Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain

Abstract

Background: Lumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction. The purpose of this study was to investigate whether there is a correlation between the severity of lumbar dysfunction and the severity of fat infiltration of LMM. Methods: In a cross-sectional study, 42 patients with acute or chronic LBP were recruited. Their MRI findings were visually rated and graded using three criteria for fat accumulation in LMM: Grade 0 (0-10%), Grade 1 (10-50%) and Grade 2 (>50%). Lumbar sagittal range of motion, dynamic upright and seated posture control, sagittal movement control, body awareness and self-assessed functional disability were measured to determine the patients' low back dysfunction. Results: The main result of this study was that increased severity of fat infiltration in the lumbar multifidus muscles correlated significantly with decreased range of motion of lumbar flexion (p = 0.032). No significant correlation was found between the severity of fat infiltration in LMM and impaired movement control, posture control, body awareness or self-assessed functional disability. Conclusion: This is the first study investigating the relationship between the severity of fat infiltration in LMM and the severity of lumbar dysfunction. The results of this study will contribute to the understanding of the mechanisms leading to fat infiltration of LMM and its relation to spinal function. Further studies should investigate whether specific treatment strategies are effective in reducing or preventing fat infiltration of LMM.

Which is the most affected muscle in lumbar back pain – multifidus or erector spinae?

“…Some studies assessed LBP with fatty degeneration of the multifidus or both the multifidus and erector spinae, and some of them support the association of LBP with fatty degeneration [13][14][15][19][20][21]. In our study, we also found that muscle fatty degeneration increased with LBP.…”

“…Some studies have shown that fat deposition in paravertebral muscles increases with the aging process [14,18,22,24]. In our study, similarly, in both case and control groups patients aged > 40 years were observed to have more fat deposition compared to patients aged < 40 years.…”

“…In the literature, there are many studies comparing fat deposition in the paravertebral muscles -especially the multifidus -with a variety of pathologic situations such as lumbar lordosis flattening [8][9][10][11][12], LBP [13][14][15][16][17], pain spreading to the leg [18], and disc degeneration [16]. However, it is still not fully clear whether fat deposition in the paravertebral muscles is a result or a cause of these pathologies.…”

“…A variety of studies have used different methods to assess fat deposition. Methods include MRI spectroscopy (MRS) [15], visual scales on MRI [9,14,16,18,[20][21][22], and MRI histogram [9,19], while for assessment of crosssectional area, CT [8,[23][24][25], MRI [8][9][10]16,20,[26][27][28][29][30][31], and US [26,32] are methods used.…”

Effects of spinal stabilization exercise with real-time ultrasound imaging biofeedback in individuals with chronic nonspecific low back pain: a pilot study

“…Although LBP is often considered as a complex or multifactorial disorder with many potential causative factors, in majority of cases (90%), the cause of the pain is unknown which is commonly referred to as nonspecific LBP (Balagué et al, 2012). However, there are different interpretations of the underlying mechanisms of pain even when specified radiological diagnoses are established (Hildebrandt et al, 2017). One mechanism that has been linked with LBP is the altered stability and motor control of specific muscles of the trunk.…”