Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain

Laasonen, E. M.

doi:10.1007/bf00328195

Cited by 65 publications

(37 citation statements)

References 18 publications

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“…Again these changes were localized to the level of injury and were associated with rapid changes in intra-muscular fat. Several studies evaluated the association between CT-evaluated paraspinal muscles density and LBP [14,15,19,28,29,34,40]. Muscle density is an expression of degeneration of the muscles and reflects the number of muscle fibers, the area of the individual muscle fiber, and the packing of the contractile material [22], whereas the CSA is mainly determined by the total number of muscle fibers, to a lesser degree, the size of the fibers [35,36], and the quantity of fat in the muscle [6,9].…”

Section: Discussionmentioning

confidence: 99%

“…Muscle density is an expression of degeneration of the muscles and reflects the number of muscle fibers, the area of the individual muscle fiber, and the packing of the contractile material [22], whereas the CSA is mainly determined by the total number of muscle fibers, to a lesser degree, the size of the fibers [35,36], and the quantity of fat in the muscle [6,9]. Laasonen [34] more than two decades ago described the decrease in CT-evaluated density of sacrospinal muscles after spinal surgery. In a study of Hultman et al [19], CT-evaluated density of erector spinae was significantly decreased in males with chronic (more than 3 years) LBP compared to males without chronic LBP.…”

Section: Discussionmentioning

confidence: 99%

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Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

et al. 2009

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The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4-L5; between multifidus at L4 and spondylolisthesis at L4-5; and between erector spinae at L4 and L5 with disc narrowing at L4-5 and L5-S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

et al. 2009

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“…38 Reduced muscle CSA was seen using RUSI in patients prior to surgery with atrophy being more severe in those with greater LBP. 32 Postoperative images showed no further decrease in CSA.…”

Section: Prelumbar Surgery and Postlumbar Surgerymentioning

confidence: 93%

“…32,38,66 In cases of unilateral LBP, researchers using computed tomography found that paraspinal muscles were 10% to 30% smaller on the affected side com-…”

Section: Prelumbar Surgery and Postlumbar Surgerymentioning

confidence: 99%

Rehabilitative Ultrasound Imaging of the Posterior Paraspinal Muscles

Stokes

Hides

Elliott

et al. 2007

J Orthop Sports Phys Ther

146

125

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T he role of muscles in joint protection and stabilization has been of increasing interest to researchers and clinicians involved in spinal pain and rehabilitation. Evidence for the importance of deep posterior muscles of the spine in the management of people with low back pain (LBP) has been provided by biomechanical 7,60,80,82 and neurophysiological 46,48 investigations. Imaging studies have further allowed definition of both normal morphology and impairments in paraspinal muscles. 22,27,32,33 Rehabilitative ultrasound imaging (RUSI) is a potentially useful tool in physical therapy for the assessment and treatment of these muscles. The advantages of RUSI over other imaging techniques have been discussed in a recently published related cles can be incorporated into neuromusculoskeletal rehabilitation. The main applications of RUSI for measurement of morphological characteristics (morphometry) and visualization of muscle contraction for biofeedback are discussed. The lumbar multifidus is the most widely studied paraspinal muscle, in both healthy populations 68 and people with spinal pain and injury. 22,26,27 Studies of different cervical muscles are also emerging. 37,39,[61][62][63] In the thoracic region, the lower trapezius is the first muscle to be measured with ultrasound imaging. 53Quantitative evaluation of the posterior paraspinal musculature using static and dynamic imaging has been used to study muscle morphology and behavior during contraction. 34,39,64,74,76 In this context, behavior relates to level of contraction (change in thickness), changes in size over time and with respect to other muscles, as well as observation of contraction as a biofeedback tool for the patient or therapist. In this commentary we review what is known about RUSI as applied to the paraspinal musculature, propose guidelines for standardizing the imaging and measurement techniques in clinical and research applications, and propose future directions for research. SYNOPSIS:Interest in rehabilitative ultrasound imaging (RUSI) of the posterior paraspinal muscles is growing, along with the body of literature to support integration of this technique into routine physical therapy practice. This clinical commentary reviews how RUSI can be used as an evaluative and treatment tool and proposes guidelines for its use for the posterior muscles of the lumbar and cervical regions. Both quantitative and qualitative applications are described, as well as measurement reliability and validity. Measurement of morphological characteristics of the muscles (morphometry) in healthy populations and people with spinal pathology are described. Preliminary normal reference data exist for measurements of cross-sectional area (CSA), linear dimensions (muscle depth/thickness and width), and shape ratios. Compared to individuals without low back pain, changes in muscles' size at rest and during the contracted state have been observed using RUSI in people with spinal pathology. Visual observation of the image during contraction indicates that RUSI may be a va...

