and investigate the association between conventional sarcopenic indices and spinal sarcopenia. METHODS AND ANALYSIS This is a prospective observational cohort study with 120 healthy community-dwelling older adults over 4 years. All subjects will be recruited in no sarcopenia, possible sarcopenia or sarcopenia groups. The primary outcomes of this study are isokinetic back muscle strength and lumbar paraspinal muscle quantity and quality evaluated using lumbar spine MRI. Conventional sarcopenic indices and spine specific outcomes such as spinal sagittal balance, back performance scale and Sorenson test will also be assessed. ETHICS AND DISSEMINATION Before screening, all participants will be provided with oral and written information. Ethical approval has already been obtained from all participating hospitals. The study results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03962530.
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Affiliation(s)
- Ju Chan Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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