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“…31,49,70,77,105,120 In particular, they provide useful qualitative/quantitative measures concerning the muscular system, including the consequential muscular degeneration (atrophy and fatty infiltrate) shown to be common in patients with low back pain, 11,22,47,51,66,75,84,95 neck pain, 1,30,40,74,83 and other peripheral musculoskeletal disorders. 124 Although MRI is considered the gold standard for musculoskeletal imaging, emerging applications of USI and CT are capable of providing insight into in vivo features of the musculoskeletal system.…”

Section: M-mode Ultrasound Imagingmentioning

confidence: 99%

Rehabilitative Ultrasound Imaging: Understanding the Technology and Its Applications

Whittaker

Teyhen

Elliott

et al. 2007

J Orthop Sports Phys Ther

195

101

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From an historical perspective, ultrasound imaging (USI) has been used for medical purposes since the 1950s. The primary use of USI continues to be for traditional radiological goals, which consider the morphological characteristics and structural integrity of various organs and tissues. However, as the technology has been embraced as a safe, portable, objective, and relatively inexpensive means of examination, the ingenuity and diversity of applications has extended beyond these realms.Ultrasound imaging related to musculoskeletal rehabilitation has been developing rapidly since the 1980s. The first report of muscle imaging linked to rehabilitation was in 1968, when Ikai and Fukunaga 63 related the size of the upper arm muscles to strength. However, it was the work of Dr Archie Young and colleagues at the University of Oxford in the 1980s that sowed the seeds for the use of USI by physical therapists. A striking finding of their work was how dramatic limb muscle wasting is underestimated with a tape measure.144 Several studies of the quadriceps muscle followed, including investigation of the effect of knee joint injury, t SynopSiS: The use of ultrasound imaging by physical therapists is growing in popularity. This commentary has 2 aims. The first is to introduce the concept of rehabilitative ultrasound imaging (RUSI), provide a definition of the scope of this emerging tool in regard to the physical therapy profession, and describe how this relates to the larger field of medical ultrasound imaging. The second aim is to provide an overview of basic ultrasound imaging and instrumentation principles, including an understanding of the various modes and applications of the technology with respect to neuromusculoskeletal rehabilitation and in relation to other common imaging modalities. J Orthop Sports Phys Ther 2007;37(8):434-449. doi:10.2519/jospt.2007 for a review). This early research used compound B-scanning, which enabled whole cross sections of large muscles to be captured, because the image could be built up as the transducer was moved over the skin. The compound technique, which was expensive, was phased out as a routine tool and replaced by real-time USI (definitions are provided in the appenDix) both in general medical and musculoskeletal settings.A recent (1990s) resurgence in the interest of rehabilitative applications of USI has been seen amongst clinical therapists. This stems from a series of studies in which USI was used to detect atrophy of the lumbar multifidus (isolated to the side and spinal level of symptoms) in individuals with acute low back pain (LBP), 51 as well as to determine that recovery of this muscle was not automatic when pain subsided, 49 thus required specific training to reduce risk of future episodes. 47 In addition, these studies

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Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain

Cited by 65 publications

References 18 publications

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

Rehabilitative Ultrasound Imaging of the Posterior Paraspinal Muscles

Rehabilitative Ultrasound Imaging: Understanding the Technology and Its Applications

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